Infected Gums Not Likely Cause of Vascular Disease
Of the 26 studies using clinical or radiographic measures of periodontal status, 18 linked worse gum disease to higher risk for atherosclerotic vascular disease-related outcomes in adjusted analyses. Another two studies showed the same in unadjusted analyses.
All eight studies that looked at clinically assessed periodontal disease in relation to myocardial infarction found a link.
The only study that looked at periodontal bacterial burden found a link to both atherosclerotic vascular disease and heart attack.
When looking at risk of stroke, 11 studies pointed to higher risk when gums were in bad shape, while three studies did not find a positive association. Six showed higher stroke risk with more teeth lost to periodontal disease, but the same number failed to show a significant association.
Chronic periodontitis also is an independent risk factor for coronary artery disease. In fact, studies show that the severity of periodontitis is directly correlated to the severity of the coronary heart disease. Additional research indicated that in individuals with coronary atherosclerotic heart disease (CAD), 84.44 percent had periodontal disease compared to only 22.5 percent in individuals without coronary heart disease. Furthermore, periodontal disease was associated with elevated inflammatory markers and is a higher risk factor for CAD than elevated low-density lipoprotein cholesterol (LDL) and pulse pressure.
Evidence also indicates that cumulative incident tooth loss is significantly related to the prevalence of peripheral artery disease (PAD,) particularly in men with periodontal disease. Additionally, research has shown that periodontal disease is significantly associated with hypertension and risk for myocardial infarction (heart attack) in middle aged individuals. This study further demonstrates that the number of periodontal diseased pockets is significantly associated with hypertension at any age. Also, a low number of natural teeth is correlated with increased risk of myocardial infarction.
Rather than looking at such hard endpoints, most studies looking at the impact of treating periodontal disease focus on surrogate measures like markers of inflammation or subclinical atherosclerosis.
Observational and clinical trial data have indicated improved endothelial dysfunction and associated markers of inflammation after mechanical debridement of the root surfaces, with or without systemic antibiotics.
That evidence “supports the theory that if cardiovascular toxicity from periodontal disease occurs, it is mediated at least in part through inflammation and endothelial dysfunction,” Lockhart’s group noted.
But studies haven’t turned up consistent results on the impact of gum disease treatment on specific inflammatory markers or established a durable benefit.
“In addition, transient proinflammation and deranged endothelial functions are observed after intensive therapy for periodontal disease,” the statement added.
It’s possible that swelling in gums leads to swelling in other parts of your body, including your arteries. This swelling can also contribute to heart disease.
Regardless of whether you have heart disease, it’s important to take care of your teeth and gums. Steps to good oral hygiene include:
- Brushing your teeth at least twice daily
- Flossing your teeth daily
- Replacing your toothbrush at least every three months
- Getting regular dental checkups, as recommended by your dentist
The one clinical trial to look at periodontal treatment for secondary prevention of cardiac events found no benefit.
A large, long-term study would be necessary to prove that good oral hygiene and dental treatment cut down on cardiovascular risk, “given the possibility of periodontal disease recurrence after therapy and the extended time course of evolution of atherosclerotic vascular disease and its manifestations,” the statement concluded.
Lockhart reported having no conflicts of interest to disclose.
Primary source: Circulation: Journal of the American Heart Association
Source reference: Lockhart PB, et al “Periodontal disease and atherosclerotic vascular disease: Does the evidence support an independent association? A scientific statement from the American Heart Association” Circulation 2012; 125; DOI: 10.1161/CIR.0b013e31825719f3.