DALLAS (American Heart Association) -- Tooth loss caused by gum disease may be a marker of cardiovascular disease before symptoms appear, researchers report in today's rapid access issue of Stroke: Journal of the American Heart Association.

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Aug. 4, 2003

By Robert H. Shmerling, M.D.
Harvard Medical School

How does this article relate to me?

Cardiovascular disease is the number one cause of death in this country and has been for many years, yet we still do not know exactly why some people have heart attacks, circulation problems and strokes while others do not. Risk factors, especially those that can be treated (such as diabetes, high cholesterol and high blood pressure), are well known and have been part of public education and medical screening for decades, but cardiovascular disease remains a challenge to prevent, detect and treat. Recent research has hinted that problems in other parts of the body, including dental disease, could be playing an important role.

A gradual but dramatic shift has taken place in recent years in the understanding of cardiovascular disease. Previous theories blamed cholesterol-filled fat deposits (called plaque) collecting along arteries and narrowing them over time. Eventually, when the narrowing reduced the blood supply enough, chest pain, leg pain or even heart attack and stroke would follow.

Newer research, however, recognizes a much more complicated process that incorporates different types of cholesterol ("good" or HDL cholesterol and "bad" or LDL cholesterol), genetic predisposition, and inflammation within the blood vessels' plaque. Many experts believe that arteries with even minor narrowing can have an unstable or inflammatory plaque that can rupture into the blood vessel and block it. The notion that inflammation is important in the development of cardiovascular disease is supported by recent research linking the C-reactive protein, or CRP — a measure of inflammation in the body — to the risk of heart attack. Increasingly, researchers are analyzing inflammation in blood vessels and throughout the body when developing therapies for cardiovascular disease.

The observation that gingivitis (gum inflammation), often coexists with cardiovascular disease could indicate a link between dental health and cardiovascular disease. In this article, researchers noticed that people with tooth loss had more plaque and narrowing in their carotid arteries, major blood vessels in the neck leading to the brain. If theories linking inflammation in the gums (a process associated with tooth loss) to inflammation in the arterial plaque prove correct, these findings might represent an important advance: they could lead to better methods of prevention, detection and treatment of cardiovascular disease.

What changes do I need to make?

For now, the connection between oral health and cardiovascular disease remains unproven. Even so, most people could improve their dental and cardiovascular risk profiles by following standard recommendations.

For example, all adults should get regular medical care that screens for cardiovascular risk factors, including:

• High blood pressure
• Diabetes
• High cholesterol
• Smoking
• Family history of heart disease

If you have any of these risk factors, lifestyle changes (especially regular exercise, improved diet and smoking cessation), medications, and close monitoring may be appropriate.

Regular dental care and prompt treatment of gum disease are also important and could turn out to have even more benefits than previously thought.

What can I expect in the future?

The research presented in this article and other studies linking dental problems with cardiovascular disease are intriguing, but do not prove that dental problems cause cardiovascular disease. Key questions remain:

• Could cardiovascular disease be triggered by an infection that started in gums?
• Is the connection between tooth loss and heart disease due to past inflammation, infection or some other problem?
• Does the severity of gum disease or other dental problems affect the risk of cardiovascular disease and can early treatment help? For example, does early treatment of even minor gum disease reduce the risk of cardiovascular disease?
• Can screening for gum disease or tooth loss affect the risk enough to warrant a change in how we screen for cardiovascular disease? For example, if a person has had significant tooth loss and slightly elevated cholesterol, would aggressive treatment to lower the cholesterol reduce the risk of heart attack?

Related Areas:

Periodontal Disease
Gingivitis