Update: Gum Disease, Heart Disease Connection

The link between periodontal disease and heart disease has been acknowledged by doctors for nearly a century. But the American Heart Association recently released a statement questioning the association between the two health conditions. According to the statement published in the journal Circulation, there is not strong enough evidence to support  the notion that treating gum disease can reduce the risk of heart disease or stroke.

Gum inflammation can be a form of periodontal disease, which typically stems from a bacterial infection that causes bleeding and swelling in the mouth. "When bacteria get around the teeth and the gums, it sets off an immune response. White blood cells, interleukin A, interleukin3, and a substance called C-reactive protein are called in to fight the bacteria, but the process also causes inflammation which can move through the body systemically," explains William Parker, DDS, a professor at Nova Southeastern University College of Dentistry in Florida.

The immune response can sometimes destabilize the naturally-occurring plaque in the blood and cause it to break off. "When that happens, clots can form which can lead to a heart attack," Parker says. "It's an unfortunate consequence of the process of fighting bacteria."

Gum disease, heart disease, and stroke all produce inflammation in the body. Because they also share some risk factors including cigarette smoking, age, and diabetes, they often develop in the same people. Cardiologist Ann Bolger, MD of the University of California, San Francisco co-chaired the group of medical experts that reviewed the literature on cardiovascular and gum disease from 1950 until July 2011 on behalf of the American Heart Association. The group found more than 500 studies but none of the studies were causational studies—designed to prove a direct cause and effect.

Causation studies have not been conducted yet likely because of the complexity and expense involved in doing them, says Parker. "These disease[s] are complex and it would require a period of time—15 to 20 years—to thoroughly evaluate and follow the numerous factors involved."

Without long-term studies, we won't fully understand the nature of the relationship between these two problems. "Without causational studies, we never would have learned that aspirin is protective against heart disease and that high cholesterol causes it," says Parker who knows of at least one long-term study underway now.

In the meantime, experts say it would be foolish to ignore the association. "Heart disease and gum disease are separate problems but the association is real," says Parker.  "We know that patients with periodontal disease have increased levels of C-reactive protein in their blood (likely because of the inflammation). C-reactive protein is a well-known marker for heart disease."

As Pamela McClain, DDS, president of the American Academy of Periodontology explains on the group's website: "Patients and healthcare providers should not ignore the increased risk of heart disease associated with gum disease just because we do not have all the answers yet."

In the meantime, Parker and others advocate good oral hygiene including regular dental checkups twice a year. "Be sure your dentist uses a periodontal probe to look for pockets of infection in your gums," says the dentist. "At home, brush teeth for at least two minutes and use dental floss to remove the sticky plaque that forms between teeth and is difficult to reach with a toothbrush."



Interview William B. Parker, D.D.S.
Associate Professor and Chair, Section of Periodontology
Nova Southeastern University College of Dental Medicine

American Academy of Periodontology

American Heart Association