TNF and endothelial dysfunction: Periodontal pathogens (and their endotoxins/proteases) can gain transient bloodstream access during daily activities, sustaining a low-grade systemic inflammatory state characterized by elevations in CRP, IL-6, and TNF-α and by endothelial dysfunction—changes that contribute to atherogenesis and adverse cardiometabolic profiles (insulin resistance, dyslipidemia, and higher blood pressure).