By: Jean Johnson for Dental1The short answer is yes. Researchers aren’t sure about the precise mechanism just yet, but studies from 2003 to one currently published in the Journal of Periodontology lean in that direction.
Conclusions tend to be similar: there are connections between periodontal gum disease and the build-up of arterial plaque (different from dental plaque) that can give rise to coronary heart disease. Especially in people under 60 years of age, the most recent 2006 study says, there is a clear connection between chronic gum disease and atherosclerosis.
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The National Institute of Dental and Craniofacial Research recommend the following home care:
Brush twice daily with a soft brush with rounded bristles.
Use small circular motions and short back and forth motions, avoiding hard back and forth motions.
Use fluoride toothpaste.
Brush the tongue frequently.
Use plenty of floss – an 18-inch piece is ideal.
Floss with a sawing motion and curve the floss around each tooth on the front and back sides.
Floss from below the gum up to the top of the tooth.
Rinse after flossing. |
Since early warning signs of heart disease can be elusive, knowing that gum disease increases the chances of cardiovascular trouble is crucial. If you understand that persistent bleeding gums have implications for the heart, it is easier to take action. Periodontitis is something that is easy to reverse, given patient motivation and compliance. Sometimes, though, this motivated attitude is difficult to muster. Devil’s Advocate
Restoring health to chronically infected and inflamed gums requires a willingness to learn and adopt new habits. Dental1 spoke with a 57-year-old woman recently who is reluctant to entertain the ideas that could improve her health.
“My gums are so bad that they are causing bone loss,” said Eunice Carson of Vancouver, Washington, speaking under an assumed name. “That’s bad, they tell me, since once the rest of my teeth fall out, I won’t have enough bone structure to support dentures, and I’ll end up a woman with sunken in cheeks and shriveled up lips.”
Carson scrunches up her face and laughs. But when we asked if her dental provider offered her ideas on good tooth and gum care, she replies that her oral hygiene has always been beyond reproach.
“Oh, that’s nothing new. I’ve known about brushing and flossing forever and have always done exactly what they’ve told me to do,” she stated with a tone that implied end of conversation.
Still, we pressed a bit further. Was Carson aware of the new links between periodontal disease and heart health? “Oh, I’m sure I’ve read about that somewhere along the line since modern medicine loves to boast about any and all its big doings,” she said, looking away to gather her thoughts. “But I don’t pay much mind to all their studies. Besides, we’ve all got to go sometime, don’t we? I just can’t see getting too excited about all this stuff. And who says it’s bad to lose your teeth anyway? We’re too vain in this culture anyway.”
As far as her heart goes, Carson says she’s had “a funny little rhythm just about forever,” but that she doesn’t worry about it. Most of us have known someone like Eunice Carson. That said, we aren’t so sure if we want to walk the cavalier road she has chosen when it comes our health.
The current research related to periodontitis and cardiovascular disease is exceptionally noteworthy and has the potential to increase the health and quality of life for people who take advantage of the findings. Those who stay informed are in the best position to take advantage of breakthroughs in medicine.
Backgrounder
A lot can happen in three years. It was just in 2003 that Moïse Desvarieux, M.D., PhD, MPH of the Department of Epidemiology at Columbia University’s Mailman School of Public Health published his seminal research on the relationship between the number of missing teeth and the prevalence of arterial plaque.
At issue in the path-breaking Desvarieux study was tooth loss associated with periodontal disease – chronic infection and inflammation of the gums – and coronary heart disease (also known simply as heart disease). Desvarieux admitted that the connection between these two seeming disparate systems of the body required an initial leap of faith. But his research resulted in solid data that validated his hypothesis.
To critics who wonder if both conditions are related because they are associated with unhealthy lifestyles, Desvarieux replied that his study controlled for those factors. The French National Academy for Research was convinced. It gave its venerable nod of approval to Desvarieux in 2005, awarding him a Chair of Excellence that goes to those who conduct “scientific projects of quality.”
2006 Research Furthers Understanding
If Desvarieux’s work doesn’t convince Carson, a recent study published in the Journal of Periondontology might. In this work, researchers looked at people under the age of 60 and found that coronary heart disease patients had more instances of periodontal disease than did participants without coronary heart disease. Specifically, researchers found that patients under age 60 with more than four millimeters of loss in the alveolar jaw bone – into which the teeth fit – had increased risk of coronary heart disease.
“This study is distinctive because to our knowledge, it is the first to include both the alveolar bone loss and full mouth recording of clinical attachment loss as measurements of periodontal disease,” said Karen Geismar, DDS, PhD, faculty of health science in the Department of Periodontology at the University of Copenhagen, Denmark.
“Alveolar bone loss was recently found to be the periodontal variable,” Geismar underscored, “that had the strongest association to coronary heart disease.”
The Connection
Researchers do know that the same bacteria that cause periodontal disease and subsequent bone loss can enter the blood stream and adhere to plaque from high cholesterol in the arteries. Still, they are not convinced that this is the entire or even the accurate explanation for the relationship between gum and heart health.
A second possibility could be the body’s immune system creating an inflammatory response to high levels of bacteria in the blood system. The inflammation that starts in the oral cavity could move throughout the circulatory system and result in a narrowing of the blood vessels. This would, in turn, make them more susceptible to the blood clots that figure so centrally in coronary heart disease.
As Geismar noted, “A number of pathways are suspected to be involved. One way is that periodontal bacteria directly invade the arterial wall and another way is that bacterial products from the periodontal pocket exert a systemic effect on atherosclerosis development based on the immune system.”
In other words, this latest study has added yet another building block of knowledge in science’s growing understanding of the relationship between coronary heart disease and periodontitis. However, in some ways the scientific community remains as skeptical as Carson.
“This is one of many studies suggesting that the spread of bacteria and bacterial products from the periodontal lesion to the blood stream may contribute to coronary heart disease,” said Preston D. Miller, DDS and president of the American Academy of Periodontology. “However, it is still uncertain whether or not the association between periodontal disease and coronary heart disease is causal. Until we know more, it is very important that people talk to their dentist or periodontist about their periodontal health.”
