By: Jean Johnson for Dental1It makes sense if you think about it. If one area of the body is amiss another may be also. If gums are so inflamed and infected that tooth loss results, another area, like the arteries, could have a problem too. After all, it’s the same blood circulating around through the body.
In this case, we’re talking plaque – both the crud that builds up around the gums from less than adequate oral hygiene, and similar funk that lodges in the arterial walls from diets heavy in too much cholesterol.
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Periodontitis is the leading cause of tooth loss in adults.
A person risks developing periodontitis if their gingivitis is left untreated. Gingivitis develops when bacteria from plaque cause the gums to become chronically inflamed.
Eventually the gums will pull away from the teeth and form deep pockets or gum crevices. These become filled with bacterial plaque and bone is lost.
As periodontitis progresses bone loss can result in loose teeth, and eventually tooth loss.
Avoid Periodontitis: Get to you dentist if you have symptoms of gingivitis – red, swollen gums which bleed easily. Regular dental check ups can catch periodontal disease in its early stages. Of course, practicing good oral hygiene is always a great idea.
Take Note
People are cautioned against assuming that any tooth loss increases cardiovascular risks: “Since tooth removal practices vary, researchers caution that not all tooth loss may indicate the same amount of severe gum disease,” wrote Ryan Demmer, M.P.H.
Only tooth loss associated with the build-up of significant plaque around the gums is being assessed for a relationship to deposits of arterial plaque.
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Crud. Funk. Plaque. Whatever the name, it’s not our friend. Still it seems that no one’s thought to explore the relationship between what’s happening in the mouth and what goes on in the circulation system, until recently. While some studies have suggested connections between gum disease and events like stroke and heart attack, none have looked at the relationship earlier on in patients’ lives – and at which point there still might be time for intervention. Thank you, Dr. Desvarieux. Lead Researcher Cited for Excellence
“To our knowledge, this is the first paper to identify a relationship between tooth loss and subclinical cardiovascular disease,” said principal investigator Moïse Desvarieux, M.D., Ph.D., M.P.H., of the Department of Epidemiology at Columbia University’s Mailman School of Public Health.
Desvarieux published his multidisciplinary team’s initial findings on oral infections and vascular disease in 2003 in Stroke: Journal of the American Heart Association. Since then, in 2005 the French National Agency for Research awarded Desvarieux a Chair of Excellence, citing him for conducting “scientific projects of quality.”
The honor was substantial enough to warrant comment from Desvarieux’s dean at Columbia University. “Dr. Desvarieux has made significant contributions in the field of traditional infectious disease epidemiology as well as in the newer interface of infectious and chronic diseases,” said Allan Rosenfield, M.D., dean of the Mailman School of Public Health. “This award is a great tribute to his innovative work and leadership in the field of oral and cardiovascular health.”
The Desvarieux Hypothesis
As the internationally recognized infectious disease epidemiologist Desvarieux postulated, there may be a link between tooth loss arising from gum disease (periodontitis) and the buildup of artery-clogging plague in the carotid arteries. The researcher is specifically looking at subclinical arterial plaque, which is the plaque deposited along the walls of the bloodstream without any detectable symptoms. It is this plaque that often, especially when clogging the carotid arteries of the neck, causes strokes and heart problems.
The Oral Infections and Vascular Disease Study (INVEST), as the Desvarieux’s study was named, obtained results from 711 initial participants for the 2003 report. People in the study were more than 55 years old, residents of Manhattan and without any history of heart disease or atherosclerotic symptoms.
The participants all had extensive dental, physical and neurological examinations prior to the study, including ultrasounds designed to detect plaque build-up in the carotid arteries. Researchers also recorded socioeconomic characteristics, cardiovascular risk factors and dental hygiene habits that quantified brushing and flossing.
“The prevalence of carotid plaque increased with the number of missing teeth. Among those missing zero to nine teeth, 45 percent had carotid artery plaque. About 60 percent of those with 10 or more missing teeth had plaque build-up in the vessels,” wrote Ryan T. Demmer, M.P.H. et al for the American Heart Association. “Researchers speculate that tooth loss is an indicator of chronic infection or inflammation of the gums. Since tooth removal practices vary, researchers caution that not all tooth loss may indicate the same amount of severe gum disease.”
In other words, the kind of tooth loss that Desvarieux and his colleagues are interested in is that associated with significant periodontitis where deposits of plaque on the gums create inflammation and infection that ultimately put teeth at risk. Just any old molar that gets so decayed that it has to go doesn’t count.
Also, Desvarieux took into account that poor oral hygiene and poor diet and exercise habits might simply make this type of correlation seem accurate when it is merely coincidental.
“Desvarieux notes that many of the study participants with periodontal disease also have other risk factors for cardiovascular disease, such as smoking, poor diet, and low levels of physical activity,” continued Demmer. “He notes that tooth loss may be more than a simple marker for lifestyle because the relationship remained after accounting for the role of other risk factors and cultural factors.”
Indeed, according to Desvarieux himself, when asked about whether or not the relationship between periodontal disease and tooth loss and atherosclerosis hinged more around simply unhealthy lifestyles, “We controlled for those factors, and the relationship still existed.”
What’s Next?
In his role as Chair of Excellence, Desvarieux is expanding the research project beyond the borders of the United States and plans to enroll another thousand people to add to the cohort at Columbia already studied. Participants from Toulouse, France, Belfast, Ireland, Greifswald, Germany and Krakow, Poland have all been recruited to further the international scope of the study. The average age of participants is 66 and efforts are being made to include a range of ethnic groups.
