The review provides an analysis of the literature of recent decades on microecological, metabolic and immunological mechanisms of the relationship between periodontal diseases and atherosclerotic vascular lesion. The role of lipid metabolism and immune mechanisms, confirmed by modern ideas about the pathogenesis of atherosclerosis, is shown. The concept of the potential significance of infectious agents as components of the dental sulcus biofilm in the pathogenesis of atherosclerosis is discussed from the standpoint of recent data on the properties of persistent bacteria. Evidence of the participation of periodontal pathogenic bacteria in the formation of atherosclerotic plaques is presented and the mechanisms of such participation are considered. The analysis of modern literature which is devoted to the significance of periodontal diseases in the development of systemic pathology on the example of atherosclerosis has shown that one of the main binding components in this case is an etiological factor, including the ability of periodontopathogenic bacteria to influence lipid metabolism in tissues, enter into macrophages, persist in the bloodstream, participate in the formation of foam cells and atherosclerotic plaques, and influence the progression of the atherosclerotic process. © 2020 Meditsina Publishers. All rights reserved.