Dental disease as a risk factor for cardiovascular disease

Background

Some years ago, the Finnish government sponsored a comprehensive study of the health risks of the Finnish people. They measured the rates of all kinds of diseases and did statistical correlations to see if there were any correlations. In an article published in British Medical Journal (BMJ), 1989 Mar 25;298(6676):779-81 showed that there was an unexpected correlation between dental disease and systemic disease (stroke, heart disease, diabetes). After correcting for age, exercise, diet, smoking, weight, blood cholesterol level, alcohol use and health care, people who had periodontal disease had a significantly higher incidence of heart disease, stroke and premature death.

More recently, these results were confirmed in studies in the United States, Canada, Great Britain, Sweden, and Germany. The effects are striking. For example Morrison found that people with periodontal disease had a factor of 2 higher risk of dying from cardiovascular disease. By comparison smokers only had a 60% increased risk. So far all of the studies which have looked for a correlation between dental disease and cardiovascular disease have found that people with periodontal disease have a significantly higher risk of cardiovascular disease. A separate US study also showed that people who had orthodontics as a child have a statistically lower level of periodontal (gum) disease, i.e. the conditions that the studies say increase the risk of cardiovascular disease.

There also have been a series of animal ( dog, rabbit, rat) studies which show that during periodontal flareups, oral bacteria can enter the bloodstream, invade aortic, heart, and vascular endothelial cells and produce vascular calcification (hardening of the arteries). Meyer and Fivestaylor showed that c-reactive proteins and "pro-inflammatory cytokines capable of eliciting effects associated with atherosclerosis and coronary heart disease" are released during periodontal flareups.

At this point this is work is current research. The FDA has not approved orthodontics as a preventive treatment for heart disease.

How large of an effect does dental disease have on heart disease

In a paper published in J Am Dent Assoc 1998 Mar;129(3):301-11 Dr Walter Loesche from the University of Michigan School of Dentistry, wrote
"Several recent studies have shown a link between dental disease and coronary heart disease. The authors studied 320 U.S. veterans in a convenience sample to assess the relationship between oral health and systemic diseases among older people. They present cross-sectional data confirming that a statistically significant association exists between a diagnosis of coronary heart disease and certain oral health parameters, such as the number of missing teeth, plaque benzoyl-DL-arginine-naphthylamide test scores, salivary levels of Streptococcus sanguis and complaints of xerostomia. The oral parameters in these subjects were independent of and more strongly associated with coronary heart disease than were recognized risk factors, such as serum cholesterol levels, body mass index, diabetes and smoking status. However, because of the convenience sample studied, these findings cannot be generalized to other populations. "

To translate this article, in this study dental disease was a larger risk factor for heart disease than being overweight, having a high cholesterol level, not exercising or smoking. Click here to see the abstract of the paper.

There have been many other studies and all of the studies so far show similar effects. Here are links to some of the papers so you can read them.

Morrison HI, Ellison LF, Taylor GW, Periodontal disease and risk of fatal coronary heart and cerebrovascular diseases. J Cardiovasc Risk 1999 Feb;6(1):7-11

Mattila KJ. Valle MS. Nieminen MS. Valtonen VV. Hietaniemi KL. DENTAL INFECTIONS AND CORONARY ATHEROSCLEROSIS. Atherosclerosis. 103(2):205-211, 1993 Nov.

Bad teeth and gums a risk factor for heart disease? Harv Heart Lett 1998 Nov;9(3):6-7

Mattila KJ. DENTAL INFECTIONS AS A RISK FACTOR FOR ACUTE MYOCARDIAL INFARCTION. European Heart Journal. 14(Suppl K):51-53, 1993

Larsson B, Johansson I, Weinehall L, Hallmans G, Ericson T Cardiovascular disease risk factors and dental caries in adolescents: effect of a preventive program in Northern Sweden (the Norsjo project). Acta Paediatr 1997 Jan;86(1):63-71

Slots J Casual or causal relationship between periodontal infection and non-oral disease? J Dent Res 1998 Oct;77(10):1764-5

Larsson B. Johansson I. Hallmans G. Ericson T . RELATIONSHIP BETWEEN DENTAL CARIES AND RISK FACTORS FOR ATHEROSCLEROSIS IN SWEDISH ADOLESCENTS Community Dentistry & Oral Epidemiology. 23(4):205-210, 1995 Aug.

Beck J. Garcia R. Heiss G. Vokonas PS. Offenbacher S . PERIODONTAL DISEASE AND CARDIOVASCULAR DISEASE Journal of Periodontology. 67(10 Suppl S):1123-1137, 1996 Oct.

Seymour RA. Steele JG . IS THERE A LINK BETWEEN PERIODONTAL DISEASE AND CORONARY HEART DISEASE British Dental Journal. 184(1):33-38, 1998 Jan 10.

Meyer DH. Fivestaylor PH . ORAL PATHOGENS - FROM DENTAL PLAQUE TO CARDIAC DISEASE [Review] Current Opinion in Microbiology. 1(1):88-95, 1998 Feb.

Mendez MV, Scott T, LaMorte W, Vokonas P, Menzoian JO, Garcia R An association between periodontal disease and peripheral vascular disease. Am J Surg 1998 Aug;176(2):153-7

DeStefano F, Anda RF, Kahn HS, Williamson DF, Russell CM Dental disease and risk of coronary heart disease and mortality. British Medical Journal 1993 Mar 13;306(6879):688-91

Garcia RI, Krall EA, Vokonas PS Periodontal disease and mortality from all causes in the VA Dental Longitudinal Study. Ann Periodontol 1998 Jul;3(1):339-49

Meyer MW, Gong K, Herzberg MC, Streptococcus sanguis-induced platelet clotting in rabbits and hemodynamic and cardiopulmonary consequences Infect Immun 1998 Dec;66(12):5906-14

Herzberg MC, Meyer MW Effects of oral flora on platelets: possible consequences in cardiovascular disease. J Periodontol 1996 Oct;67(10 Suppl):1138-42

Herzberg MC, Weyer MW Dental plaque, platelets, and cardiovascular diseases Ann Periodontol 1998 Jul;3(1):151-60

Related links

Gum Disease: Not Just a Pain In the Mouth

Gum Disease might increase stroke risk

What does this have to do with orthodontics

Orthodontics generally lowers the risk of the types of oral conditions which the studies above indicate are risk factors for heart disease or stroke. It is like going on a diet. If you get orthodontics as a child, it is thought that you will have a lifetime reduction in the oral conditions which the studies above suggest to be risk factors for heart disease.

Admittedly, no one has demonstrated that orthodontics will reduce the risk of heart disease. There was one 1981 study which did not find a significant reduction in oral conditions from orthodontics. Therefore more work is needed. However, the consensus is that orthodontics does lower the risk of oral disease. The studies cited above seem to suggest that oral disease raise your risk of heart disease.

Does Adult Orthodontics Reduce Cardiovascular Disease Too?

I do not know. Cardiovascular disease takes many years to develop. There have not been any studies on the influence of adult orthodontic treatment on cardiovascular disease.

Are there any other things I can do?

The FDA has not approved any treatments. Still there are some facts that you ought to consider:

  1. Toothbrushing has been shown to reduce the levels of all of the harmful bacteria in your mouth. In particular a bacteria called Steptococus sanguis is substantially reduced. This is the bacteria which has been shown to induce. bloodclots and hardening of the arteries in rabbits.
  2. . It happens that Colgate total contains triclosin. Clinical studies indicate that triclosin substantially reduces Streptococus sanguis levels in your mouth.
  3. Regular visits to your dentist and periodontist are also importnat in controlling the bacteria levels in your mouth.

You should consult your dentist or physician for specific treatment advice.

How can I find out more information?

There have been many papers on this subject. Click here to get titles and abstracts of some recent papers Also be sure to consult your personal physician and dentist. They are excellent sources of information.