Commentary on Periodontal Disease and Atherosclerotic Vascular Disease:

A recent literature review published in Circulation, the journal of the American Heart Association, was widely referenced in the general media as “debunking” the “myth” that gum disease can cause heart disease.

The literature review covered 537 peer-reviewed publications between 1950 and July, 2011, on the association between periodontal disease (PD) and “any cerebrovascular, peripheral vascular, or cardiovascular disease” (ASVD) excluding certain other complicating diseases. The search did not include dental caries. The review was motivated, in part, because “Patients and providers are increasingly presented with claims that PD treatment strategies offer ASVD protection; these claims are often endorsed by professional and industrial stakeholders.”

Quoting from the article: “The link between ASVD and inflammatory mediators in blood is well established, with consistent associations between levels of systemic inflammatory markers and increases in clinical events such as MI and nonhemorrhagic stroke ….” and “Chronic periodontal infection contributes to systemic inflammation characterized by elevation of … CRP. CRP has been linked to incident MI, stroke, peripheral arterial disease, and sudden cardiac death in multiple prospective epidemiological studies…”

The article concluded that: “Extensive review of the literature indicates that PD is associated with ASVD independent of known confounders. This information comes mostly from observational studies, however, and therefore does not demonstrate that PD is a cause of ASVD, nor does it confirm the contention that therapeutic periodontal interventions prevent heart disease or stroke or modify the clinical course of ASVD.” And from the abstract: “Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.”

Contrary to the contention by the NY Times that it “debunked” the “myth” the review showed that: (1) PD is independently associated with ASVD, (2) the nature of the studies to date, and the confounding mutual risk factors, preclude drawing inferences as to any causative relationship, (3) certain associated biomarkers co-vary with PD and ASVD, and (4) data does not support claims that treating established periodontal disease will reduce or prevent ASVD. In consideration of the independent association of PD and ASVD, one would still be well advised to establish good oral hygiene at a young age which should be maintained throughout adulthood.

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