Gum disease and heart problems not linked: Review

By Dr. Ananya Mandal, MDApr 22 2012

It has been claimed for the past few decades that gum disease is linked to heart problems or strokes but according to latest findings the link does not hold up on deeper research says the American Heart Association.

“The message sent out by some in health-care professions, that heart attack and stroke are directly linked to gum disease, can distort the facts, alarm patients and perhaps shift the focus on prevention away from well-known risk factors for these diseases,” said Dr. Peter Lockhart, a professor and chair of oral medicine at the Carolinas Medical Center in Charlotte, N.C. Lockhart wrote the heart group's new position statement in the journal Circulation.

The expert panel led by a dentist and a cardiologist - Dr. Ann Bolger of the University of California, San Francisco, prepared the write up after a three-year analysis of about 600 studies on cardiovascular and gum disease from 1950 until mid-July 2011. Books and medical websites, say that periodontal disease is a risk factor based on small observational studies. But gum disease hasn't been proved to cause heart disease, and treating gum disease hasn’t been proved to prevent heart disease or stroke, according to the group. Statements that imply a cause and effect relationship between periodontal disease and cardiovascular disease, or claim that dental treatment may prevent heart attack or stroke, are “unwarranted,” the panel concluded.

Both gum disease, known formally as periodontal disease, and cardiovascular disease produce markers of inflammation. The two types of disease also share common risk factors such as cigarette smoking, age and Type 2 diabetes. The studies pointing to a link were not designed well enough to find more than an association, Lockhart explained.

Keeping teeth and gums healthy remain important for overall health. Experts agree that those having either type of disease need to be treated. Gum disease can also contribute to other health conditions, said Dr. Robert MacGregor, president of the Canadian Dental Association. “Senior citizens can aspirate bacteria from their mouth into their lungs and that can result in pneumonia. The other health risk that we've long known in dentistry is association between periodontal disease and diabetes. Again, that's not a cause and effect but periodontal disease can exacerbates diabetes,” he said. MacGregor's advice for a healthy mouth and heart remains eating right, not smoking and exercising.

“If patients have heart disease and gum disease, they have two separate problems,” said Dr. Robert Myerburg, a professor of medicine in the division of cardiology at the University of Miami Miller School of Medicine. Those with gum disease and heart disease should be aware, Myerburg said, that treatment of gum disease is not going to improve their heart problems. “Nor will treatment of your heart problems improve your gum problems.”

In agreement with the new statement, too, is the American Academy of Periodontology, said Dr. Pamela McClain, a periodontist in Aurora, Colo., and president of the academy. Its members treat patients with gum disease. “The academy agrees that science doesn't support a causal relationship between periodontal disease as a direct cause of cardiovascular disease,”she said. However, she disagrees with Lockhart's statement that if a cause-effect relationship is found, it will be minor. “It's hard to predict. We may find a stronger link,” she said. “The message should be, we can't say there is proof of a causal relationship,” McClain said. “We know there is definitely a link between these.”

The American Dental Association's Council on Scientific Affairs agrees with the statement. The World Heart Federation, a nongovernmental organization that fights heart disease globally, also endorses it.

Many U.S. adults suffer from some form of gum disease, which can range from mild swelling and redness to periodontitis, when the gums pull away from the teeth and develop pockets that get infected.