Cardiovascular
disease (CVD), the leading killer in the United States, is a major
public health issue contributing to 2,400 deaths each day. Periodontal
disease, a chronic inflammatory disease that destroys the bone and
tissues that support the teeth affects nearly 75 percent of Americans
and is the major cause of adult tooth loss. While the prevalence rates
of these disease states seem grim, research suggests that managing one
disease may reduce the risk for the other.
A
consensus paper on the relationship between heart disease and gum
disease was recently developed by the American Academy of
Periodontology (AAP) and The American Journal of Cardiology (AJC).
Developed
in concert by cardiologists and periodontists, the paper includes
clinical recommendations for both medical and dental professionals to
use in managing patients living with, or who are at risk for, either
disease. As a result of the paper, cardiologists may now examine a
patient’s mouth, and periodontists may begin asking questions about
heart health and family history of heart disease.
Specific clinical recommendations include:
-
Patients
with periodontitis who have 1 known major atherosclerotic CVD risk
factor such as smoking, immediate family history for CVD, or history of
dyslipidemia should consider a medical evaluation if they have not done
so within the past 12 months. -
A
periodontal evaluation should be considered in patients with
atherosclerotic CVD who have: signs or symptoms of gingival disease;
significant tooth loss, and unexplained elevation of hs-CRP or other
inflammatory biomarkers. -
A
periodontal evaluation of patients with atherosclerotic CVD should
include a comprehensive examination of periodontal tissues, as assessed
by visual signs of inflammation and bleeding on probing; loss of
connective tissue attachment detected by periodontal probing
measurements; and bone loss assessed radiographically. If patients have
untreated or uncontrolled periodontitis, they should be treated with a
focus on reducing and controlling the bacterial accumulations and
eliminating inflammation. -
When
periodontitis is newly diagnosed in patients with atherosclerotic CVD,
periodontists and physicians managing patients’ CVD should closely
collaborate in order to optimize CVD risk reduction and periodontal
care.
The
clinical recommendations were developed at a meeting held in early 2009
of top opinion-leaders in both cardiology and periodontology. The
consensus paper also summarizes the scientific evidence that links
periodontal disease and cardiovascular disease and explains the
underlying biologic and inflammatory mechanisms that may be the basis
for the connection.
According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology
and a co-author of the consensus report, the cooperation between the
cardiology and periodontal communities is an important first step in
helping patients reduce their risk of these associated diseases.
“Inflammation is a major risk factor for heart disease, and periodontal
disease may increase the inflammation level throughout the body. Since
several studies have shown that patients with periodontal disease have
an increased risk for cardiovascular disease, we felt it was important
to develop clinical recommendations for our respective specialties.
Therefore, you will now see cardiologists and periodontists joining
forces to help our patients.”
“Both
periodontal disease and cardiovascular disease are inflammatory
diseases, and inflammation is the common mechanism that connects them,”
says Dr. David Cochran, DDS, PhD, President of the AAP and Chair of the
Department of Periodontics at the University of Texas Health Science
Center at San Antonio. “The clinical recommendations included in the
consensus paper will help periodontists and cardiologists control the
inflammatory burden in the body as a result of gum disease or heart
disease, thereby helping to reduce further disease progression, and
ultimately to improve our patients’ overall health. That is our common
goal.”
A copy of “The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease” can be viewed at http://www.joponline.org/toc/jop/0/0.
