Since the first case-control report published in 1989 several investigations have repeatedly shown a consistent association between cardiovascular disease and gum disease. The majority of systematic reviews on the topic indicated that gum disease is consistently associated with a 15 to 20% increased risk of developing future CVD whilst these associations were independent of traditional CVD risk factors.
Atherosclerosis, with its consequent cardiovascular disease, represents one of the leading causes of death in the industrialised world and it is now recognised that atherosclerosis is a chronic inflammatory disease affecting the arterial wall. However the causes of arterial inflammation remain poorly understood and traditional CVD risk factors (i.e. age, gender, smoking, hypercholesterolemia, hypertension) do not explain a proportion of cardiovascular events.The role of infections in causing atherosclerosis received increasing attention well over 20 years ago and numerous studies had shown an association between specific chronic infections and CVD.
The main finding reported to date after periodontal therapy is a substantial improvement of measures of endothelial function (which represents a surrogate marker of CVD. The endothelium is a key regulator of blood vessel biology, whilst the loss of normal endothelial function and integrity, called endothelial dysfunction, occurs in the early stage of the atherosclerosis and its progression. Endothelial dysfunction can predict adverse CVD events and long-term outcomes and flow-mediated dilatation (FMD) represents the most widely used non-invasive ultrasound method to assess endothelial function of the brachial artery. Several clinical periodontal studies demonstrated a positive effect of periodontal treatment on endothelial function (improvement).
One of the largest randomised trials included 120 patients suffering from periodontitis and who received randomly either an intensive course of subgingival instrumentation and locally delivered antimicrobials or scaling and polishing. Six months after periodontal therapy, patients in the intensive treatment group presented with the greatest improvement in periodontal health and endothelial function (2.0% improvement compared to controls.
Overall, researchers found that gum disease was significantly more common in heart attack patients than healthy adults. Approximately 43% of heart attack patients had gum disease, while gum disease affected only 33% of healthy adults. After analysis, researchers found that individuals with gum disease were 49% more likely to have a heart attack than those without. These findings strengthen the possibility of a relationship between cardiovascular disease and gum disease. Many studies have now linked gum disease to increased risk for heart disease and it’s likely that inflammation is to blame and there is a clear link between the two.
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