In the last few years, scientific studies have shown connections and strong links between gum disease and the risk of heart disease or stroke. Other medical conditions that have been linked to gum disease include obesity, diabetes, kidney disease, lung disease, and other systemic illnesses. A connection that might surprise you — even premature births have been linked to untreated gum disease.

Besides gum disease, there are other oral health conditions that can affect your overall health. Tooth decay, if not treated promptly, can lead to infections in the nerves of the teeth. Neglected and infected teeth — or wisdom teeth that need to be extracted — can also cause severe infections in the mouth. These infections can then spread into the bones and the bloodstream, and potentially cause a variety of harmful medical conditions.

Your oral health can also have an effect on your partner. Dental studies have shown that the “bad bacteria” that cause gum disease can potentially be spread from one partner to another, by kissing and sharing saliva.

So be sure to keep up with your oral health routines and visit your dentist or periodontist regularly. You’re doing more than just maintaining a nice smile. You’re defending your health, by and large.

Are you surprised to hear some of the connections I mentioned? Have poor oral conditions affected your greater health in any way?

Researchers examined 20 individuals with chronic periodontitis. In 13 of the 20 patients, bacterial pathogens most frequently found in severe chronic periodontitis were also found in atherosclerotic plaque of coronary vessels. In 10 cases, those species of bacteria were also present in atherosclerotic plaque and in subgingival plaque”. (Atherosclerosis is a multistage process set in motion when cells lining the arteries are damaged as a result of high blood pressure, smoking, toxic substances and other agents.)

“We found that patients with periodontal pathogens detected in atherosclerotic plaque had four millimeters or greater of deep periodontal pockets and a significantly higher bleeding index,” said study author Dr. Maciej Zaremba. “This supports the possibility that bacteria associated with periodontitis can permeate into coronary vessels.”

“Since periodontal and cardiovascular diseases have several common risk factors, more studies are needed to evaluate the strength of association between the two diseases,” said Dr. Preston D. Miller, DDS, and AAP president. “It is very important for people to talk to their dentist or periodontist about their periodontal health and their at-home oral hygiene routine to prevent periodontal disease and maybe even coronary artery disease.”

According to the American Heart Association, coronary heart disease is the number one single cause of death in the United States. Knowledge of the risk factors and possible links to coronary heart disease, such as periodontal disease is the first step towards preventing it. To find out if you are at risk for periodontal disease, please visit the AAP’s Web site and take a free risk assessment test.

A referral to a periodontist in your area and free brochure samples including ones titled Periodontal Diseases: What You Need to Know and Ask Your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for periodontists—specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth, and in the placement of dental implants. Periodontists are also dentistry’s experts in the treatment of oral inflammation. They receive three additional years of specialized training following dental school, and periodontics is one of the nine dental specialties recognized by the American Dental Association. The AAP has 8,000 members worldwide.

CHICAGO – October 26, 2004 – Research is racing to help healthcare professionals further understand how periodontal diseases are linked to cardiovascular disease. A study published in a recent issue of the Journal of Periodontology explains another reason why people with periodontal diseases are at a significant risk for coronary artery disease (CAD).

The study looked at 108 patients with CAD with a mean age of 59.2 +/- 10.9 years and a group of 62 people without CAD with a similar mean age (57.7 +/- 8.7 years).

“The results of this study showed that periodontitis in cardiac patients was significantly more frequent than in non-cardiac patients.” said Professor E.H. Rompen, Department of Periodontology – Dental Surgery, C.H.U. Liège, Belgium. “We found that 91% of patients with cardiovascular disease suffered from moderate to severe periodontitis, while this proportion was 66% in the non-cardiac patients.”

Periodontitis seems to influence the occurrence and the severity of coronary artery disease and increases the risk of heart attack or stroke, and the study proposes two hypotheses for this occurrence. One hypothesis is that periodontal pathogens could enter the bloodstream, invade the blood vessel walls and ultimately cause atherosclerosis. (Atherosclerosis is a multistage process set in motion when cells lining the arteries are damaged as a result of high blood pressure, smoking, toxic substances, and other agents.)

Another hypothesis is based on several studies that have shown that periodontal infections can be correlated with increased plasma levels of inflammation such as fibrinogen (this creates blood clots), C-reactive protein, or several cytokines (hormone proteins).

“This study supports earlier findings, and even showed a significantly higher prevalence of periodontal diseases in cardiac patients. There is still much research to be done to understand the link between periodontal diseases and systemic diseases, such as cardiovascular, and difficult-to-control diabetes,” said Dr. Michael P. Rethman, DDS, MS, and president of the American Academy of Periodontology. “The data in this study shows the importance of regular dental checkups to ensure a healthy, diseased-free mouth.”

A referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist About Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – May 19, 2005 – Researchers have found evidence that the amount of bacteria in subgingival plaques, the deep plaques in periodontal pockets and around the teeth, may contribute to an individual’s risk of a heart attack, according to two studies appearing in the Journal of Periodontology. These studies further researchers’ understanding that periodontal bacteria may increase the risk for heart disease.

In one study researchers looked at 150 individuals with periodontal diseases and found that the total number of periodontal bacteria in subgingival plaques was higher in individuals that have suffered from an acute myocardial infarction (heart attack). The second study found that the same DNA from different kinds of periodontal bacteria in plaque was also in the patients’ heart arteries. Researchers believe that these findings may help substantiate what they have long known; if there is a sterile pathway, such as a bloodstream, near a periodontally infected area that the bacteria from this infected area cause inflammation in the gums that opens up pores in the surrounding blood vessels, which enables the bacteria to enter the bloodstream and travel to other parts of the body and cause great harm.

“It is like setting up a garbage dump on the edge of a river. You wouldn’t be surprised if the lake downstream ended up polluted with the garbage from the dump,” said Vincent J Iacono DMD and president of the American Academy of Periodontology. “A patient’s bloodstream acts very much like the river in this analogy, in that it carries the bacteria from the periodontal plaques, possibly ‘polluting’ the arteries of the heart with periodontal bacteria, causing inflammation of the arteries which may lead to a heart attack. This potential effect of periodontal bacteria further supports the need for periodic deep cleanings to enhance overall health and wellbeing.”

These studies represent two in a large body of research that investigates the possible link between periodontal diseases and other systemic conditions such as heart disease. “Intervention data is not available to prove a causal relationship between the two. Right now we are currently advising patients that maintaining good periodontal health can only help not hurt,” said Iacono.

Referral to a periodontist in your area and free brochure samples including one titled Ask your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – July 18, 2006 – The presence of specific bacteria and combinations of bacteria in periodontal pockets might be an explanation for the relationship between periodontal disease and acute coronary syndrome (ACS), according to a new study published in the Journal of Periodontology. Study Abstract *

The amount of oral bacteria was two times higher in the ACS group for the combination of the bacteria streptococci spp, P. gingivalis, T. forsythia and T. denticola. Specifically, the findings suggest that T. denticola, T. forsythia and streptococci spp are bacteria in a shared infectious etiology for periodontitis and ACS.

“This might be one of several explanations as to why elevated bacteria and the combination of specific pathogens in periodontal pockets can be linked to a history of ACS,” said Stefan Renvert, DDS, PhD and Department of Health Sciences, Kristianstad University. “We also found that the amount of periodontal bacteria results in an inflammatory response that elevates the white blood cell counts and high sensitivity C-reactive protein levels, which has also been linked in past studies to heart disease.”

It was also found that the extent of alveolar bone loss was significantly greater among subjects with ACS. Seventy-seven percent of the participants in the ACS group and 42 percent in the control group demonstrated evidence of periodontitis. The extent of bone loss was more severe in the ACS group than in the non-ACS group.

Another reason people diagnosed with ACS may have higher oral bacteria could be due to their infectious susceptibility and lack of an adequate host inflammatory response, which may induce other systemic vascular effects participating in the onset of ACS.

“Although this study supports past findings, further research is needed to evaluate the effects of reducing specific bacteria such as T. forsythia and T. denticola on reducing the risk for ACS,” said Kenneth A. Krebs, DMD and AAP president. “This data highlights the importance of routine periodontal examinations and at-home dental care.”

Background Information

Researchers evaluated 161 subjects diagnosed with ACS and a control group of 161 participants of not having ACS. Diagnosis of the ACS group was based on chest pain associated with electrocardiogram changes that were combined with typical patterns of cardiac markers (such as creatine kinase). The control group included people without cardiovascular disease. This included the absence of elevated blood pressure, or the use of statins and beta-blockers.

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—September 26 2006—Researchers found an increased risk of coronary heart disease for people below the age of 60 who have more than four millimeters of alveolar bone loss (the bone that holds the teeth in the mouth) from periodontal disease, according to a new study that is printed in the Journal of Periodontology. Study Abstract *

It was found that participants with coronary heart disease had an increase of periodontal disease indicators, including alveolar bone loss, clinical attachment loss and bleeding compared to the group without coronary heart disease.

“This study is distinctive because to our knowledge, it is the first to include both the alveolar bone loss and full mouth recording of clinical attachment loss as measurements of periodontal disease,” explains Dr. Karen Geismar, Department of Periodontology, School of Dentistry, Faculty of Health Science, University of Copenhagen, Denmark. “Alveolar bone loss was recently found to be the periodontal variable that had the strongest association to coronary heart disease.”

The association between periodontal disease and coronary heart disease has been that chronic infections and the inflammatory response from diseases such as periodontal disease may be involved in the initiation and progression of atherosclerosis.

“A number of pathways are suspected to be involved,” said Geismar. “One way is that periodontal bacteria directly invade the arterial wall and another way is that bacterial products from the periodontal pocket exert a systemic effect on atherosclerosis development based on the immune system.”

“This is one of many studies suggesting that the spread of bacteria and bacterial products from the periodontal lesion to the bloodstream may contribute to coronary heart disease,” said Preston D. Miller, DDS and AAP President. “However, it is still uncertain whether or not the association between periodontal disease and coronary heart disease is causal. Until we know more, it is very important that people talk to their dentist or periodontist about their periodontal health.”

Background Information

This study included 110 patients with coronary heart disease and 140 people without coronary heart disease. The mean age was 65 years and 70 percent of the participants were male. All 250 participants received a medical and dental examination. Researchers found a significantly higher odds ratio of 6.6 for individuals below age 60 having being a patient with coronary heart disease when having a mean alveolar bone loss of more than four millimeters.

A referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist About Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO – October 10, 2006 – People missing some or all of their teeth or who have significant loss of bone and tissue surrounding their teeth may be at an increased risk for having a stroke, according to a new study that appeared in the October issue of the Journal of Periodontology (JOP). Study Abstract *

Researchers from Boston University investigated the relationship between periodontal disease and history of stroke in patients 60 years of age and older by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).

“We found that patients 60 years and older who were edentulous, partially edentulous and/or had significant clinical attachment loss were more likely to have a history of stroke compared to dentate adults without significant clinical attachment loss,” said Dr. Martha E. Nunn, Goldman School of Dental Medicine, Boston University. “However, based on the results of this study, it is unclear whether periodontal disease is an independent risk factor for stroke or simply a risk marker that reflects negative effects of risk factors common to both periodontal disease and stroke.”

Age, tobacco use, hypertension, diabetes, serum glucose, C-Reactive protein (CRP) and alcohol intake were also included as additional risk factors in this study. These confounders are independent risk factors for cardiovascular disease and if left untreated, periodontitis has been shown to have harmful effects on the control of diabetes, serum glucose levels and increases CRP levels.

Evidence continues to accumulate associating severe periodontitis with an increased risk of forming atherosclerotic plaques, which are responsible for myocardial infarction and ischemic stroke. According to past JOP studies, this relationship could be due to elevated CRP levels in patients with chronic periodontal disease.

Further investigation is needed to support periodontal treatment intervention as a means of controlling systemic inflammation. Based on findings from another study in the same issue of the Journal, CRP levels may now be reduced by periodontal treatment such as scaling and root planing in patients with severe periodontal disease. Study Abstract *

“Studies evaluating additional treatment methods such as repeated scaling and root planing or surgical treatment are needed to conclusively demonstrate that CRP can be improved by periodontal treatment,” said Preston D. Miller, DDS and AAP president. “Until science presents a definitive direction, the periodontists ultimate goal is to lead patients to the right side of health. What we do know is that eliminating periodontal infection saves teeth.”

A referral to a periodontist in your area and free brochure samples including one titled Periodontal Diseases: What You Need to Know are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—March 1, 2007—Research presented in a recent paper by Tonetti et al published in the New England Journal of Medicine (NEJM) suggests that intensive periodontal treatment may reverse atherosclerosis by improving elasticity of the arteries, or endothelial function. Findings from previous studies have suggested a link between periodontal disease and atherosclerosis and proposed that periodontal treatment may reduce cardiovascular risk. This study is important because it furthers the understanding of the potential relationship between periodontal disease and cardiovascular disease.

The study examined two groups: a control treatment group and a periodontal treatment group. The control treatment group received supragingival mechanical scaling and polishing, also known as a prophylaxis. According to the study author, the periodontal treatment group underwent four to six hours of scaling and root planing performed by a periodontist, local delivery antimicrobials, and the extraction of hopeless teeth. It is well documented that meticulous scaling and root planing is an essential form of periodontal treatment when compared to supragingival scaling and polishing because the latter is not used to treat periodontitis. This study did not examine the effects of scaling and root planing without local delivery antimicrobials, so the potential added value of local delivery antimicrobials remains unclear. It will be important for future research to examine the cost-benefit analysis of scaling and root planing compared to scaling and root planing and local delivery antimicrobials. In addition, research is necessary to identify how the results of this study would translate when treatment is provided by dental professionals other than periodontists.

According to the American Heart Association, it is estimated that nearly 80 million Americans had one or more forms of cardiovascular disease in 2004. Cardiovascular disease involves a complex interplay of many risk factors. The interesting findings of the Tonetti study support the need for additional research to determine whether the treatment of severe periodontitis could reduce the risk of developing atherosclerosis and cardiovasular events in adults.

Knowledge of the risk factors and possible links to coronary heart disease, such as periodontal disease is the first step towards preventing it. To find out if you are at risk for periodontal disease, please visit the AAP’s Web site at www.perio.org and take a free risk assessment test. To find out if you are at risk for heart disease, visit www.americanheart.org.

NOTE: An article abstract and pay-per-view copy of the New England Journal of Medicine study are available at www.nejm.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—January 08, 2008—Each year, cardiovascular disease kills more Americans than cancer. And while most people are aware that lifestyle choices such as eating right, getting enough exercise and quitting smoking can help prevent cardiovascular disease, they may not know that by just brushing and flossing their teeth each day, they might also be avoiding this potentially lethal condition.

An article published in the December issue of the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP), suggests that periodontal patients whose bodies show evidence of a reaction to the bacteria associated with periodontitis may have an increased risk of developing cardiovascular disease. Study Abstract

“Although there have been many studies associating gum disease with heart disease, what we have not known is exactly why this happens and under what circumstances,” said JOP editor Kenneth Kornman, DDS, PhD. “The findings of this new analysis of previously published studies suggest that the long-term effect of chronic periodontitis, such as extended bacterial exposure, may be what ultimately leads to cardiovascular disease.”

Researchers at Howard University identified 11 studies that had previously examined clinically-diagnosed periodontal disease and cardiovascular disease. The team then analyzed the participants’ level of systemic bacterial exposure, specifically looking for the presence of the bacteria associated with periodontal disease, as well as measuring various biological indicators of bacterial exposure. They found that individuals with periodontal disease whose biomarkers showed increased bacterial exposure were more likely to develop coronary heart disease or atherogenesis (plaque formation in the arteries).

“While more research is needed to better understand the connection between periodontal disease and cardiovascular disease, this study suggests the importance of taking of your teeth and gums and how that can help you take care of your heart,” said Susan Karabin, DDS, President of the AAP. “With the number of people with heart disease continuing to increase, it is important to understand that simple activities like brushing and flossing twice a day, and regular visits to your dental professional can help lower your risk of other health conditions.”

EDITOR’S NOTE: Representatives of the media may contact the AAP Public Affairs Department to receive a copy of the articles Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk. Abstracts of Journal of Periodontology articles are available to the public online. Full-text of studies may be accessed by AAP members and Journal subscribers or purchased online for $20.

To find out if you are at risk for periodontal diseases, take the Academy’s risk assessment test. Referral to a periodontist in your area and free brochure samples including one titled Ask Your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site at www.perio.org.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for

CHICAGO—June 1, 2009—Cardiovascular disease, the leading killer of men and women 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 bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems 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 published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy or Periodontology (AAP). Developed in concert by cardiologists, the physicians specialized in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains 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.

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology. In addition to the clinical recommendations, the consensus paper 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.”

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The paper also recommends that physicians managing patients with cardiovascular disease evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums.

While additional research will help identify the precise relationship between periodontal disease and cardiovascular disease, recent emphasis has been placed on the role of inflammation – the body’s reaction to fight off infection, guard against injury or shield against irritation. While inflammation initially intends to have a protective effect, untreated chronic inflammation can lead to dysfunction of the affected tissues, and therefore to more severe health complications.

“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.”

NOTE: A copy of The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease can be viewed online.

To find out if you are at risk for periodontal diseases, take the Academy’s risk assessment test. Referral to a periodontist in your area and online brochure samples including one titled Ask Your Periodontist about Periodontal Disease and Heart Disease are available by calling 800-FLOSS-EM or visiting the AAP’s Web site.

About the AAP

The American Academy of Periodontology (AAP) is the professional organization for