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Study shows relationship between oral and cardiovascular health

February 23, 2006

Indicates need for patients to balance oral health with other cardiovascular risk factors
New research is reinforcing the longstanding belief that a connection exists between periodontal disease, or severe gum inflammation, and cardiovascular disease. But according to Moise Desvarieux, MD, PhD, infectious disease epidemiologist in the Department of Epidemiology at Columbia University's Mailman School of Public Health, the nature of the relationship is still unclear and patients cannot rely only on good oral hygiene as a way to reduce their risk for heart disease-they must manage other risk factors for the disease as well.

"It appears a relationship exists, but we don't know exactly what it is and if it is a causal relationship.Therefore, we can't make recommendations for people with periodontal disease in respect to cardiovascular disease," said Dr. Desvarieux, whose team studies periodontal disease in relation to atherosclerosis, or hardening of the arteries, "To reduce their risk for cardiovascular disease, patients must manage all their risk factors, including smoking, diabetes, and weight."

Dr. Desvarieux, who coordinates the INVEST study, an NIH-funded study in Northern Manhattan, as well as the international network investigating the oral health-cardiovascular disease relationship, spoke today at the American Medical Association and American Dental Association media briefing, Oral and Systemic Health: Exploring the Connection, in New York City.

Most research to date has been specifically on the clinical level, explained Dr. Desvarieux. Using a manual probe, dentists measure for signs of periodontal disease, including gum inflammation, gum pocket depth, or spacing around each tooth and tooth-bone attachment loss and compare these data to ultrasound measurements of the carotid artery. If cholesterol or fatty buildup is detected on the wall of the artery, there's a good chance the patient has atherosclerosis, a direct link to future stroke and cardiovascular disease.

Dr. Desvarieux and a collaborative team including researchers from the Mailman School of Public Health, the College of Dental Medicine and neurologists at the College of Physicians & Surgeons at Columbia University Medical Center, took this research one step farther.

"Our research brings in the microbiological factors that may connect the two diseases," explained Dr. Desvarieux. "We analyzed bacterial samples from the oral cavity, three of which are specifically associated with periodontal disease. We found that those patients with one or any combination of these three bacteria also had atherosclerosis."

He hypothesizes that the atherosclerosis may be a result of bacteria from gum infection entering the bloodstream, creating inflammation in other parts of the body. However, he cautions "Because both pieces of the puzzle were being measured simultaneously, we don't know which came first and we can't say whether the relationship is causal."

He continued "Further research is needed. We need to follow these patients over the course of their lives and see whether those with the highest levels of the gum disease bacteria end up having more heart attacks and strokes than the others."

"If we determine that there is a causal relationship between periodontal disease and cardiovascular disease, patients at risk will have to manage their oral health in addition to their other risk factors. The periodontal disease-cardiovascular disease connection won't negate their diabetes, weight or smoking habit. Individually, each contributes to the disease and the more risk factors, the more likely that one will have an episode."

But Dr. Desvarieux stressed that even though the exact relationship has not been discovered, it doesn't mean patients should neglect their oral health. "It is hard for anyone to be against good oral health" he said. "If a causal relationship is found, you'll already be ahead of the game in regards to your heart health. If there is no relationship, you'll have a healthy mouth that will benefit your overall well-being."

Columbia University's Mailman School of Public Health