- A study has found that people with active periodontitis, or gum disease, have a greater risk of experiencing major cardiovascular events, such as heart attacks and strokes.
- People who have had gum disease in the past but no longer have inflamed gums do not appear to be at greater risk.
- The study suggests that gum disease leads to increased arterial inflammation, which is responsible for cardiovascular events.
Periodontitis, or gum disease, is a serious infection of the soft tissues that surround the teeth. Without treatment, gum disease can lead to bone destruction and, ultimately, tooth loss.
Bacteria in dental plaque, or tartar, cause gum disease by triggering an inflammatory response that steadily erodes soft tissue and bone.
In the early stages of the disease, called gingivitis, the gums become swollen and red and may bleed. Without treatment, the gums may start to recede from the teeth, there may be bone loss, and the teeth can loosen or fall out.
Dentists recommend using a soft toothbrush twice a day and flossing once a day to prevent the buildup of plaque and reduce the chances of gum disease.
They also recommend undergoing scaling and debridement twice a year, which is the only way to remove plaque that has built up below the gumline.
The incidence of gum disease increases with age. According to the Centers for Disease Control and Prevention (CDC), 47.2% of people aged at least 30 years in the United States have gum disease to some degree. This figure increases to 70.1% among people aged at least 65 years.
There is a clear association between gum disease and a wide range of illnesses that involve inflammation, including Alzheimer’s disease, cancer, respiratory disease, and heart disease.
However, scientists have found it challenging to prove a direct, causal link between gum disease and these conditions because they have several risk factors in common, such as smoking.
A new study led by researchers at two institutions in Massachusetts, the Harvard School of Dental Medicine, in Boston, and the Forsyth Institute, in Cambridge, among others, provides evidence that gum disease really can set people on the road to major cardiovascular events, such as strokes and heart attacks.
“If you’re in the age zone for cardiovascular disease or have known cardiovascular disease, ignoring your periodontal disease can actually be dangerous and may increase your risk for a heart attack,” says lead study author Dr. Thomas Van Dyke, the senior member of staff at the Forsyth Institute.
The researchers have published their findings in the Journal of Periodontology.
Ongoing inflammation
For their study, the team reviewed PET and CT scans of 304 individuals for signs of inflammation associated with gum disease and inflammation in the arteries.
The scans had been done for other purposes, mostly during cancer screening. By the time that follow-up scans were performed, around 4 years later, 13 individuals had experienced a major cardiovascular event.
The researchers discovered that individuals with signs of inflammation associated with active gum disease at the start of the study were significantly more likely to have a cardiovascular event.
Individuals with inflammation of their gums were also more likely to develop inflammation in their arteries, which can go on to cause cardiovascular disease.
Crucially, these associations remained statistically significant, even after the scientists had accounted for other factors associated with both gum disease and heart disease, including age, sex, smoking, high blood pressure, diabetes, and dyslipidemia, or abnormal levels of fat in the blood.
The study found that individuals with signs of bone loss from previous gum disease, but no ongoing inflammation, were not at increased risk of developing heart disease.
“This is very definitely related to people who have currently active inflammatory disease,” says Dr. Van Dyke.
He acknowledges that the sample size was relatively small, so scientists will need to carry out larger studies to confirm the findings.
Primed immune cells
The authors speculate that local inflammation associated with gum disease activates and mobilizes immune cells in bone marrow. These cells, in turn, trigger inflammation in the arteries.
A previous study in animals, reported by Medical News Today, found that gum disease primes immune cells called neutrophils in bone marrow, which then overreact when they encounter signs of infection elsewhere in the body.
Neutrophils release immune signaling molecules known as cytokines, which exacerbate inflammation.
The authors of the present study hope that larger studies will confirm their findings. They also hope that researchers will investigate whether treating gum disease can reduce arterial inflammation and thereby reduce the risk of developing cardiovascular disease.
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