The biggest problem with the American Heart Association's report is that it is based on previous studies over the last 60 years that do not have a uniform definition of Periodontal Disease. Let's remember that Periodontal Disease has been defined the same way for over 50 years: a simple observational, just looking at it, measuring with a probe that is often misread. But actually we now are assessing this subject in regards to "oral inflammation, genetic variability, verified testing, and microbial burden," none of which were taken into account in the studies used in the discussion.
For example I will use my own health situation: I have no traditional signs of Periodontal Disease: no pocketing, no bleeding. I'm a dentist and a son of a dentist. And yet I test Il-1 positive, meaning that I am a hyper-responder to oral inflammation. And, even though I do not present with a traditional observational view of Periodontal Disease, I had a microbial burden that is associated with oral inflammation and systemic disease. Also, I'm physically active, have a reasonable diet, healthy weight, and have controlled cholesterol numbers. I should be in the less than 50% risk for Cardiovascular disease....and yet I have a buildup of plaque in my carotid. I "had" elevated Lp-PLA2 (a huge marker and player in Cardiovascular Disease) and was at large risk for a Heart Attack and/or Stroke in the near future. In the studies reviewed by the American Heart Association, I would have been missed because they were not looking for anything but a "simple traditional observational view of Periodontal Disease" rather than the advanced tests that more advanced healthcare providers are incorporating, including leading healthcare facilities of the world.
So if we use the old way of evaluating Periodontal Disease, we are not addressing what the leading preventive cardiology approaches are suggesting.
Also, the American Heart Association's recent report states that upon reviewing the past 60 years of research there is no definitive proof that a traditional view of Periodontal Disease is THE Cause of Heart Disease. They say that larger prospective studies are needed to prove causality. They are correct. These studies are extremely expensive and will not be able to prove causality in my lifetime. With that said, they fail to emphasize that no study
disproves the theory that oral disease is one of the many causes of vascular disease. The American Heart Association acknowledges that there is an association between oral disease and systemic disease. They even acknowledge that treatment of periodontal disease reduces systemic inflammation and endothelial dysfunction, both known risk factors for cardiovascular disease.
In my opinion and in the opinion of many of the Physicians involved with preventive cardiology, the AHA is irresponsible by making a statement that deceptively leads people to believe that oral disease does not contribute to vascular disease. Although Cause has not been proven, there is strong evidence to suggest that certain high risk bacteria may be an under-identified cause of heart attacks, strokes, and progression of atherosclerosis.
I applaud the American Heart Association for their noting that "oral health is important for overall health." And I formally thank the American Heart Association for their extensive literature review which confirms our recognition of the oral/systemic association. According to Bale/Doneen, the nation's leading preventive cardiology educators, "We believe that a strong association of periodontal disease and vascular disease exists with the trend for reduced systemic inflammation and improved endothelial health when effective periodontal therapy is achieved. We also recommend that the evaluation and treatment of periodontal disease along with appropriate medical care be included in any strategy for the prevention of cardiovascular disease. Both the medical and dental communities should realize that there are positive health benefits when both fields of medicine work in harmony for the prevention of atherosclerotic vascular disease."
Dr. Dan Sindelar Director, Foundation for Oral Systemic Health
Co-founder, American Academy for Oral Systemic Health
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