Several studies have shown relationships between periodontal disease and cardiovascular disease (CVD). A few studies have also shown that tooth loss may be associated with increased risk of coronary heart disease and stroke. We have reviewed the relevant literature to assess possible explanations for the reported associations between tooth loss and CVD. In particular, we considered whether the reported association between tooth loss and CVD could be explained by antecedent periodontal disease, antecedent caries, the extraction process, dietary changes following tooth loss, or confounding or bias from other sources. Since access to care and attitudes to health care may influence the decision to extract teeth, as well as cardiovascular disease risk, one needs to be cautious about confounding from behaviorally related factors. Available evidence suggests that further studies are needed to rule out that confounding is a possible explanation for the tooth loss and CVD relationship, that prior periodontal disease may not completely explain the tooth loss-CVD relationship, and that the role of diet needs to be further explored