Gum Disease and Heart Disease: What's the Connection?

In this blog, I often like to highlight how other medical conditions might influence your risk for heart disease. Some of these connections between different diseases are fascinating. Here, I interview Sunal S. Makadia, MD, and Swati C. Makadia, DMD, about gum disease and heart disease.

Sunal MakadiaSwati Makadia

Periodontal disease (gum disease) and heart disease--really?

Many studies have in fact shown a significant association between these two; however, there is still insufficient evidence to conclude a cause-effect relationship. Although some experts remain skeptical, it's been established that these diseases can be linked through a common mechanism, increased inflammation.

To learn more about this interesting link, I sat down with the Johns Hopkins husband and wife team of Drs. Sunal and Swati Makadia. Sunal is a research fellow in our Johns Hopkins Ciccarone Center for the Prevention of Heart Disease.

Dr. Blaha: What is periodontal disease?

Drs. Sunal and Swati Makadia: The term periodontal disease (or periodontitis) refers to inflammation of tissues that surround and support the teeth, including the gingiva (gums) and alveolar bone. Poor oral hygiene often results in an increased local growth of bacteria. These bacteria cause local inflammation, which causes destruction of alveolar bone and results in pockets, which are deepening gaps between teeth and the supporting bone.

Dr. Blaha: What is the proposed link between periodontal and heart disease?

Drs. Makadia: People with periodontal disease and heart disease often share certain risk factors, including increasing age, smoking, alcohol abuse, race/ethnicity, education/socioeconomic status, male gender, diabetes, and obesity. These shared risk factors are one link. However, there seems to be more to this relationship than just the shared risk factors.

People who have periodontal disease have much greater populations of bacteria within the periodontal pockets (up to 100,000,000 per surface per tooth) compared to healthy people, who may only have 1,000 bacteria. This bacterial growth causes local inflammation, which can in turn lead to increased whole-body inflammation that is marked by higher inflammatory markers in the bloodstream. Most of the scientific data suggest that those people who have increased whole-body inflammation, even those with no obvious heart disease to begin with, have an increased risk of developing heart disease.

Studies have also found that patients with periodontal disease have higher rates of atherosclerosis (the accumulation of plaque in the arteries). Furthermore, studies have also suggested that those with periodontal disease have signs of dysfunction of their blood vessels (so-called endothelial dysfunction). Blood vessel dysfunction is thought to be one of the earliest signs of heart disease, because blood vessels that are normal are able to actively prevent plaque build-up and blockage.

Dr. Blaha: Do medicines that treat heart disease improve periodontal disease?

Drs. Makadia: Recent media attention has highlighted research suggesting that statins (a common class of medications used to treat patients with heart disease) may be beneficial in preventing and halting the progression of a variety of different diseases, ranging from dementia to atrial fibrillation to blood clots to Parkinson disease.

Statins are known to be anti-inflammatory and may have a role in treating periodontal disease, which is of course an inflammatory condition. In fact, a recent study from Harvard Medical School found that patients with severe periodontal disease who were treated with a high dose of statins had marked reductions in periodontal inflammation, as measured by PET scans.

Dr. Blaha:Should cardiologists be treating an individual with known periodontal disease but no known heart disease?

Drs. Makadia: This is a challenging question to answer. If we believe that those people who have periodontal disease also have an increased risk for heart disease (which the data seem to suggest), then it may be beneficial to treat these patients with statins, even before they have any heart disease. Of course, we still need more research on this topic before making any final recommendations. Regardless, more physicians should encourage their patients to have regular dental examinations twice a year.

Dr. Blaha: Are there any specific approaches that an individual with periodontal disease can take to help prevent an increased risk for heart disease?

Drs. Makadia: Individuals with periodontal disease should be vigilant about their oral hygiene—brushing two to three times a day and flossing daily is recommended. And they need to quit smoking! Exercise reduces the risks for obesity, diabetes, and cardiovascular disease, and probably helps with overall gum health as well. Regular visits to the doctor and dentist are all recommended. Last, those individuals with periodontal disease, or any other cardiac risk factor, should talk to their doctor about the possibility of starting a statin medication after they have adjusted their lifestyle to be more heart healthy.

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