Heart Disease and Stroke: An Oral Health Link?

Some of the most intriguing oral health research is attempting to connect the dots between diseases of the mouth and other illnesses. For example, a 2007 study published in the Journal of the National Cancer Institute reported that gum disease may increase the risk of developing pancreatic cancer. So far it’s unclear how periodontal disease might contribute to pancreatic cancer, and no definite cause-and-effect relationship has been proven, but the findings are intriguing and will no doubt spur further research.

Links between other health conditions and gum disease have been studied in greater depth. Under particular scrutiny is how periodontal disease may relate to diabetes, heart disease, and pregnancy complications.

Does having gum disease put you at greater risk for cardiovascular disease? And, by extension, would averting gum disease actually reduce your chances of heart disease and stroke? Those questions have been—and continue to be—heavily researched. But as yet, researchers haven’t found the smoking-gun evidence that solidifies this link.

Studies Suggest Associations

Numerous studies have suggested associations between chronic gum infection and cardiovascular disease. According to theAmerican Academy of Periodontology, people with gum disease are almost twice as likely to have heart disease as those without it. A 2006 study found that people younger than age 60 with a certain amount of alveolar bone loss from gum disease were at greater risk for heart disease. Two studies linked the bacteria of periodontal disease to heart problems. The first, a 2005 study in Circulation, found that older adults who had higher proportions of four types of gum disease–causing bacteria also had thicker carotid arteries, which is a predictor of stroke and heart attack. The second study, published in the Journal of Periodontology in 2006, found that people with acute coronary syndrome—which encompasses a variety of heart problems ranging from unstable angina to heart attack—had higher levels of oral bacteria. In 2008, an article reviewing the scientific literature that was published in the Journal of Clinical Periodontology cautiously confirmed that periodontitis may be a contributor to heart disease and stroke. However, the authors went on to say that additional studies and intervention trials are needed before this knowledge can be put into clinical practice.

How Are They Connected?

How might gum disease influence heart health? One possibility is that oral bacteria enter the bloodstream and attach to fatty plaques on artery walls, contributing to the formation of blood clots. Another is that inflammation from infectious agents damages artery walls and leads to the formation of plaques. The 2006 Journal of Periodontology study supports the idea that inflammation plays a role. This study showed that oral bacteria provoked an inflammatory response, elevating levels of white blood cells and C-reactive protein, both of which are linked to cardiovascular disease.

Also unclear is whether treating advanced gum disease can reduce cardiovascular risk. A 2007 study in The New England Journal of Medicine showed that six months after individuals received intensive gum disease treatment, the linings of their coronary arteries showed less inflammation and exhibited a healthier ability to expand. However, there’s no information from clinical trials available as yet that indicates if this sort of treatment would lower an individual’s risk for heart disease or stroke.

Source: Dental Health for Adults: A Guide to Protecting Your Teeth and Gums. Copyright © by Harvard University. All rights reserved.