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 disease26 and numerous reports from leading dental and medical journals substantiate a link.27‑30 One of the most recent trials, 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.27 Endothelial function of arteries is an important factor in CVD. A recent meta-analysis suggests the association between periodontal disease and CVD is stronger for stroke than coronary disease.31 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.32

A common element between CVD and periodontal disease is inflammation, which contributes to narrowing of the arteries in CVD and tissue destruction in periodontitis.33 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.34 Gingival hyperplasia, xerostomia, and/or taste impairment are common manifestations encountered from such medications. Dental 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.