Improving Gum Health May Reduce Heart Risk

Researchers at Columbia University in New York suggest that if you look after your gums, you could also be reducing your risk of heart disease. They claim that improving dental care slows the speed with which plaque builds up in the arteries.

Writing in a recent online issue of the Journal of the American Heart Association, they report a prospective study that shows how improving gum health is linked to a clinically significant slower progression of atherosclerosis, the process where plaque builds up in arteries and increases a person's risk of heart disease and stroke death.

Lead author Moïse Desvarieux, associate professor of Epidemiology at Columbia's Mailman School of Health, says:

"These results are important because atherosclerosis progressed in parallel with both clinical periodontal disease and the bacterial profiles in the gums. This is the most direct evidence yet that modifying the periodontal bacterial profile could play a role in preventing or slowing both diseases."

For their study, the researchers followed 420 adults aged between 60 and 76 from northern Manhattan who were taking part in the Oral Infections and Vascular Disease Epidemiology Study (INVEST).

Measuring Artery Thickness

All participants underwent oral infection and artery thickness exams at the start of the study and at the end of follow-up, which was a median of 3 years.

The oral infection exams retrieved a total of over 5,000 plaque samples. For each participant, the samples came from several teeth and under the gums.

The oral plaque samples were analyzed for the presence of 11 strains of bacteria known to be involved in periodontal disease and seven control bacteria.

Samples of fluid from around the gums were also taken and assessed for levels of Interleukin-1β, a marker of inflammation.

The extent of atherosclerosis, was assessed using high-resolution ultrasound scans to measure artery thickness or intima-medial thickness (IMT) in both carotid arteries.

The results showed that both improved gum health and a reduction in the proportion of bacteria linked to periodontal disease correlated to a slower progression of atherosclerosis, as measured by IMT.

These results did not change significantly when adjusted for factors that could influence them, such as body mass index, cholesterol levels, diabetes and smoking.

Previous studies have linked an increase in carotid IMT of 0.033 mm per year (about 0.1 mm over 3 years), to a more than double increase in risk of heart attack and stroke.

In this study, the participants whose gum health got worse over the 3 years showed a 0.1 mm increase in carotid IMT, compared with the participants whose gum health improved.

Co-author Panos N. Papapanou, professor at Columbia's College of Dental Medicine, says:

"Our results show a clear relationship between what is happening in the mouth and thickening of the carotid artery, even before the onset of full-fledged periodontal disease. This suggests that incipient periodontal disease should not be ignored."

Atherosclerosis and Periodontal Infections

Although the researchers did not look into how bacteria in the mouth can lead to atherosclerosis, one theory suggested by animal studies is they increase inflammatory markers, which can trigger or worsen the inflammation in atherosclerosis.

In a previous study that took measures at one point in time, the team had already found that higher levels of disease-causing bacteria were linked to thicker carotid IMT. This new study builds on those results by looking at the participants over time.

Prof. Desvarieux adds:

"It is critical that we continue to follow these patients to see if the relationship between periodontal infections and atherosclerosis carries over to clinical events like heart attack and stroke and test if modifying the periodontal flora will slow the progression of atherosclerosis."

Funds from the National Institutes of Health (NIH), the National Institute of Neurological Disorders and Stroke (NINDS), the Institut National de la Santé et de la Recherche Medicale (INSERM), among others, helped finance the study.

In 2010, UK researchers reported that gum bacteria can increase risk of heart attack and heart disease, because the same bacteria that cause dental plaque can escape from the mouth into the bloodstream and trigger clots.

medicalnewstoday.com

Periodontal Disease and Heart Disease

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