By Gena Krikler,
Due to its high prevalence, and potentially life-threatening consequences, the prevention and treatment of heart disease is a prominent area of research. It has been suggested that there may be a link between inflammatory diseases and heart health. Periodontal disease is a form of dental disease caused by poor dental health. It is the inflammation and infection of the ligaments and bones that support the teeth, and is characterized by gingival inflammation accompanied by the loss of supportive connective tissues, including alveolar bone (1). This inflammation may be an indicator or a risk factor of coronary heart disease (2). Heart disease is one of the leading causes of death in Canada, with more than 1.4 million Canadians suffering from heart disease (3). Coronary heart disease is disease caused by plaque build up inside the coronary arteries (the arteries that deliver oxygenated blood to the heart muscle). This plaque build up reduces or blocks transport of oxygen-rich blood to the heart muscle (4). Coronary heart disease kills more than 7 million people globally each year (2).
In 2008, Humphrey et al. reviewed all recent literature about the connection between periodontal disease and coronary heart disease. A meta-analysis was performed, in which they combined the data from multiple credible studies in order to determine whether there is a relationship between coronary heart disease and periodontal disease. They found that people with baseline periodontal disease have a 24% increased risk or coronary heart disease or cardiovascular disease, there is a 34% increased risk of coronary heart disease or cardiovascular disease among individuals with between 1 and 10 teeth compared to people with 25 to 32 teeth. They also found that people with gingivitis had a 35% increase in coronary heart disease occurrence (2).
Based on their meta-analysis, Humphrey et al. conclude that there appears to be an association between periodontal disease (and thus dental health), and coronary heart disease. It is possible that there are confounding variables, which affect the correlations found, though it seems less likely because these results have been reproduced in multiple studies, all of which have large sample sizes. They suggest multiple biological mechanisms to explain the association between periodontal disease and coronary heart disease. It is plausible that periodontal disease is caused by chronic infection, which results in a chronic inflammatory state; this is supported by studies that demonstrate elevated inflammatory markers in people with periodontal disease. Inflammation is a cellular response to infection by toxins, bacteria or physical stresses. Damaged cells release chemicals that cause blood vessels to leak into surrounding tissues, causing swelling. Acute inflammation is normal and essential for cell response, but chronic inflammation may lead to tissue destruction. It has been proven that inflammation is associated with coronary heart disease, linking coronary heart disease to periodontal disease (2). It is also possible that the bacteria associated with periodontal disease cause inflammation that affects endothelial tissue surfaces, which may cause calcification or build up of plaque in the blood vessels (2). Periodontal disease may also cause increased platelet activation, which could contribute to plaque instability (2).
Though it cannot be definitely concluded that there is a causative relationship between periodontal disease and coronary heart disease at this stage, it seems likely that there is some type of relationship. Longitudinal studies following young patients with and without periodontitis may be necessary in order to definitively establish the connection and clearly understand how the two are related. The important message, however, is that periodontitis is highly preventable and highly treatable, so even as a precautionary measure, maintaining good oral health may help your heart.
- Wilder, Rebecca S., and Antonio J. Moretti. “Gingivitis and Periodontitis in Adults: Classification and Dental Treatment.” UpToDate. Ed. Daniel G. Deschler and Lee Park. N.p., 6 May 2015. Web. 30 Sept. 2015.
- Humphrey, Linda L., Rongwei Fu, David I. Buckley, Michele Freeman, and Mark Helfand. “Periodontal Disease and Coronary Heart Disease Incidence: A Systematic Review and Meta-analysis.” J GEN INTERN MED Journal of General Internal Medicine 23.12 (2008): 2079-086. Web.
- “Heart Disease – Heart Health.” Government of Canada, Health Canada and the Public Health Agency of Canada. N.p., n.d. Web. 30 Sept. 2015.
- “What Is Coronary Heart Disease?” National Heart, Lung and Blood Institute. N.p., 29 Sept. 2014. Web. 30 Sept. 2015.