I doubted this earlier when the news first came out here.
Newest article here:
http://www.medpagetoday.com/Cardiology/Prevention/32243
Healthy gums aren't proven to prevent atherosclerotic vascular
disease, nor will treating periodontal disease clearly reduce risk of
heart attack or stroke, according to a scientific statement from the
American Heart Association (AHA).
The two conditions are linked through common risk factors without
convincing evidence for a causal relationship, the statement cautioned
in the May 22 issue of Circulation: Journal of the American Heart Association.
"Patients and providers are increasingly presented with claims that
periodontal disease treatment strategies offer atherosclerotic vascular
disease protection; these claims are often endorsed by professional and
industrial stakeholders," Peter B. Lockhart, DDS, and colleagues wrote,
warning that such assertions "are unwarranted."
The AHA scientific statement stemmed from a systematic review by a
group of cardiologists, dentists, and infectious disease specialists and
was endorsed by the American Dental Association and World Heart
Federation.
"A link between oral health and cardiovascular disease has been proposed for more than a century," it noted.
Pockets of bacteria around the teeth in diseased gums are thought to contribute to systemic inflammation and thus to atherosclerotic disease.
Periodontal disease also lets oral bacteria enter the blood during
chewing and tooth brushing, which may contribute to vascular disease
more directly.
With the intense interest and active research, a strong causative
link likely would have been found already if there were one, Lockhart
argued in a press release.
"Although a contribution of periodontal disease to atherosclerotic
vascular disease is biologically plausible, periodontal and
cardiovascular diseases share multiple risk factors that are prevalent
and powerful promoters of disease, including tobacco use, diabetes
mellitus, and age," the scientific statement noted.
But lack of a causative relationship to vascular disease isn't free
license to neglect oral health, Ronald Burakoff, MDM, MPH, chair of
dental medicine at Long Island Jewish Medical Center in New Hyde Park,
N.Y., warned in an email to reporters.
"Managing inflammatory issues, such as chronic gum disease, is part
of a heart healthy lifestyle," agreed Suzanne Steinbaum, DO, a
preventive cardiologist at Lenox Hill Hospital in New York City.
Lockhart's group reviewed 537 studies on the topic, most observational in design and thus unable to prove causality.
They found plenty of evidence for an association between periodontal disease and atherosclerotic vascular disease.
Of the 26 studies using clinical or radiographic measures of
periodontal status, 18 linked worse gum disease to higher risk for
atherosclerotic vascular disease-related outcomes in adjusted analyses.
Another two studies showed the same in unadjusted analyses.
All eight studies that looked at clinically assessed periodontal disease in relation to myocardial infarction found a link.
The only study that looked at periodontal bacterial burden found a
link to both atherosclerotic vascular disease and heart attack.
When looking at risk of stroke, 11 studies pointed to higher risk
when gums were in bad shape, while three studies did not find a positive
association. Six showed higher stroke risk with more teeth lost to
periodontal disease, but the same number failed to show a significant
association.
Rather than looking at such hard endpoints, most studies looking at
the impact of treating periodontal disease focus on surrogate measures
like markers of inflammation or subclinical atherosclerosis.
Observational and clinical trial data have indicated improved
endothelial dysfunction and associated markers of inflammation after
mechanical debridement of the root surfaces, with or without systemic
antibiotics.
That evidence "supports the theory that if cardiovascular toxicity
from periodontal disease occurs, it is mediated at least in part through
inflammation and endothelial dysfunction," Lockhart's group noted.
But studies haven't turned up consistent results on the impact of gum
disease treatment on specific inflammatory markers or established a
durable benefit.
"In addition, transient proinflammation and deranged endothelial
functions are observed after intensive therapy for periodontal disease,"
the statement added.
The one clinical trial to look at periodontal treatment for secondary prevention of cardiac events found no benefit.
A large, long-term study would be necessary to prove that good oral
hygiene and dental treatment cut down on cardiovascular risk, "given the
possibility of periodontal disease recurrence after therapy and the
extended time course of evolution of atherosclerotic vascular disease
and its manifestations," the statement concluded.
Read the comments they are all over the place.
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