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Impact of Periodontal disease on Cardiac Health

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Cardiovascular disease is the leading cause of mortality and is associated nearly always with periodontal or gum disease. Read the article to learn more.

Medically reviewed by

Dr. Infanteena Marily F.

Published At March 4, 2022
Reviewed AtMay 6, 2024

How Is Cardiac Health Linked to Oral Health?

Coronary artery disease and atherosclerotic cardiovascular disease are one of the leading causes of death globally. Although research has been elusive on establishing the direct link between periodontitis, gingival disease, and cardiac health, there is evidential documentation that periodontal disease has pathogenesis associated with increased risk for coronary heart disease (CHD).

As per holistic model reviews, oral health pathogenesis and CHD pathogenesis are interlinked, measured by the level of serum biomarkers that indicate if an individual has an increased incidence of being prone to developing CHD. Due to the prevalence of more than 700 microbes populating the oral cavity, the dental plaque seen as a tooth biofilm is adapted to the changes in the environmental flora. When this plaque extends to the surrounding gingival structure, the immune response is triggered, and the resulting inflammation is termed gingivitis (inflammation of the gingiva).

If left untreated by the dental surgeon, gingivitis eventually progresses to periodontitis or periodontal disease, characterized by irreversible destruction of the connective tissue fibers to which teeth are bound. This leads to attachment loss in the long-term, causing tooth mobility due to the underlying alveolar bone resorption and eventually if left untreated again, leads to tooth loss.

What Are the Risk Factors of Periodontal Diseases?

The risk factors for developing periodontal disease are:

  • Smoking.

  • Stress.

  • Diabetes, both type 1 and type 2.

  • Hypertension.

  • Certain therapeutic drugs.

  • Genetic factors.

  • Defective fillings.

  • Ill-fitting bridges.

  • Hormonal changes in pregnancy or use of oral contraceptives in females.

  • Compromised immune functions in immunosuppressive patients.

  • Medications that cause xerostomia or dry mouth.

  • Obesity (associated with chronic inflammatory diseases).

  • Poor oral hygiene.

What Does the Phenomenon of Dysbiosis and Bacteremia Mean?

Dysbiosis is a phenomenon that occurs due to periodontal disease because of an imbalance in the oral microbiota that triggers bacteremia (bacterial proliferation in the bloodstream). This bacteremia leads to local and, eventually, systemic immune-mediated responses associated with local or systemic inflammation in the host. This is because the bacteria are now systematically disseminated that compromises the normal host immune response.

The proposed mechanisms that link periodontal disease to the development of atherosclerotic cardiovascular disease (ASCVD) are associated with the presence of Interleukins, CRP (C-reactive protein), matrix metalloproteinases, TNF (tumor necrosis factor), intercellular adhesion molecules, and P-selectin. They have been implicated in triggering the inflammatory response that might cause the development of atherosclerotic disease (by the initiation and progression of ASCVD).

The biological mechanism widely elucidated is bacterial translocation. Though the exact picture may be unclear on how the bacteria or its byproducts translocate systemically, the identification of periodontal pathogens, as seen in aortic plaques in patients suffering from cardiovascular disease or in the thrombi of patients with acute myocardial infarction, suggest the direct effect of encroaching oral bacteria on these distant systemic sites.

As per research, the identified pathogens, Aggregatibacter actinomycetemcomitans or Porphyromonas Gingivalis (P. gingivalis, the keystone pathogen of periodontal disease), are known to cause a dysfunction of the vascular endothelium by the mechanism of LPS (lipopolysaccharide) mediated effect.

The pathways studied for P. gingivalis show how it can affect the oxidized LDL cholesterol levels (ox-LDL) due to periodontal infection and inflammation. This may happen or is attributed to the formation of ROS (reactive oxygen species) that oxidizes the LDL cholesterol. Similar pathways have been shown to induce an effect by these reactive oxygen species upon systemic inflammation by activating certain growth factors, inflammatory cytokines, and nuclear factors. These inflammatory factors may be capable o producing rampant, systemic inflammation that is unregulated by the presence of circulating periodontal pathogens (by the mechanism of bacteremia).

Studies have indicated a ride in the serum evaluation levels of C reactive protein, fibrinogen, tumor necrosis factor-alpha, and interleukins. These cardiac markers can be assessed by a blood test showing serum evaluation of markers if the dental surgeon suspects chronic or rampant periodontal disease, especially in elderly individuals. Also, the other detrimental effect of these pathogens, apart from causing systemic inflammation, is increased insulin resistance. High insulin resistance will cause vasodilatory changes because insulin is a potent vasodilator.

Another hypothesis elaborated for the potential link of cardiovascular diseases is periodontal pathogens in platelet activation associated with periodontal disease that contributes to thrombosis and plaque instability. In the documentation of animal models, there is a definitive link between the presence of periodontal pathogens and the formation of atheromas.

Thus, proatherogenic changes in lipoprotein metabolism are due to increased cholesterol, triglycerides, and non-esterified fatty acids in the circulation. Data collected from angiography studies also suggest a direct relationship between the degree of periodontal disease and cardiovascular disease in patients who have atherosclerosis. Though not causally linked with CHD, the research data is suggestive of the periodontal status of an individual playing a pivotal role while evaluating the cardiac health markers that are also affected by the presence of other risk factors like smoking, alcoholism, diabetes, diet, and socioeconomic factors.

How to Prevent Gum Diseases?

The gums can be kept healthy by:

  • By brushing teeth twice a day with a fluoride paste.

  • By flossing regularly as this will remove the plaque from between the teeth.

  • Regular dental checkups by dentist and professional cleaning.

  • Quit smoking.

What are the Treatment Options of Gum Disease?

The treatment options range from non-surgical therapies to surgical treatments.

The non-surgical options includes:

  • Deep cleaning.

  • Scaling and root planing.

Surgical treatment includes:

  • Flap surgery.

  • Bone graft.

  • Soft tissue graft.

  • Guided tissue regeneration.

Conclusion:

To conclude, systemic inflammation due to elevated cardiac risk markers, inflammatory cytokines, reactive oxygen species, increased insulin resistance, hypercoagulability, and vascular endothelium impairment is an indirectly proven yet definitive detrimental effect of periodontal disease.

Maintaining periodontal and gingival health, regular visits to the dentist, and maintenance of oral hygiene can be crucial for stopping or altering the pathogenesis linked with the potential development of cardiovascular disease in all individuals.

Improved dental screening for periodontal disease and regular oral prophylaxis and hygiene are significant contributors to a healthy system. An interdisciplinary approach between the cardiologist and dentist can significantly benefit the patient suffering from cardiac disease. Dental surgeons should hence focus on the plausible ways or risk factors in individuals who can develop heart disease and vice versa with cardiologists.

Frequently Asked Questions

1.

Does Periodontitis Increase the Risk of Cardiovascular Disease?

The chance of cardiovascular disease like myocardial infarction, peripheral artery disease, stroke, and atherosclerosis in people with periodontitis is two or three times more than in healthy people. Many people with cardiovascular disease also have healthy gums. Not everyone with gum disease develops cardiovascular disease.

2.

Can Gum Disease Contribute to Coronary Heart Disease?

Research studies show strong evidence regarding the association between gum disease and coronary heart disease. Actinobacillus actinomycetemcomitans and Prevotella intermedia are the two periodontal pathogens involved in coronary heart disease. However, parameters like the total amount of periodontal pathogens like Actinobacillus actinomycetemcomitans are higher in the gum pockets of patients with this condition.

3.

How Can Periodontitis Lead to Heart Attacks?

Gum disease and heart disease are related in several ways. Chronic inflammation from gum disease can enter the bloodstream and increase inflammation throughout the body, including in the blood vessels. This can lead to the formation of plaque buildup, blood clots, and other factors that increase the risk of a heart attack.

4.

Is There a Connection Between Oral Health and Cardiovascular Health?

Yes, there is a connection between dental health and cardiovascular health. Poor oral hygiene can lead to gum disease, which can cause inflammation and increase the risk of heart disease and stroke. Additionally, the bacteria associated with gum disease have been found in the fatty deposits in the arteries, further supporting the link between oral and cardiovascular health.

5.

What Are the Five Most Significant Risk Factors for Cardiovascular Disease?

The five significant risk factors are:
- High blood pressure.
- Smoking.
- High blood cholesterol.
- Diabetes.
- Physical inactivity/obesity.

6.

Is There a Link Between Dental Issues and Heart Problems?

Dental issues can indirectly contribute to heart problems by increasing the risk of bacterial endocarditis, an infection of the heart's inner lining. Bacteria from oral infections can enter the bloodstream and settle in the heart, leading to endocarditis. Additionally, poor oral hygiene and gum disease have been linked to an increased risk of cardiovascular disease due to inflammation and bacterial infections in the mouth, potentially affecting the cardiovascular system

7.

Can Periodontal Disease Lead To Congestive Heart Failure (CHF)?

Periodontal disease does not directly cause congestive heart failure (CHF). However, studies have shown a possible association between the two conditions. People with periodontal disease may be at increased risk for other health problems, including cardiovascular disease, which could increase the risk of CHF. 

8.

Does a Dental Infection Increase the Risk of Heart Problems?

Dental infections can lead to heart problems, as the bacteria from a dental infection can spread through the bloodstream and reach the heart, leading to endocarditis, an inflammation of the heart's inner lining. This is why prompt treatment of dental infections is essential to minimize the risk of severe health complications.

9.

How Does Gum Disease Impact Blood Pressure?

Periodontal disease has been linked to high blood pressure in some studies, although the exact mechanism by which this occurs is not yet fully understood. It is believed that the inflammation caused by periodontal disease may contribute to developing high blood pressure and other cardiovascular problems.

10.

Can Tooth Infection Result in Heart Failure?

Tooth decay itself does not directly cause heart failure. However, the inflammation and infection resulting from untreated tooth decay can contribute to developing other health problems, including cardiovascular disease. Chronic inflammation, a common consequence of periodontal disease, has been linked to an increased risk of heart disease and other cardiovascular problems. 

11.

What Is the Connection Between Periodontal Disease and Atherosclerosis?

In periodontal disease, the inflammation caused by a bacterial infection in the gums leads to the destruction of the tissues that support the teeth. This inflammation can also affect other body parts, including the blood vessels, where it can contribute to plaque formation and atherosclerosis development.

12.

What Are the Consequences of Not Treating Periodontal Disease?

If periodontal disease (also known as gum disease) goes untreated, it can lead to a range of severe oral health problems, including:
- Tooth loss.
- Receding gums.
- Bone loss.
- Spread of infection.
- Bad breath.

13.

Is There a Relationship Between Periodontal Disease and Elevated Cholesterol Levels?

Some evidence suggests that periodontal disease and high cholesterol may be linked. Inflammation associated with periodontal disease has been shown to increase cholesterol levels, and people with high cholesterol are at increased risk for developing gum disease. However, more research is needed to fully understand the relationship between these two conditions.

14.

What Is the Correlation Between Periodontitis and Stroke?

There is evidence of an association between periodontitis (a chronic inflammatory disease affecting the gums and supporting structures of the teeth) and an increased risk of stroke. However, more research is needed to establish a causal relationship and to determine the underlying mechanisms.

15.

Will Tooth Extraction Eliminate Periodontal Disease?

Removing teeth (tooth extraction) may be necessary in some cases of advanced periodontal disease, but it is not a cure. Periodontal disease is caused by bacterial infection and inflammation in the gums and surrounding structures that support the teeth. Tooth extraction can help reduce the burden of bacteria in the mouth and improve oral hygiene, but it does not address the underlying causes of the disease.
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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periodontal gum diseasecardiovascular disease risk
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