Healthy Gums & a Healthy Heart: The Perio-Cardio Connection

Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body.

CHICAGO—June 1, 2009—Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other.

A consensus paper on the relationship between heart disease and gum diseasewas published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy or Periodontology (AAP). Developed in concert by cardiologists, the physicians specialized in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease. As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease.

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology. In addition to the clinical recommendations, the consensus paper summarizes the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection.

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases. “Inflammation is a major risk factor for heart disease, and periodontal disease may increase the inflammation level throughout the body. Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties. Therefore, you will now see cardiologists and periodontists joining forces to help our patients.”

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The paper also recommends that physicians managing patients with cardiovascular disease evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums.

While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation - the body’s reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.

“Both periodontal disease and cardiovascular disease are inflammatory diseases, and inflammation is the common mechanism that connects them,” says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the Department of Periodontics at the University of Texas Health Science Center at San Antonio. “The clinical recommendations included in the consensus paper will help periodontists and cardiologists control the inflammatory burden in the body as a result of gum disease or heart disease, thereby helping to reduce further disease progression, and ultimately to improve our patients’ overall health. That is our common goal.”

Periodontal Treatment

If you’ve recently been diagnosed with periodontal disease, you probably have some questions about your treatment. Be assured that periodontists believe that periodontal therapy, including non-surgical treatment, should be achieved in the least invasive and most cost-effective way possible.

The Expert Care of Periodontists

Periodontists are uniquely qualified to treat a disease of the gum tissue and underlying bone in the mouth. With three additional years of specialized training after dental school, periodontists are masters of the treatment skills necessary for predictable and successful periodontal disease treatment.

Remember that the first step toward good periodontal health begins with proper oral hygiene, which can go a long way toward preventing certain forms of periodontal disease and reversing gingivitis, an early stage of periodontal disease. Good oral hygiene includes brushing your teeth at least twice each day, flossing at least once each day, and seeing a periodontist annually for a comprehensive periodontal evaluation. If you are diagnosed with periodontal disease, common treatments include the following:

Deep Cleaning/Scaling & Root Planing

A deep cleaning, also known as scaling and root planing, is a non-invasive measure of preventing the progression of periodontal disease. A deep cleaning goes beneath the gum line to remove plaque, bacteria, and other toxins from areas that brushing and flossing cannot reach, reducing the risk of disease advancement. A routine cleaning does not require the dentist or hygienist to go below the gum line; therefore, the procedure does not eliminate the cause of disease if it is present.

Medication

Oral antibiotics, as well as anti-microbial mouth rinses, can be prescribed short-term to control bacteria and treat acute periodontal infection. Other medicinal treatments include antibiotic gels, slow-release antiseptic chips, microspheres, and enzyme suppressants used after scaling and root planing procedures.

Surgery

If inflammation and deep pockets are present after deep cleaning and medication, a periodontist may perform flap surgery to minimize the depth of the pocket. The surgery consists of plaque removal below the gum line and then closure of the gums so that they fit snugly against the tooth. A bone and tissue graft procedure helps to regenerate any tissue or bone lost to periodontal disease through the placement of natural or synthetic bone material to promote bone growth. A soft tissue graft uses synthetic material or tissue from the mouth to cover tooth roots that have been exposed.

After a period of healing, your periodontist will evaluate your condition to determine if further treatment is necessary. If additional treatment is required, your periodontist will develop a treatment plan to help restore your smile to a state of health. If you don’t require further treatment, you’ll enter a maintenance phase, and thorough checkups on your teeth and gums will occur every few months or so.

Pregnancy & Periodontal Disease

There used to be an old wives’ tale that said “A tooth is lost for every child.” While it may seem far-fetched, it may actually be based loosely on fact. Your teeth and gums can be affected by pregnancy, just like other areas of your body. Most commonly, pregnant women can develop gingivitis, or pregnancy gingivitis, beginning in the second or third month and can increase in severity through the eighth month of pregnancy. During this time, some women notice swelling, bleeding, redness, or tenderness in the gum tissue. In some cases, gums swollen by pregnancy gingivitis can react strongly to local irritants and form a large lump. These growths, called pregnancy tumors, are not cancerous and are generally painless. They usually disappear after pregnancy, but some may require removal by a dental professional, such as a periodontist.

Infertility Treatment

Researchers have found that women undergoing infertility treatment and who are subjected to ovulation induction for more than three menstrual cycles had higher levels of gingival inflammation and bleeding. More studies are needed to examine the impact of infertility treatments on periodontal health. Until more information is known, meticulous at-home oral care including routine tooth brushing and flossing and regular cleanings by a dental professional is a practical approach while receiving infertility treatment.

The best way to avoid periodontal conditions associated with pregnancy is to begin with healthy gums. If you are thinking about becoming pregnant, you should visit your dentist or periodontist for a comprehensive periodontal evaluation. If you are pregnant, or planning to become pregnant, you need to know that your periodontal health may affect the pregnancy and ultimately the health of your baby.

Pregnant women who experience periodontal disease during their pregnancies may be twice as likely to develop preeclampsia, which is characterized by high blood pressure and the presence of protein in the urine. It can put you and your baby at risk for severe complications. Additionally, studies have suggested that women who experience periodontal disease during pregnancy may be at risk of having a premature or low birth weight baby.

The good news is that researchers are making strides to find out exactly how periodontal disease affects pregnancy outcomes. Some studies have suggested that treating periodontitis during pregnancy may reduce the risks of a preterm birth. Preventing gum problems from developing during the stresses of pregnancy also appears to be important in improving the health of mother and baby. If you are already pregnant and have been diagnosed with periodontal disease, treatment by your dental professional may reduce your chances of having a preterm, low birth weight baby. Talk to your dentist or periodontist for more information.

If you’re considering pregnancy, it’s a good idea to include a periodontal evaluation as part of your prenatal care. A healthy mouth can help give you, and your baby, something to smile about! Pregnancy and Periodontal Disease The American Academy of Periodontology Patient Page is a public service of the AAP and should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org to assess your risk and for more information on periodontal disease. 

The American Academy of Periodontology Patient Page is a public service of the AAP and should not be used as a substitute for the care and advice of your personal periodontist. There may be variations in treatment that your periodontist will recommend based on individual facts and circumstances. Visit perio.org to assess your risk and for more information on periodontal disease.