Teething Trouble

Created on 10th September 2009

Looking after your teeth might have more advantages than just a perfect smile: new research has suggested a link between gum disease and heart disease. Dr Farid Monibi and his colleagues at 76 Harley Street, Dr David Brull and Dr Hatem Algragrafee, explain

Despite advances in the treatment of coronary heart disease (CHD), it remains the most common cause of death in the UK. It is caused by atherosclerosis, where fatty substances build up inside the coronary arteries reducing blood flow, leading to angina and heart attack.

There is now evidence linking chronic inflammation to the development of atherosclerosis. Inflammation is the body's response to a variety of harmful stimuli that occurs in many tissues including blood vessels. Many cardiac risk factors have been identified such as smoking, elevated cholesterol, diabetes and high blood pressure, but a significant number of heart disease cases are not explained by just these traditional risk factors alone.

Doctors and dentists are increasingly aware that there might be another cause: evidence suggests there may be an association between heart disease and gum disease or periodontitis. This is a common chronic inflammatory condition affecting the gums and tooth-supporting structures caused by bacteria within the tooth socket.

How then are these two very different processes linked? Could better dental care and aggressive treatment of periodontal disease be a new approach to treating heart disease?

There is abundant clinical evidence that elevated levels of inflammation are detectable years in advance of the first ever cardiac event. These levels of inflammation are present in those suffering gum disease and suggest a link.

A number of potential mechanisms might link an oral infection with more serious illnesses such as cardiac disease. One is thought to be the direct passage of mouth-bacteria into the circulation leading to an immune response. Another is thought to be the local release of inflammatory mediators from the tooth socket into the circulation generating an inflammatory response.

Since chronic heart disease is a complex multi-factorial process with a number of identifiable risk factors research needs to take place to establish a firm association between gum disease and heart disease.

Evidence already exists that by treating gum disease there are demonstrable reductions in markers of systemic inflammation and improvements in vascular function, however we will need to look at the effect on heart attacks and other cardiovascular problems before firming up such an association.

Although there are no current large trials to link successful treatment of gum disease with a reduction in cardiac disease and other cardiovascular problems there is still a rationale for promoting the public health message that good oral health could contribute to overall health.

The perfect smile is important and is now possible with the vast array of cosmetic solutions offered by dentists but a healthy mouth is just as important as research is proving.
CS&AM