Sunday, January 04, 2009 For years there have been hints and hypotheses that heart disease and periodontal (gum) disease are associated or share common factors.  Among the more humorous notions held by the uninformed press and public was that heart plaque and tooth plaque were somehow the same thing.  That dubious notion notwithstanding there have long been provocative findings that have pointed to a relationship between a healthy mouth and a healthy heart.

The first and most widely studied theory was that the bacteria associated with periodontal disease (most notably Porphyromonas gingivalis) somehow traveled through the blood stream and provoked an inflammation response in the heart.  Indeed, one of the first large studies (9760 participants over 17 years) found that “those with periodontitis had a 25% increased risk of coronary heart disease relative to those with minimal periodontal disease.”   The link became even closer when a subsequent study determined that treating gum disease resulted in improved endothelial function and blood flow.  Since then there have been numerous other studies that have detected a statistically significant association between gum disease and a variety of biomarkers for heart disease such as C-Reactive Protein (CRP) and Lipoprotein-associated Phospholipase A2 (Lp-PLA2).

One of the first direct links between periodontal and heart disease was found in a study that determined those with chronic periodontitis had higher triglyceride levels and a greater prevalence of small LDL a particularly powerful promoter of heart disease even among people with low cholesterol.   The problem with these and many other studies is that it is often difficult to determine whether these similar biomarkers actually cause the disease or whether they are simply common indicators of a disease whose cause is some other common factor.

It could be that people without gum and/or heart disease simply live healthier, exercise, eat better, etc., than those with either or both diseases!   However, for the first time, a study has shown that treating even mild gum disease in otherwise healthy people not only improves endothelial function but significantly reduces carotid intima media thickness (CIMT).  That’s right, they found unequivocal evidence that treating gum disease regresses a standard measure of atherosclerosis.

To be fair, the study only looked at carotid arteries and not coronary arteries, it was a fairly small study (just 35 people), and CIMT is among these easiest markers of atherosclerotic lesions to regress.  Head researcher Dr. Mario Clerici is quoted as stating, “The novelty of this study is that this is the first physical evidence that you can reverse a lesion that is already growing in the intima by doing something as simple as taking care of your gums . . . To tell you the truth, we were really surprised by the result, but it turned up in subject after subject.”   The study involved nothing more than the simple removal of tartar and cleaning of the gums.  There were no other procedures, no antibiotics or other prescription drugs or supplements, just the same basic dental hygiene measures you might receive at your dentist’s office.

Researchers used Echocardiography of carotid arteries to compare baseline CIMT against measurements made at several time points after treatment.  They also measured common inflammatory biomarkers associated with cardiovascular risk.  The study treatments resulted in significant reductions in CIMT at multiple sites as well as reductions in bacterial load and of the inflammation biomarkers.   For the record, there is still much to be learned about the connection between heart disease and dental health.  To recap the study was small, it only looked at carotid arteries not coronary arteries, and CIMT is perhaps the easiest atherosclerosis marker to regress.  Nonetheless, we have the first solid evidence that there IS a connection between heart health and dental health.    The takeaway heart health hint here is that you have another reason to follow the age-old admonition to visit your dentist regularly for a cleaning and check-up.  You will now have two reasons to smile – whiter teeth and a potentially healthier heart.