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Preventive
Dentistry
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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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Early
versus Later Orthodontic Treatment in Children
Which approach works best for children who need orthodontic care: early
two-phase treatment (which begins when a child still has all or most
of his or her "baby" teeth) or later single-phase treatment
(which is implemented when most, or all, of the permanent teeth are in)?
Proponents of early two-phase orthodontic treatment argue that it is
better able to modify the patient's skeletal growth and improve the patient's
self-esteem. They also believe this approach achieves a better and more
stable result and reduces the need for extensive therapy later. A University
of North Carolina study, however, reports early two-phase orthodontic
treatment is not necessarily superior to later single-phase treatment,
nor does it always achieve all the goals some orthodontists claim it
does.
Most people do not have perfect teeth, however, malocclusion is a condition
where the jaws are misaligned. In very severe forms of malocclusion,
the misalignment may interfere with the ability to speak or eat. The
children in the North Carolina trial did not have such extreme misalignment.
These children were determined to have moderate-to-severe Class II malocclusion.
Children with a Class II malocclusion have some jaw misalignment. In
addition, teeth may be crowded, abnormally spaced, or misaligned. This
type of malocclusion can also involve upper teeth that protrude excessively
or front teeth that do not meet. Malocclusion usually becomes apparent
between ages 6 and 14, when the teeth and jaw are growing and often runs
in families.
In this study, researchers randomly assigned children who still had most
of their baby teeth to one of three groups: headgear treatment (fixed-appliance
therapy), bionator therapy (removable-appliance therapy), or to an observational
group that received no treatment. Seventy-five percent of the children
in both the headgear and bionator therapy groups showed improvement in
jaw alignment (although there was significant variation across all three
groups).
The second phase of the study was to see whether the improvements achieved
in the first phase of the study truly represented long-term results.
Once the children's permanent teeth came in, study investigators randomly
assigned members of all three groups to receive fixed-appliance therapy.
Researchers discovered that the skeletal changes resulting from early
treatment did not last. In addition, skeletal relationships, as well
as the relationship between the upper and lower jaws, did not differ
significantly between the groups that received the early two-phase treatment
and the group that received later single-phase treatment. Neither the
length of treatment nor the severity of the malocclusion was an important
influence on the end result. Individual skeletal growth patterns, however,
did play an important role.
One of the conclusions from this study is that the success of Class II
correction does not depend on when treatment begins as long as it begins
while the child is still growing. If the criterion for success of Class
II correction is a better, more stable result, the later single-phase
treatment would be preferable because treatment time is shorter. However,
if the criteria for success include better self-esteem, then it may be
preferable to start treatment earlier. It is important to keep in mind
that early treatment is not the only way to correct malocclusion. A Class
II correction can be achieved early or later with equally beneficial
results. Other studies have been conducted that support these findings
among children with more severe occlusions and other orthodontic problems.
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