Periodontal Inflammation and Heart Disease

Similarities in the body's response to these two diseases may indicate a connection

Dear Doctor,
I have periodontal (gum) disease. I have heard there is a relationship between gum inflammation and heart disease, and with my family history of the latter, I'm worried. Can you give me some information and advice?

Dear Eileen,
You've asked an important question, although the answer is somewhat complicated. Here's what we in the dental and medical profession know and what you can do to protect your health.

Periodontal diseases (“peri” – “around;” “odont” – “tooth”) result in the destruction of the attachment tissues of the teeth — the gums, bone and periodontal ligament. In some people, the bacteria found in their dental plaque — the soft material that collects at the gum line in the absence of effective oral hygiene — can cause an inflammation of the gums. This inflammation is actually a response by the body's immune system (resistance) to fight an infection threatened by the bacteria found in dental plaque. If not halted, this inflammation can ultimately lead to the destruction of the attachment tissues, resulting in bone loss and eventual tooth loss.

There are also factors that seem to be common to both periodontal and heart disease, which make some individuals like you susceptible to both types of disease. Inflammation is a very primary way that bodily tissues respond to both trauma (damage) and disease, and can be the process by which both healing and/or disease begins. The occurrence and severity of inflammation depend in large part on the way an individual's particular immune system responds to specific types of bacteria.

There are also factors that seem to be common to both periodontal and heart disease, which make some individuals susceptible to both types of disease.

There is convincing evidence that this same type of inflammatory response is associated with changes in blood vessels that cause both cardio-vascular (heart and related blood vessels) and cerebro-vascular (brain and related blood vessels) diseases. The relationship of periodontitis (inflammatory gum disease) to these diseases is supported by several studies. While there is strong statistical evidence showing an indirect link between these two types of diseases, we also have strong evidence that periodontal disease is associated with the entry of bacteria from inflamed gum tissues, as well as other inflammatory factors or “mediators,” into the bloodstream.

What we don't know right now, and what scientists are working hard to find out, is the nature of any direct relationship between these diseases and how exactly they interact. In other words, what is the mechanism at play in this complicated interaction of bacteria and the body's response by inflammation, and in what way might it progress to cause both heart attacks and strokes?

The healthier you keep your mouth and body, the better your chances of reducing your risk for both periodontal and heart disease.

Researchers are now evaluating whether the treatment of periodontal disease alters the progress of cardiovascular disease. The early answer seems to be yes — initial studies indicate that treatment of periodontitis does reverse damage to blood vessel linings. The next step is to validate whether improvement in blood vessel function actually reduces the occurrence of stroke or heart disease.

So, as to what we know, moderate to severe periodontitis does appear to increase a person's risk for cardiovascular disease. Today, we also believe that reducing inflammation in the periodontal (gum) tissues may affect the progression of cardiovascular (heart and blood vessel) disease and its outcomes. However, we cannot say that periodontitis actually causes heart disease.

Future exciting research will focus on the complex relationships that occur within the body that alter, promote or reduce inflammation. Researchers are looking into the use of new classes of molecules called resolvins and lipoxins that promote the reduction of inflammation. Others are looking more closely at genetic variations and how environment, diet, age, habits, and physical activity alter the risk of all inflammatory diseases.

One thing is for sure: we can change and control external factors — good oral hygiene to reduce bacteria along with periodontal therapy, good diet and exercise for cardiovascular health. The healthier you keep your mouth and body, the better your chances of reducing your risk for both periodontal and heart disease.