Can regular cleaning and good oral hygiene reduce your risk of a heart attack?

Can regular cleaning and good oral hygiene reduce your risk of a heart attack?
It’s possible, according to the editors of the American Journal of Cardiology and Journal of Periodontology. Dr. Jack Lipkin agrees.

“As medical science moves forward it becomes more and more evident that we are a series of incredibly complex biological processes and those processes are intertwined in countless ways,” says Lipkin. “So, an abnormality anywhere can have profound effects on many other areas. The connection between gum disease and cardiac disease is just such a case.”

Periodontitis, commonly known as gum disease, is a local, chronic inflammatory disease caused by bacteria. It destroys the connective tissue and bone that supports the teeth. Mild to moderate periodontitis is common, affecting 30% to 50% of adults in the US and the severe generalized form affects 5% to 15%.

“Gum disease begins with a microbial infection and leads to the destruction of soft tissue and bone,” says Dr. Jack Lipkin. “Without the accumulation of bacteria on the teeth, the disease can’t begin. Once it’s established though, the immune system plays a major role in each person’s response and the progression of the disease. Environmental, genetic and acquired risk factors like diabetes, depression, obesity and tobacco use can also accelerate destruction of tissue and bone. So although bacteria starts periodontitis, each person’s risk factors influence the severity and extent of disease.”

So while it appears that reducing risk factors like obesity, depression and tobacco use can improve oral health, evidence is beginning to show that the reverse is also true - that treating periodontitis can improve other aspects of your health:

Diabetes and Gum Disease

A large-scale study in Pima Indians reported that among children and teens with diabetes and periodontitis, the degree of control they had of their metabolism changed the severity of soft tissue and bone loss related to gum disease. And, worsening gum disease decreased their glycemic control.

“It may be that inflammation is the link between diabetes and gum disease, that requires more study,” adds Dr. Lipkin, “but it is known that treating gum disease in people with diabetes improves their glycemic control.”

Cardiovascular Disease (CVD) and Inflammation

It’s well established that LDL cholesterol is a primary factor in heart disease and that reducing the level of LDL cholesterol in the body is the best-known way to reduce the risk of heart disease. There are also other risk factors, like age, gender, high blood pressure, diabetes and smoking. But over the past 20 years or so, inflammation has emerged as another contributing factor for cardiovascular disease. The precise role of inflammation as a direct, causative factor remains an area of intense current investigation.

Cardiovascular Disease (CVD) and Periodontitis

The association between gum disease and cardiovascular disease is getting the attention of researchers, but the results so far are unclear. Some say there is no causative relation between the two, but others say the connections are strong. That’s because the studies use different populations, including different age groups, ethnicities, and geographic locations, and because they don’t use a consistent definition of evidence or degree of gum disease.
Coronary Artery Disease (CAD) and Periodontitis

Recent evidence shows that periodontitis is a risk factor, independent of other risk factors, for people with Coronary Artery Disease. One study found that people with gum disease have significantly more coronary artery disease, raising the possibility that gum disease can be an indicator of CAD.

Cerebrovascular Disease and Periodontitis

Cerebrovascular Disease affects blood flow in the brain. Gum disease is an important risk factor for all forms of cerebrovascular disease, especially strokes caused by blocked veins. Data from the Health Professionals Follow-Up Study (HPFS), which involved more than 50,000 male health professionals, revealed that those with periodontitis and fewer teeth at the beginning of the study had an increased risk for stroke during the 12-year follow-up period.

How does Gum Disease relate to these other conditions?

“The direct relationship between gum disease, heart disease and diabetes is not clear, but there are a number of studies that support two plausible theories,” adds Dr. Lipkin. “The first is that moderate to severe gum disease, like all inflammatory diseases, increases the level of inflammation throughout the body. So treating the disease reduces the overall burden on the immune response. The second is that the bacteria often found around each diseased tooth in a patient with periodontitis is similar to a species found in the fatty deposits that line the arteries.”

Of course some of the risk factors for gum disease are the same as other diseases, like cigarette smoking, depression, inactivity or obesity.

So, what do we recommend?

“Based on this review of the data, it seems reasonable that untreated moderate to severe gum disease increases the inflammatory burden on the body, so it may independently increase your risk for Cardiovascular Diseases,” says Dr. Lipkin.

Following are the strongest recommendations for patients from the reviews of current studies:

1) Patients with gum disease and high LDL cholesterol should follow a multifaceted lifestyle approach to reduce the risk of Cardiovascular Disease.

This includes treating the gum disease and establishing good ongoing oral hygiene as well as emphasizing weight loss, quitting smoking, increasing physical activity and reducing the amount of bad cholesterol (saturated fats) they consume.

2) All patients with periodontitis who smoke tobacco should quit smoking because this is a major risk factor for atherosclerotic CVD and periodontitis.

3) All patients with gum disease and high blood pressure should work with their physician to reduce their blood pressure and maintain good oral health.

Elevated blood pressure can be significantly decreased by lifestyle changes, including weight reduction for those who are overweight; a diet high in potassium and calcium and low in sodium; physical activity and moderation of alcohol intake.

4) Patients with periodontitis who have metabolic syndrome should work to address all the risk factors for atherosclerotic CVD, beginning with lifestyle changes aimed at weight reduction.

Dr. Lipkin sums it up, this way, “As health professionals, we learn to specialize on certain areas of the body, like dentists and cardiologists do. But the reality is that the interconnections go beyond these speciality areas. What this means for patients - for all of us really - is that we need to resist localized thinking when it comes to our health. If you aren’t taking care of one aspect of your health, you’re not taking care of all of your health. You never really know where the results will turn up.”
It’s possible, according to the editors of the American Journal of Cardiology and Journal of Periodontology. Dr. Jack Lipkin agrees.

“As medical science moves forward it becomes more and more evident that we are a series of incredibly complex biological processes and those processes are intertwined in countless ways,” says Lipkin. “So, an abnormality anywhere can have profound effects on many other areas. The connection between gum disease and cardiac disease is just such a case.”

Periodontitis, commonly known as gum disease, is a local, chronic inflammatory disease caused by bacteria. It destroys the connective tissue and bone that supports the teeth. Mild to moderate periodontitis is common, affecting 30% to 50% of adults in the US and the severe generalized form affects 5% to 15%.

“Gum disease begins with a microbial infection and leads to the destruction of soft tissue and bone,” says Dr. Jack Lipkin. “Without the accumulation of bacteria on the teeth, the disease can’t begin. Once it’s established though, the immune system plays a major role in each person’s response and the progression of the disease. Environmental, genetic and acquired risk factors like diabetes, depression, obesity and tobacco use can also accelerate destruction of tissue and bone. So although bacteria starts periodontitis, each person’s risk factors influence the severity and extent of disease.”

So while it appears that reducing risk factors like obesity, depression and tobacco use can improve oral health, evidence is beginning to show that the reverse is also true - that treating periodontitis can improve other aspects of your health:

Diabetes and Gum Disease

A large-scale study in Pima Indians reported that among children and teens with diabetes and periodontitis, the degree of control they had of their metabolism changed the severity of soft tissue and bone loss related to gum disease. And, worsening gum disease decreased their glycemic control.

“It may be that inflammation is the link between diabetes and gum disease, that requires more study,” adds Dr. Lipkin, “but it is known that treating gum disease in people with diabetes improves their glycemic control.”

Cardiovascular Disease (CVD) and Inflammation

It’s well established that LDL cholesterol is a primary factor in heart disease and that reducing the level of LDL cholesterol in the body is the best-known way to reduce the risk of heart disease. There are also other risk factors, like age, gender, high blood pressure, diabetes and smoking. But over the past 20 years or so, inflammation has emerged as another contributing factor for cardiovascular disease. The precise role of inflammation as a direct, causative factor remains an area of intense current investigation.

Cardiovascular Disease (CVD) and Periodontitis

The association between gum disease and cardiovascular disease is getting the attention of researchers, but the results so far are unclear. Some say there is no causative relation between the two, but others say the connections are strong. That’s because the studies use different populations, including different age groups, ethnicities, and geographic locations, and because they don’t use a consistent definition of evidence or degree of gum disease.
Coronary Artery Disease (CAD) and Periodontitis

Recent evidence shows that periodontitis is a risk factor, independent of other risk factors, for people with Coronary Artery Disease. One study found that people with gum disease have significantly more coronary artery disease, raising the possibility that gum disease can be an indicator of CAD.

Cerebrovascular Disease and Periodontitis

Cerebrovascular Disease affects blood flow in the brain. Gum disease is an important risk factor for all forms of cerebrovascular disease, especially strokes caused by blocked veins. Data from the Health Professionals Follow-Up Study (HPFS), which involved more than 50,000 male health professionals, revealed that those with periodontitis and fewer teeth at the beginning of the study had an increased risk for stroke during the 12-year follow-up period.

How does Gum Disease relate to these other conditions?

“The direct relationship between gum disease, heart disease and diabetes is not clear, but there are a number of studies that support two plausible theories,” adds Dr. Lipkin. “The first is that moderate to severe gum disease, like all inflammatory diseases, increases the level of inflammation throughout the body. So treating the disease reduces the overall burden on the immune response. The second is that the bacteria often found around each diseased tooth in a patient with periodontitis is similar to a species found in the fatty deposits that line the arteries.”

Of course some of the risk factors for gum disease are the same as other diseases, like cigarette smoking, depression, inactivity or obesity.

So, what do we recommend?

“Based on this review of the data, it seems reasonable that untreated moderate to severe gum disease increases the inflammatory burden on the body, so it may independently increase your risk for Cardiovascular Diseases,” says Dr. Lipkin.

Following are the strongest recommendations for patients from the reviews of current studies:

1) Patients with gum disease and high LDL cholesterol should follow a multifaceted lifestyle approach to reduce the risk of Cardiovascular Disease.

This includes treating the gum disease and establishing good ongoing oral hygiene as well as emphasizing weight loss, quitting smoking, increasing physical activity and reducing the amount of bad cholesterol (saturated fats) they consume.

2) All patients with periodontitis who smoke tobacco should quit smoking because this is a major risk factor for atherosclerotic CVD and periodontitis.

3) All patients with gum disease and high blood pressure should work with their physician to reduce their blood pressure and maintain good oral health.

Elevated blood pressure can be significantly decreased by lifestyle changes, including weight reduction for those who are overweight; a diet high in potassium and calcium and low in sodium; physical activity and moderation of alcohol intake.

4) Patients with periodontitis who have metabolic syndrome should work to address all the risk factors for atherosclerotic CVD, beginning with lifestyle changes aimed at weight reduction.

Dr. Lipkin sums it up, this way, “As health professionals, we learn to specialize on certain areas of the body, like dentists and cardiologists do. But the reality is that the interconnections go beyond these speciality areas. What this means for patients - for all of us really - is that we need to resist localized thinking when it comes to our health. If you aren’t taking care of one aspect of your health, you’re not taking care of all of your health. You never really know where the results will turn up.”