PERIODONTAL DISEASE and CARDIOVASCULAR DISEASE
Abstract: Periodontal disease and especially if it is fairly advanced can increase the risk of cardiovascular disease significantly. Although it is not now feasible to quantify this effect adequately, Life Ahead will suggest a possible debit to health if this disease is present. Although good teeth care via brushing and flossing may help deter periodontal disease, there is no assurance that this will be true. Regular visits to the dentist for diagnosis and correction of any periodontal problems are a requirement not only for maintenance of teeth but for best protection against heart disease.
The Life Ahead review of results of ten different studies confirmed that differing levels of Periodontal disease increased the risk of coronary disease risk by values from a low 1.10 to a high 3.8 times. The average risk of found by these studies was a highly significant 1.5 times. Three studies noted similar or larger effects of periodontal disease on stroke and/or on all cardiovascular disease (CVD). Two noted effects on overall death rates. But no useful studies were found relating periodontal disease to cancer or other diseases.
The Mechanism: How can a problem with teeth affect something so different as heart disease? A possible scenario is that infection increases inflammation, and this inflammation moves widely into the body and into the coronary arteries where it produces sites for plaque development. This mechanism is supported by the fact that Periodontal disease increases the value of C-reactive protein (CRP), the marker for inflammation. In fact, the increase in CRP found related to Periodontal disease is sufficient to explain much of its effect on heart disease. A study (Mattila,KJ, Atherosclerosis, 1993, 103:205) showed that periodontal disease increased extent of atherosclerosis, and another showed that gum disease increased blood levels of fibrinogen, a clotting factor. These studies of mechanism reinforce the validity of the results of the population studies.
Some Problems: There are problems, however, in attempting to quantify Periodontal disease as a Life Ahead measurable and correctable risk. First there are major differences in the level of Periodontal disease extending from a small problem on one tooth, to gingivitis as swelling or some bleeding of gums, or to severe infection that destroys multiple teeth. Research shows clearly that coronary risk level is related to severity of Periodontal disease and that higher risks above 1.5 are associated with deep tooth pockets and actual loss of bone and teeth. Few individuals are capable of identifying their level of this disease, and no accepted index of Periodontal disease severity appears available for valuing its role in increasing coronary risk over long time periods..
A second problem is that there probably is a genetic relationship for susceptibility to Periodontal disease that could be identified via another factor as for example family history of heart disease. A third problem is that those who take better care of their teeth tend to be those who also take better care via other habits that were not adequately adjusted for by the research. Finally, there is little research that verifies that correction of Periodontal disease really reduces risk of coronary disease. One study (Hujoel, J Am Dental Assoc 2001, 132:883) found only a 12% benefit in risk of coronary disease for correcting Periodontal disease. Another problem is the duration of Periodontal disease. It often can be corrected, and it may last for some defined durations rather than for life. Life Ahead assumes lifetime duration from present age of a health factor for its computations of Well-Days..
It seems reasonable that that better brushing and flossing will help prevent Periodontal disease. Yet research on this is far from convincing. At least one research study found little relationship between the disease and self-reported information on teeth brushing habits. (Merchant, A, J Periodontal Dis 2002, 73:531). Claims in some health computer models that "Brushing or flossing your teeth will add some number of years to your life" are absurd. There is no hard evidence now that supports this. Periodontal disease is problem that usually can only be diagnosed by and corrected by the dentist.
The Present Approach: With recognition of these problems of quantification, the current Life Ahead model includes an arbitrary risk factor of 1.30 on cardiovascular diseases if the question about Periodontal disease is checked as a 'Yes'. This single value will not quantify the disease in the way most other factors are valued. But it will provides a message to the user that a health and life risk exists that should recognized and corrected. Further, if Periodontal disease is advanced, cardiovascular risks and loss in Well-Days can be two or three times this presently computed value.
What can be done? Despite the discouraging research, it seems logical that regular and adequate teeth brushing after meals accompanied by flossing still should help prevent the loss of teeth that can so seriously diminish the pleasure of eating. And this should help prevent Periodontal disease. But there is no assurance this will avoid this potential problem. Regular visits to the dentist for examination, removal of tooth deposits and plaque, and diagnosis of and correction of any actual Periodontal disease is an important health MUST for every health-interested person.