Infected Gums Not Likely Cause of Vascular Disease

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.

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