Periodontal Disease and Heart Disease: When Headlines Collide

Marjorie Jeffcoat, DMD


May 17, 2012

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Hello. This is Dr. Marjorie Jeffcoat, coming to you from the University of Pennsylvania in Philadelphia.

This month we are going to be discussing a timely topic, "When Headlines Collide." In the last few weeks we have been treated to a series of conflicting headlines. In fact, these headlines emanated from the same organization [American Heart Association].[1] A [news story, from Heartwire, and posted on Medscape] said that there was no proof that gum disease causes heart disease or stroke (AHA: No Evidence That Gum Disease Causes CHD).

Another headline in the same week, about the same scientific statement, showed us that periodontal disease was linked to cardiovascular disease (Periodontal Disease Linked to Cardiovascular Disease).

These are very different headlines from the same source. What do we really know?

Most large observational studies that have been conducted over the last 10 years have taken into account the known confounders for both cardiovascular disease and periodontal disease. These are factors such as smoking, obesity, diabetes, and cholesterol, for example, and they have shown an association between cardiovascular disease and periodontal disease. The statistics are complicated and not suited to a headline, but that does not mean that they weren't done and that they weren't done appropriately.

The American Heart Association statement also reported that there was no convincing evidence that proves that the treatment of gum disease will cure heart disease (to put it a little more strongly than they did). But a lack of studies does not show that the studies, if you did them, would be negative. Only when you do well-controlled clinical trials can you establish something to the level of clinical proof.

In order to get clinical proof, we have to do a clinical treatment trial. These studies, in my opinion, are few and far between. Why is that? It's because they are expensive to do and they take many patients, so you have to recruit and retain the patients. We don't know how long we really need to study cardiovascular disease patients. What is the outcome we should be studying? I don't really want to wait for all my patients to die in a clinical trial, so we need a surrogate. What should we use? High blood pressure? Stroke? The ECG?

So what do we know now? We know several things. First of all, let's not lose sight of the fact that oral health is a good thing and that heart disease and stroke are associated with periodontal disease, even when we account for the known risk factors. The lack of intervention studies does not mean that if those studies were performed that they would be negative. Lack of intervention studies does not mean negative intervention studies. I suggest that you do what I do: Pick up the original report, read it, and compare it with the press release. Make yourself a short list of science writers that you trust. A trustworthy list is a wonderful thing to have.

All of these studies are in samples of patients, but you and I treat patients one at a time and we must make our clinical decisions on the basis of individual patients. Always do your best for each patient. This is Dr. Marjorie Jeffcoat coming to you from the University of Pennsylvania.


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