Putting a number on periodontitis as cardiovascular risk: a proposed score

Everyone agrees periodontitis is linked to cardiovascular disease — but clinicians still can't answer the patient's question: how much of my endothelial risk comes from my gums? This narrative review (explicitly not a systematic review or meta-analysis) sets out to close that translational gap by proposing a hypothesis-generating heuristic, the Endothelial Risk Score (ERS).

The premise is well established: periodontitis is consistently associated with endothelial dysfunction, the earliest detectable stage of atherosclerosis. Synthesising mechanistic studies, clinical association studies, intervention trials and existing cardiovascular risk frameworks, the authors propose integrating the Periodontal Inflamed Surface Area (PISA) with age, sex, systolic blood pressure, smoking pack-years, diabetes status and hs-CRP into a four-strata score: Low, Moderate, High and Very High vascular burden.

The authors are careful about what this is and is not. The point assignments are evidence-informed heuristics, not empirically derived coefficients, and the ERS is not a validated prediction tool — it is a conceptual scaffold to structure existing evidence, guide patient education, foster collaboration between dentistry and cardiology, and define testable hypotheses. A detailed validation blueprint is included. For the periodontist, the value is conceptual rather than immediately clinical: a structured way to talk about cardiovascular risk with patients and colleagues, and a research agenda — not yet a calculator to deploy at the chair.