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March 2002
Periodontitis and Heart Disease
The question of whether gum disease is associated with heart disease
is controversial. The first research to suggest a connection, published
in 1989, found that even after controlling for such cardiovascular disease
risk factors as smoking and diabetes, heart-attack patients had significantly
worse dental health than control subjects. Since then, several studies
have also suggested a link, but the nature of the relationship —
is it causative or coincidental? — remains in question.
In 2001, researchers sought an answer to this question, examining data
from 4,027 people who participated in the First National Health and Nutrition
Examination Survey Epidemiologic Follow-up Study. During 17 years of
follow-up, there were 1,238 cases of heart disease, 538 of which proved
fatal. The rate of heart disease was three times higher in those with
periodontitis than in those with healthy gums.
However, the connection became less prominent once investigators adjusted
the numbers to account for other risk factors for cardiovascular disease
— smoking, cholesterol levels, high blood pressure, and diabetes.
After this adjustment, the heart disease risk among people with and without
chronic dental infections was similar.
In fact, even those people who had eliminated any potential of dental
infection through extraction of all teeth didn't have a lower heart disease
risk when compared to those diagnosed with periodontitis (inflammation
of the gums). The risk of developing CHD didn't decrease over time among
those with no dental infections or increase over time among people with
periodontitis.
A higher rate of other heart-disease risk factors among people with periodontitis
might explain this relationship between gum disease and heart disease.
For example, those with periodontitis were more likely to have high blood
pressure and diabetes, and to smoke cigarettes.
These findings support the theory that the presence of periodontitis
may occur coincidentally with increased cardiovascular risk but it is
not its cause.
March 2002 Update
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Timing of pregnancy tests affects accuracy
Pregnancy test instructions routinely approve testing "as early
as the first day of the missed period." However, a recent study
suggests such guidance could lead to inaccurate results.
Researchers in North Carolina evaluated the number of pregnancies that
were actually detectable on the first day of a woman's missed period.
The participants, women ages 21–42, were planning to conceive. Of
the pregnancies conceived during the five-year study, 10% of the fertilized
eggs had not yet implanted in the woman's uterus on the day a period
was expected. Even one week after the first day of the missed period,
the test was only accurate 97% of the time.
In addition, due to natural fluctuation in the schedule of ovulation,
implantation does not necessarily occur before a woman's regular period
should. The timing of implantation varies widely in its relation to the
expected period. Many women will test positive a week or more before
their period is expected, while some will test positive only a week or
more afterward. As a result, women should avoid substances known
to harm a fetus (cigarette smoke, large quantities of alcohol) if they
are trying to conceive, even if a pregnancy test comes back negative
on the first day of a missed period.
March 2002 Update
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