Periodontal Disease and Heart Attacks

Brush your teeth or you’ll have a heart attack!”

This is not an admonishment that I either heard as a child or ever made to my own children or patients. However it is becoming increasingly evident that maintaining good dental hygiene and treating periodontal disease is one of the easiest and most important things that we can do to prevent heart disease, stroke and several other illnesses.

Periodontitis is defined as inflammation of the supporting tissues of the tooth. These tissues include bone, the periodontal membrane and the gums. Gingivitis (infection of the gums) is a common cause of periodontitis as is the dental plaque that forms on the other periodontal tissues. Periodontitis has been known for centuries to be responsible for a large proportion of dental problems but recent research has shown that its deleterious effects extend far beyond the mouth.

In a recent article I wrote about a condition called chronic systemic inflammation which is a low grade, pervasive form of inflammation that damages the endothelial linings of arteries and has also been implicated in causing harm to a variety of other tissues and organs.

Periodontitis is a very important cause of this sinister inflammatory process and is associated with infection and inflammation of the periodontal tissues and the release of bacteria, toxins, protein acids, pro-inflammatory chemical messengers and other harmful compounds into the mouth and blood stream. Once in the blood stream these agents stimulate a systemic inflammatory response that in turn causes problems a long way from the mouth. Some of the most important targets of periodontitis-induced systemic inflammation are the blood vessels especially the endothelial linings of the arteries.

These inflammatory agents cause narrowing and rigidity of the arteries that results in reduced blood supply to the heart, brain, kidneys and other organs. In addition, systemic inflammation is thought to contribute to an inflammatory process in the arterial endothelium itself. Inflammation in this important part of the blood vessel aggravates the formation of cholesterol plaques in the arteries and ultimately causes the rupture of these plaques events that result in heart attack or stroke.

The theory of the effects of periodontitis on heart disease and other illnesses is backed up by several very recent clinical trials.

One study found that those who had recently suffered a heart attack had far higher levels of pathogenic bacteria in their mouths than those in a non-heart attack control group. In another study arterial blood flow was measured in those with periodontal disease before and after intensive treatment for their periodontal disease. Interestingly, the arterial blood flow in these patients diminished slightly over the first few days following the treatment but a few weeks later it increased substantially and was significantly better than that of the untreated control group.