Gum health and cardiovascular events

Conflicting research has been published to support and disprove the theory that the management of gum disease is associated with better prevention of cardiovascular events such as heart attacks and strokes.

A recent study from Chen et al.¹ suggests there is a link between professional removal of plaque through tooth scaling and a reduced risk of cardiovascular disease. Twenty-two thousand Taiwanese adults aged 50 years and over were involved in the study, which reflected that those who had attended at least one deep cleaning appointment in the past year were significantly less likely to suffer heart attacks or strokes over the next seven years. Only 1.6% of the exposed group who had received tooth scaling suffered a heart attack in the years to follow compared with 2.2% of the non-exposed group who had not received a deep clean. Similarly, the percentage of those in the exposed group who had experienced strokes was lower than in the non-exposed group at 8.9% and 10% respectively. Those who received tooth scaling more than once in the two year follow-up period decreased the risk of cardiovascular events further.

This study has numerous limitations, however, which have been recognised by the authors. Whilst age, gender, diabetes, hypertension, hyperlipidaemia and history of coronary artery disease were considered in the study, weight, smoking habits and family history were not noted. Chen's positive correlation between periodontal care and reduced heart failure could be undermined be the general argument that those who are more acutely aware of oral health may take better care of themselves overall, resulting in a healthier heart as a by-product.

This view is taken by the American Heart Association, who has released a statement amid intensifying debate, advising that there is no scientific proof that periodontal interventions will reduce the risk of heart disease.² The two share common risk factors, such as age and smoking, thus inextricably linking the disorders through causality, but that does not mean management of one can prevent the other. Furthermore, gum disease and cardiovascular events occur in both smokers and non-smokers and all other risk and non-risk associated groups. Medical literature from 1950 to July 2011 was searched and examined for relevance to the report, yielding 473 articles that met the inclusion criteria. Results did not offer conclusive evidence of a direct cause and effect relationship between periodontal and cardiovascular disease, though an association between the two independent of joint risk factors was noted in many studies.

The American Association for Dental Research has stressed the importance of the AHA review as an impressive and comprehensive analysis of the current literature.³ However, in this response the AADR also notes the need for further research, highlighted by the gaps in scientific understanding in this field.