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Public Health Implications of Chronic Periodontal Infections in Adults
Potential Public Health Implications of Periodontal Disease and
Cardiovascular Disease Relationships
James Beck, MS, PhD,
Distinguished Professor, Dental Ecology and Research, and Steve Offenbacher,
DDS, PhD, Professor, Periodontology, University of North Carolina School of Dentistry, Chapel Hill,
North Carolina
Periodontitis is a destructive disease that affects the supporting
structures of the teeth including the periodontal ligament, cementum, and
alveolar bone. Periodontitis represents a chronic, mixed infection by
gram-negative bacteria, such as Porphyromonas gingivalis, Prevotella
intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans,
and gram positive organisms, such as Peptostreptococcus micros and
Streptococcus intermedius. Due to periodic changes in concepts of
periodontal disease pathogenesis and restructuring and renaming periodontal
disease types, actual prevalence and incidence estimates for periodontal
disease have been debated for decades. It is generally thought that in
developed countries, 44%
to 57% of adults have moderate periodontitis, and about 7% to 15% have advanced periodontitis. Partly
because of uncertainty about the public health importance of this disease
and partly because primary prevention depends on personal oral hygiene
behavior and professional services, public health programs to prevent
periodontal disease are underdeveloped.
Since 1989, a number of cross-sectional, case-control,
and longitudinal studies have reported that the clinical signs of periodontitis may be associated with cardiovascular events; other studies
have reported no significant association. Several basic science and animal
studies also have reported systemic effects of periodontal infection.
Cardiovascular disease is the top cause of death in the United States for
men and women and carries with it considerable morbidity. In addition,
total costs for cardiovascular disease in 2003 were estimated to reach almost $352 billion. This
presentation assumes that periodontal disease will be shown to be a risk
factor for cardiovascular disease. Because periodontal and cardiovascular
diseases are highly prevalent in the United States population, periodontal disease also
becomes a public health problem worthy of attention, even though the
strength of the association may be only moderate.
As a result of this link with cardiovascular disease, interest in
periodontal disease prevention and treatment is likely to intensify in the
private and public health sectors and in the general public. One
consequence of this link is that dentists and physicians may need to focus
more on primary prevention of infection by periodontal pathogens and, in
patients with disease, they may need to focus more on secondary prevention.
End-points for secondary prevention will involve eliminating periodontal
pathogens and reducing inflammation, while pocket reduction, tooth
retention, and regenerative procedures may become less important.
Controlling inflammation and infection may create an increased need for
anti-infective and anti-inflammatory pharmacological strategies for
high-risk patients.
Other actions likely to be needed are (1) educating health professionals
and the public about the relationship between periodontal and
cardiovascular diseases; (2) restructuring benefits for public programs to
provide infection control services to Medicaid and Medicare recipients; (3)
advocating for medical insurance coverage of periodontal services; and (4)
establishing a surveillance program to monitor periodontal disease trends
in the population and identify high-risk groups to target with intervention
programs. Finally, coordinating efforts with groups that are active in
reducing other cardiovascular disease risk factors, such as smoking,
diabetes, and obesity, may be a useful strategy.
Back to Chronic Periodontal Infections Conference
Historical Document
Page last reviewed: February 2, 2005
Content source:
Division of Oral Health,
National Center for Chronic Disease Prevention and
Health Promotion |
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