Most people believe that oral health and the heart have nothing to do with each other. However, there is growing evidence that both are related. Periodontal disease and cardiovascular disease are serious health concerns. Cardiovascular Disorders (CVDs) are the leading cause of death worldwide, according to the World Health Organization (WHO), taking an estimated 17.9 million people per year. (World Health Organization, 2021) On the other hand, periodontal diseases are prevalent both in developed and developing countries and affect about 20-50% of the global population. (Nazir, 2017)
Periodontitis is a chronic infectious disease targeting the connective tissue and alveolar bone supporting the dentition. Progressive deterioration of periodontal health is linked to the accumulation of specific oral microorganisms able to trigger tissue damage and also affect the balance of the different species present in the dental biofilm, switching from a symbiotic into a dysbiotic state by altering the normal homeostatic relationship with the host. (Orlandi et al, 2020)
Several factors increase the risk of periodontal diseases. These risk factors can be modifiable and non-modifiable. Among the modifiable risks, we can find smoking, poor oral hygiene, hormonal changes in the female sex, diabetes mellitus, stress, and some medications. Moreover, among the non-modifiable are age, sex, and hereditary factors. (Nazir, 2017)(Carrizales et al, 2018)
Many studies, including systematic reviews and meta-analyses, show that periodontal disease is linked to heart diseases. For instance, Larving et al. in 2021 published a systematic review and meta‐analysis in which they examined the risk of incident cardiovascular disease in people with periodontal disease using longitudinal cohort studies. Their findings demonstrate that there is a higher risk of all incident cardiovascular disorders outcomes in periodontal disease populations compared to non‐PD, and this risk is consistent across the periodontal disease diagnosis method, periodontal disease severity, gender, and study regions. The risk of incident Cardiovascular Disorders is not different between clinical and self‐reported diagnosis, or between male and female, but the CVD risk is associated with PD severity. (Larvin et al, 2021)
Additionally, systemic inflammation tends to play a significant role in the proposed mechanisms of this interaction. Evidence suggests that periodontal inflammation triggers a systemic inflammatory state that, added to the damage mediated by antibodies that cross-react between periodontal pathogens and components of the intimal wall, the innermost layer of an artery or vein, and the direct lesion of the intima by bacteria entering the circulation, promotes atheroma plaque development and progression. Other research has found a connection between periodontal disease severity, inflammatory marker elevations, and the presence of atherosclerosis. (Carrizales et al, 2018, p1)
However, it’s difficult to show that periodontitis is the cause of inflammation that leads to CVD, since people with severe periodontitis are more likely to have other sources of inflammation, such as diabetes and tobacco use, which may skew results. For this reason, in 2012, the American Heart Association tried to clarify statements established by certain investigations, which suggested a causal relationship between periodontal disease and cardiovascular diseases. This organization explained that there is scientific evidence that supports the association between periodontal disease and atherosclerotic vascular disease. However, it clarifies that periodontal disease is not a cause of atherosclerotic vascular disease. (Niederman in, 2012)
Lavigne and Forres, in 2020, published an article whose aim was to investigate whether sufficient evidence exists for a causal relationship between periodontal disease and cardiovascular disease. The findings of this study show that, although there is a correlation, the existence of that connection remains unclear. At this time, there is inadequate evidence to conclude that the connection is causal. (Lavigne, Forrest, 2020)
In summary, both periodontal disease and cardiovascular disease are serious health problems. Both disorders are multifactorial, with a large range of risk factors in common. Inflammation is linked to the progression of cardiovascular disease, and periodontal disease is associated with a chronic inflammatory state. Therefore, whether you have heart disease or not, it is important to attend regular dental cleanings due to the vital aspect of long-term preventative care. Brushing and flossing at least twice a day is part of a proper oral care regimen, as is visiting a dentist at least once every six months for an exam and cleaning.
Furthermore, dental examinations are necessary not only to avoid dental illness but also to prevent and monitor possible oral and systemic complications.
Carrizales-Sepúlveda, E. F., Ordaz-Farías, A., Vera-Pineda, R., Flores-Ramírez, R. (2018). Periodontal Disease, Systemic Inflammation and the Risk of Cardiovascular Disease. Heart, lung & circulation, 27(11), 1327–1334. https://doi.org/10.1016/j.hlc.2018.05.102
Larvin, H., Kang, J., Aggarwal, V. R., Pavitt, S., & Wu, J. (2021). Risk of incident cardiovascular disease in people with periodontal disease: A systematic review and meta-analysis. Clinical and experimental dental research, 7(1), 109–122. https://doi.org/10.1002/cre2.336
Lavigne, S. E., & Forrest, J. L. (2020). An umbrella review of systematic reviews of the evidence of a causal relationship between periodontal disease and cardiovascular diseases: Position paper from the Canadian Dental Hygienists Association. Canadian journal of dental hygiene : CJDH = Journal canadien de l’hygiene dentaire : JCHD, 54(1), 32–41.
Nazir M. A. (2017). Prevalence of periodontal disease, its association with systemic diseases and prevention. International journal of health sciences, 11(2), 72–80.
Niederman, R., & Weyant, R. (2012). Periodontal disease, cardiovascular disease, the American Heart Association, the American Academy of Periodontology, and the rooster syndrome. Evidence-based dentistry, 13(2), 34–36. https://doi.org/10.1038/sj.ebd.6400851
Orlandi, M., Graziani, F., & D’Aiuto, F. (2020). Periodontal therapy and cardiovascular risk. Periodontology 2000, 83(1), 107–124. https://doi.org/10.1111/prd.12299
Cardiovascular diseases. (2021). Retrieved 3 May 2021, from https://www.who.int/health-topics/cardiovascular-diseases/#tab=tab_1