Periodontal Disease and the Risk for Cardiovascular Disease

Charles P. Vega, MD, FAACP

Disclosures

April 07, 2009

In This Article

Introduction

Best Evidence Reference

Humphrey LL, Fu R, Buckley DI, Freeman M, Helfand M. Periodontal disease and coronary heart disease incidence: a systematic review and meta-analysis. J Gen Intern Med. 2008;23:2079-2086.

Abstract

This study was selected from Medscape Best Evidence, which uses the McMaster Online Rating of Evidence System. Of a possible top score of 7, this study was ranked as 5 for newsworthiness and 7 for relevance by clinicians who used this system.

Brief Summary

Previous research has found that periodontal disease can increase the risk for cardiovascular risk factors. The current systematic review and meta-analysis examine the association between periodontal disease and coronary heart disease (CHD). A summary of its findings as well as recommendations in regard to how physicians may promote better oral and cardiovascular health are described below.

Background

Dental and periodontal disease is very common, but this significant public health problem receives little attention from physicians. Using data from the 1999-2002 National Health and Nutrition Examination Survey (NHANES), researchers demonstrated that approximately 90% of adults had caries in their adult teeth.[1] The average number of retained natural teeth was 24 (of a possible 28) among adults, and 8% of adults were edentulous. The rate of edentulism grew by 6% among older adults between the 1988-1994 and 1999-2002 study periods. Another study described the risk factors for edentulism, and older age was the most prominent.[2] Tooth loss was not related to biological sex, and rates of tooth loss were lowest among Mexican Americans and highest among black, non-Hispanic adults. Poverty is also associated with a disproportionate burden of periodontal disease. Adults with low income and less than a high school education are approximately twice as likely to have periodontal disease compared with more affluent adults with higher educational attainment.[3]

Physicians should be concerned about the high rates of caries, tooth loss, and periodontal disease because these oral conditions are associated with significant negative health outcomes. In one analysis that adjusted for traditional risk factors, the prevalence of the metabolic syndrome was 2.31 times higher among patients with severe periodontal disease compared with adults without periodontal disease.[4] Moreover, the prevalence of metabolic syndrome increased gradually with the severity of periodontal disease, with a 12% increase in the risk for metabolic syndrome per 10% increase in the measurement of gingival bleeding.

One of the significant ways that periodontal disease may promote metabolic syndrome and subsequent cardiovascular disease is an increase in the degree of intravascular inflammation. Periodontal disease has been associated with increases in the levels of inflammatory markers, including an increase in serum C-reactive protein (CRP) levels of over 40% and an increase in plasma fibrinogen levels.[5] However, this same study failed to demonstrate a significant relationship between periodontal disease and serum lipid values.

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