Can Flossing Teeth Foil Heart Disease?

Larkin M

Scientists and doctors are excited by a possible link between oral health and heart health. According to Paula Fives-Taylor, a microbiologist and molecular geneticist, if preventing periodontal disease can help prevent heart disease, then curing periodontitis—which can currently be done—could have a major public health impact. Research Scientists are looking at a variety of links between periodontitis and heart disease. Both diseases have nearly identical risk factors, such as age, male gender, smoking, and diabetes; both involve inflammatory processes, therefore, periodontal disease could be stimulating immune mediators that affect the heart; both conditions involve the same inflammatory mediators; and periodontal organisms have been found in atheromas. Periodontist and immunologist Robert Genco—principal investigator for Periodontal Intervention in Cardiovascular Disease (PAVE)—launched a trial in September to assess the effects of treating periodontal infection in high-risk patients who have had a heart attack, vascular surgery, or coronary artery surgery, or who have 50 percent blockage in one or more arteries. Although there are no definitive treatment trials, Genco is encouraged by the accumulating evidence for the role of infection—including periodontal infection—in cardiovascular disease. However, periodontologist and epidemiologist Philippe Hujoel claims that it is smoking—not infection or inflammation—that may link oral periodontitis and heart disease. He stresses the importance of doing studies involving never-smokers to determine the association between the two diseases. "The fact that periodontitis is associated with all diseases related to smoking is evidence that we cannot distinguish the effect of smoking on periodontal disease or on any systemic disease," he says, noting that "edentulous people are not at a lower risk for heart disease than people with periodontal disease." Mark Ide, lecturer in periodontology and preventive dentistry, agrees that the link may be "a bit hyped." His group recently conducted a study that measured surrogate markers of cardiovascular disease, including C-reactive protein and fibrinogen, in patients with moderate periodontal disease. Non-smokers did not have elevated values of inflammatory markers. However, Ide doesn't deny the possible connection between gum disease and other systemic diseases. One proposed mechanism from Ide's group is chewing. When people chew, they create a bacteraemia and pump toxins into the circulation that have a systemic effect and may cause promotion of atherogenesis and similar effects. Conclusion According to Fives-Taylor, regardless of whether this association is proven or not, doctors have nothing to lose by encouraging people to take care of their teeth. The Lancet 2002; 360 (9327):147. Return to Top