The prevalence of atherosclerotic complications (myocardial infarction, stroke, and sudden death) is increased in end-stage renal disease (ESRD) patients, especially in haemodialysis patients. Increasing evidence suggests that both in general population and in dialysis patients, systemic inflammation plays a dominant role in the pathogenesis of atherosclerotic complications. In general population, also, evidence shows that moderate to severe periodontitis can contribute to inflammatory burden by increasing serum CRP levels and may increase the prevalence of atherosclerotic events. Moreover, the results of some new interventional studies reveal that effective phase I periodontal therapy may decrease serum CRP levels, the most important acute phase protein, monitored as a systemic marker of inflammation and endothelial dysfunction as well, used as an initial predictor of atherosclerotic events. Considering that moderate to severe periodontal diseases have a higher prevalence in CKD and in dialysis population and that periodontal examination is not part of the standard medical assessment, destructive periodontitis might be an ignored source of systemic inflammation in end-stage renal disease patients and may add to the chronic inflammatory status in CKD. 1. Biology and Pathology of Periodontal Diseases Periodontal diseases represent a group of infectious inflammatory diseases affecting the supporting tissues of the teeth in disease susceptible individuals. The current classification of periodontal diseases, according to the latest one done by AAP consensus meeting in 1999, recognizes plaque-induced gingival disease, early-onset, chronic, and aggressive periodontitis [1]. Plaque-induced gingival diseases (gingivitis) are reversible by treatment as they are limited to the gingiva, different from early-onset, chronic, and aggressive periodontitis which are irreversible forms of periodontal diseases finally causing tooth loss if untreated. Because of great variance in the criteria defining disease, the prevalence of periodontitis is different from one study to another; however, the Third National Health and Nutrition Survey (NHANES III) reported a prevalence of 14% of both moderate and severe periodontitis in the US population older than 20 years of age [2]. The microorganisms that are responsible for initiation and progression of periodontal diseases, along with other bacterial species, colonize the surface of teeth at/or below gingival margin and the epithelial surfaces; in subgingival sites, counts range between 108 in healthy sulci and >108 in deep
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