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Aging, Systemic Disease and Oral Health: Implications for Women Worldwide (Part I)

Course Number: 302

Oral Connections

The relationship between cardiovascular disease and periodontal disease has been the topic of many reports in contemporary dental literature. Experts generally agree that some level of association exists. However, the exact nature of this relationship has yet to be definitively established.

Studies have shown patients with periodontal disease are more likely to have cardiovascular disease than those without periodontal disease33 and numerous reports from leading dental and medical journals substantiate a link.34‑37 Periodontal disease is an important risk factor for total cerebrovascular accidents (CVA) and, in particular, nonhemorrhagic or ischemic stroke.33 A conclusion of a 2014 study showed a correlation between putative bacteria contributing to atheromatous plaques and species associated with periodontal disease.35 Several studies found periodontal disease to be independently associated with increased risk of CHD.37 A 2007 trial published in the New England Journal of Medicine, showed patients with severe periodontitis had improved endothelial function (blood flow) following 6 months of intensive periodontal treatment.34 Endothelial function of arteries is an important factor in CVD. Knowing, this, how can we intervene to keep patients healthy, especially those at increased risk and co-morbidities? One study showed that advanced periodontal therapy lowers the rate of CVD, especially myocardial infarction and heart failure. Dental management has a beneficial effect on the overall and cardiovascular health of patients with type 2 diabetes.38 Periodontal disease is a potential risk factor that may potentiate the development, maturation, and instability of atheroma in the arteries. In this study, two mechanisms were suggested to explain the potential association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators.39 While there is a significant body of evidence supporting an association between CVD and periodontal disease, there are also conflicting findings and causality has yet to be proven. At the present time, there is insufficient evidence for a possible causal relation between periodontal disease and atherosclerotic disease, with somewhat stronger evidence for stroke. If future studies show consistent associations, periodontal disease may be revealed as an independent and potentially modifiable causal risk factor for atherosclerotic disease.39

A common element between CVD and periodontal disease is inflammation, which contributes to narrowing of the arteries in CVD and tissue destruction in periodontitis.40 Researchers believe the outcomes from the inflammatory process in periodontal disease are related to the components of specific bacteria destroying gingival tissues and trigger host responses to rupture atherosclerotic plaques. Most heart attacks are believed to be triggered by ruptured plaques rather than arterial blockage.

While the link between periodontal disease and cardiovascular continues to be investigated, the oral manifestations commonly associated with medications used to treat CVD are well-known.41 Gingival hyperplasia, gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and/or taste impairment are common manifestations encountered from such medications. Oral healthcare professionals are challenged to stay abreast on the potential links between CVD and periodontal disease, as well as recognize potential associations during clinical assessments, active treatment, and maintenance phases of patient care.