Gum disease and heart disease: The common thread

How plaque on your teeth may be connected to plaque in your arteries.

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For decades, researchers have probed the link between gum disease and cardiovascular health. Gum disease begins when the sticky, bacteria-laden film dentists refer to as plaque builds up around teeth. A completely different type of plaque — made of fat, cholesterol, calcium, and other substances found in blood — can build up inside arteries. Known as atherosclerosis, this fatty plaque is the hallmark of coronary artery disease.

People with gum disease (also known as periodontal disease) have two to three times the risk of having a heart attack, stroke, or other serious cardiovascular event. But there may not be a direct connection. Many people with heart disease have healthy gums, and not everyone with gum disease develops heart problems. Shared risk factors, such as smoking or an unhealthy diet, may explain the association. Still there's a growing suspicion that gum disease may be an independent risk factor for heart disease.

The inflammation link

"Periodontal disease increases the body's burden of inflammation," says periodontist Dr. Hatice Hasturk of the Harvard-affiliated Forsyth Institute, a not-for-profit research organization focused on oral health. Acute inflammation — which involves an outpouring of immune cells that attack irritants and microbial invaders — fosters healing over the short term. But long-term (chronic) inflammation is a key contributor to many health problems, especially atherosclerosis.

Quelling chronic inflammation has become a keen focus of medical research in recent years. Preliminary research by Dr. Hasturk and colleagues suggests that unique compounds called resolvins show promise for treating inflammation-associated diseases such as periodontitis and atherosclerosis (see "A topical liquid that helps resolve artery inflammation?").

A topical liquid that helps resolve artery inflammation? To explore the connections between oral and heart health, Dr. Hasturk and her colleagues used rabbits fed cholesterol-rich diets as a model to mimic human heart disease. Some of the rabbits were then infected with bacteria known to cause periodontal disease. Those rabbits developed atherosclerotic plaques that were less stable (and therefore more likely to cause a heart attack) and also had higher blood levels of inflammation than the rabbits that had not been exposed to the gum disease bacteria. Next, the researchers treated the rabbits with an oral topical liquid that contained resolvins, which are molecules derived from omega-3 fatty acids believed to help quell inflammation. The treatment not only prevented periodontal disease in the infected rabbits, but also lowered inflammation and atherosclerosis. The findings highlight the potential connection between the two conditions, says Dr. Alpdogan Kantarci, a colleague of Dr. Hasturk's at the Forsyth Institute who was involved in the research. "If you can control one type of inflammation, you might be able to control another," he says. A study testing a related compound called lipoxin in people with gum disease is currently under way.

To date, there's no proof that treating gum disease will prevent cardiovascular disease or its complications. But the connection is compelling enough that dentists (and many doctors) say it's yet another reason to be vigilant about preventing gum disease in the first place.

Daily toothbrushing and flossing can prevent and even reverse an early stage of gum disease, known as gingivitis. If your dentist says you have gingivitis, ask for a brushing and flossing demonstration to make sure you're doing both correctly, says Dr. Hasturk. Many people don't spend enough time or care when brushing (the recommended duration is two minutes). Flossing sweeps away the sticky film between teeth that leads to plaque buildup. Twice-yearly cleanings by a dentist or hygienist are also advisable.

Left untreated, gingivitis can turn into periodontal disease (see "Signs of gum disease"). The gums become loose around the root of the tooth, creating a gum pocket that gradually deepens. Eventually, the infection and inflammation can cause the tooth to loosen and possibly fall out.

Signs of gum disease Any of these signs can be a clue that you have periodontal disease: swollen, red, or tender gums gums that bleed easily pus between the teeth and gums bad breath buildup of hard brown deposits along the gum line loose teeth or teeth that are moving apart changes in the way dental appliances fit.

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