Traditional risk factors for heart disease include obesity, high blood pressure, diabetes, high cholesterol, smoking, age and family history of heart disease. Over recent years, nontraditional risks have been identified, particularly those associated with inflammation. One such risk is periodontal disease, which ranges from minor inflammation of the gums, or gingivitis, to destruction of teeth and surrounding soft tissue, called periodontitis, according to the National Institute of Dental and Craniofacial Research. Gingivitis and periodontitis are usually caused by pathogenic, or disease-causing, bacteria.
Significance
According to the University of Maryland Medical Center, or UMMC, gum disease is one of the most prevalent medical conditions, present in more than 75 percent of the U.S. population. People with periodontal infections are twice as likely to have coronary heart disease when compared with those without periodontal disease. A study in the March 2008 issue of the journal "Circulation" reports that in patients with chronic periodontitis, the highest incidence of coronary heart disease was found in men less than 60 years old, independent of other risk factors.
Types
It is normal to have bacteria in the mouth, but normal bacteria can be replaced with pathogenic bacteria. The most frequent abnormal bacteria found in the mouth include Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia, according to an article published in the March 2006 issue of "Archives of Internal Medicine." These bacteria have been found in plaques lining coronary arteries, supporting a link between pathogenic periodontal bacterial and coronary artery disease.
Theories/Speculation
It is unknown exactly how pathogenic periodontal bacteria cause coronary heart disease, which is characterized by the accumulation of plaque within the coronary arteries, possibly leading to obstruction of blood flow to the heart muscle. Plaque is composed of cholesterol, cells and fibrous tissue. Rupture of the plaque may lead to a heart attack. Plaque buildup is accelerated by the presence of inflammation anywhere in the body. According to the "Archives of Internal Medicine" article, periodontal disease can contribute to heart disease in at least two ways. One is that oral bacteria that have been released into the blood, even by the simple act of brushing, attach to the plaque within a coronary artery, causing destabilization of the plaque with a rupture that can lead to clot formation and heart damage. Another possibility is that the presence of gum infection initiates a systemic inflammatory response, leading to acceleration of plaque formation and blockage of coronary arteries.
Treatment
Treatment of established heart disease depends on the extent of disease, symptoms and prognosis, and includes medications, possible stent implantation or surgery, as well as modification of underlying risk factors, including periodontal disease. The National Institute of Dental and Cranial Research reports eradication of periodontal disease can be complicated, but begins with good oral hygiene. Antibiotic rinses, gels or chips can be used to eliminate pathogenic bacteria. Surgery may be required in extreme cases to perform scaling and root planing, as well as more extensive surgery to repair bone and soft-tissue damage.
Prevention
Prevention of periodontitis-related heart disease is possible. Good daily hygiene and regular dental exams are the foundation for prevention of periodontal disease. Controlling the risk factors for gum disease is also important, including not smoking; decreasing sugar and acid foods and drinks, which can harm teeth and gums; and treating underlying risk-related diseases such as diabetes and autoimmune diseases.
References
- National Institute of Dental and Craniofacial Research: Periodontal (Gum) Disease--Causes, Symptoms and Treatments
- University of Maryland Medical Center: Periodontal Disease--Complications
- "Circulation"; "Age-Dependent Associations Between Chronic Periodontitis/Edentulism and Risk of Coronary Heart Disease"; T. Dietrich et al; March 2008
- "Archives of Internal Medicine"; "Periodonatal Infections and Coronary Heart Disease"; A. Spahr et al; March 2006
