Infected Gums Not Likely Cause of Vascular Disease

Healthy gums aren’t proven to prevent atherosclerotic vascular disease, nor will treating periodontal disease clearly reduce risk of heart attack or stroke, according to a scientific statement from the American Heart Association (AHA).

The two conditions are linked through common risk factors without convincing evidence for a causal relationship, the statement cautioned in the May 22 issue of Circulation: Journal of the American Heart Association.

“Patients and providers are increasingly presented with claims that periodontal disease treatment strategies offer atherosclerotic vascular disease protection; these claims are often endorsed by professional and industrial stakeholders,” Peter B. Lockhart, DDS, and colleagues wrote, warning that such assertions “are unwarranted.”

The AHA scientific statement stemmed from a systematic review by a group of cardiologists, dentists, and infectious disease specialists and was endorsed by the American Dental Association and World Heart Federation.

“A link between oral health and cardiovascular disease has been proposed for more than a century,” it noted.

Pockets of bacteria around the teeth in diseased gums are thought to contribute to systemic inflammation and thus to atherosclerotic disease. Periodontal disease also lets oral bacteria enter the blood during chewing and tooth brushing, which may contribute to vascular disease more directly.

Is there a link between periodontal disease and cardiovascular disease?
Researchers and government agencies continue to investigate the possible relationship between periodontal disease and cardiovascular disease. Some studies have shown that bacteria in the mouth that are involved in the development of periodontal disease can move into the bloodstream and cause an elevation in C-reactive protein, a marker for inflammation in the blood vessels. These changes can, in turn, increase the risk of heart disease and stroke.

There is research to both support and refute the possible link between periodontal disease and cardiovascular disease, and more studies are needed to see how the two may be linked. Regardless of the relationship, maintaining optimal oral hygiene is an important component of your overall health.

With the intense interest and active research, a strong causative link likely would have been found already if there were one, Lockhart argued in a press release.

“Although a contribution of periodontal disease to atherosclerotic vascular disease is biologically plausible, periodontal and cardiovascular diseases share multiple risk factors that are prevalent and powerful promoters of disease, including tobacco use, diabetes mellitus, and age,” the scientific statement noted.

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Another possibility is that the inflammation caused by periodontal disease increases plaque build up, which may contribute to swelling of the arteries.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

Periodontal disease can also exacerbate existing heart conditions. Patients at risk for infective endocarditis may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental procedures.

But lack of a causative relationship to vascular disease isn’t free license to neglect oral health, Ronald Burakoff, MDM, MPH, chair of dental medicine at Long Island Jewish Medical Center in New Hyde Park, N.Y., warned in an email to reporters.

“Managing inflammatory issues, such as chronic gum disease, is part of a heart healthy lifestyle,” agreed Suzanne Steinbaum, DO, a preventive cardiologist at Lenox Hill Hospital in New York City.

Lockhart’s group reviewed 537 studies on the topic, most observational in design and thus unable to prove causality.

They found plenty of evidence for an association between periodontal disease and atherosclerotic vascular disease.

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