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Periodontal Disease: The Cardio Connection


Medical Risks of Periodontal lnfection

  • The risk of developing heart disease was increased by 168% in those who had periodontal infection. Patients with periodontitis are 72% more likely to have coronary hearth disease...mortality is 2.12 times more likely.
  • A common route of infection by oral microorganisms is through aspiration of fluids containing pathogenic microorganisms which may infect the lower respiratory tract and cause pneumonia.
  • The odds of spontaneous preterm birth are sevenfold if severe periodontal infection is present. Periodontal infection can be as deleterious to the mother and fetus as smoking and alcohol abuse.
  • The risk of stroke is 2.5 times as high in people with periodontal infection...only the dental factor is causative and significant.
  • Patients with serious periodontal disease were at double risk of having a precancerous lesion and four times the risk of having an oral tumor of any kind, compared to people with healthy gums
  • Treatment of periodontal infection reduces the level of glycolsylated hemoglobin, thus improving the metabolic control of diabetes mellitus.
  • Individuals with rheumatoid arthritis have a greater prevalence of advanced forms of periodontal infection, and vice versa.
  • Heart Disease
  • Fatal Coronary Heart Disease
  • Stroke
  • Oral Cancer
  • Pre-Term Birth
  • Diabetes
  • Rheumatoid Arthritis
  • Pneumonia

A Note from the American Academy of Periodontology:

Clinical recommendations encourage cardiologists to examine the mouth and periodontists to ask questions about heart health.

CHICAGO—June 1, 2009—Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other.

A consensus paper on the relationship between heart disease and gum disease was published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP). Developed in concert by cardiologists, the physicians specialized in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease.

The clinical recommendations were developed at a meeting held earlier this year of top opinion‑leaders in both cardiology and periodontology. In addition to the clinical recommendations, the consensus paper summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co‑author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. “Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients.”

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The paper also recommends that physicians managing patients with cardiovascular disease evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums.

While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation - the body’s reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.

“Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them,” says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. “The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients’ overall health. That is our common goal.”

"Healthy Gums and a Healthy Heart: The Perio-Cardio Connection.” American Academy of Periodontology. 1 June 2009.

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