Oral Systemic Care
Researchers discovered that bacteria responsible for many cases of periodontal disease (PD) can also be a contributing cause of cardiovascular disease, the leading killer of Americans.
Millions of Americans have a dental disorder that can lead to heart attacks and strokes, according to a new peer-reviewed study published in Postgraduate Medical Journal (PMJ). The researchers discovered that bacteria responsible for many cases of periodontal (gum) disease (PD) can also be a contributing cause of cardiovascular disease, the leading killer of Americans.
The landmark study builds on earlier research, including a scientific statement from the American Heart Association, showing with level A evidence an independent association between PD–an oral infection affecting the majority of U.S. adults over age 30–and cardiovascular disease (CVD), which is also called heart disease.
It was only a matter of time until causality was demonstrated between periodontal bacteria and cardiovascular disease. A recently published journal article states: “There is scientific evidence that PD (periodontal disease) caused by the high-risk pathogens can influence the pathogenesis triad in an adverse manner. With this appreciation, it is reasonable to state PD, due to high-risk pathogens, is a contributory cause of atherosclerosis. Distinguishing this type of PD as causal provides a significant opportunity to reduce arterial disease.” (1)
The pathogenesis triad refers to the three criteria necessary to determine causality for atherosclerosis (arteriosclerotic vascular disease or ASVD), specifically serum lipoprotein concentration, endothelial permeability, and lipoprotein binding in the intima. If a medical condition or other agent influences all of these elements, it can be concluded that it is a contributory cause of ASVD.
The article states that the periodontal pathogens Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Fusobacterium nucleatum (Fn), and Treponema denticola (Td) are causal for ASVD by affecting the triad in a manner favoring the development of atherosclerosis. (1)
The authors further stated: “From a clinical perspective there is a significant difference between being associated with versus being causal of a disease. Optimal management of an associated condition may not impact the end disease, whereas such management of a causal condition would have a favorable effect on the end disease.” (1) Their conclusions included the following: “PD due to these high-risk microbes must be treated effectively to reduce the risk of ASVD.” (1)
The primary takeaway is the critical need to identify the bacteria by salivary testing, reduce the bacterial population, and then retest. Diminishing the likelihood of a cardiovascular event, such as a heart attack or stroke, from atherosclerosis is an enormous opportunity and now our responsibility as dental professionals.