Heart Disease

Evidence does not support a link between periodontal disease and increased risk of coronary heart disease

Several studies have suggested a relationship between periodontal disease, a chronic inflammatory disease that results in the breakdown of bone that surrounds teeth, and coronary heart disease (CHD). Researchers have proposed several biological mechanisms through which periodontal disease may contribute to CHD. These include the invasion of chronic low-level bacteria that occurs with periodontal disease into endothelial coronary cells, the harmful cardiovascular effects of the inflammation sparked in response to periodontitis, and the contributions of oral microorganisms to acute cardiac events.

However, a recent analysis of 16 years of data from a national study found no convincing evidence of a causal association between periodontal disease and CHD.

With joint support from the National Institute of Dental Research and the Agency for Healthcare Research and Quality, University of Washington researchers evaluated 8,032 adults aged 25 to 74 years with no reported history of cardiovascular disease, including 1,859 people with periodontitis, 2,421 with gingivitis, and 3,752 with healthy periodontal tissues. They compared a first occurrence of hospitalization or death from CHD with the patient's periodontal history.

After adjustment for known cardiovascular risk factors, gingivitis was not associated with CHD (hazard ratio, 1.05; 1 is equal risk), while periodontitis was associated with a nonsignificant increased risk for a CHD event, such as a heart attack (hazard ratio, 1.14). This was not convincing evidence of a causal association between periodontitis or gingivitis (which affects about 50 percent of U.S. adults) and CHD. Furthermore, markers of periodontal inflammation associated with either periodontitis or gingivitis—such as swollen red papillae, bleeding gums, or diffuse marginal inflammation—were not associated with an increased risk for CHD. Finally, there were no obvious dose-response relationships between the severity of periodontitis and CHD risk.

Details are in "Periodontal disease and coronary heart disease risk," by Philippe P. Hujoel, Ph.D., Mark Drangsholt, D.D.S., M.P.H., Charles Spiekerman, Ph.D., and Timothy A. DeRouen, Ph.D., in the September 20, 2000 Journal of the American Medical Association 284(11), pp. 1406-1410.

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