Gum conditions may lead to heart disease?
Strong evidence is below: May 2011
Recent developments and summaries will be included each month to keep you on the cutting edge of dental science.C-reactive protein levels correlate with heart disease.Since some people experience heart disease without the traditional risk factors, researchers are looking for new predictors of disease to allow early intervention and prevention. A protein produced by the liver called C-reactive protein is a marker of underlying inflammation in the body. Elevated levels of C-reactive protein are associated with heart disease, with peak levels being reached within 48 hours of an acute myocardial infarction or heart attack. It has been suggested that periodontal disease may increase C-reactive protein levels, but research to date is controversial. Most of the studies reviewed on this topic lacked confirmed medical and dental diagnosis. Patients are often simply asked if they have or have had gum disease or heart disease with no medical or dental examination to confirm findings. Researchers at Kristianstad University in Sweden evaluated 85 consecutive subjects admitted to the hospital for heart problems. Evidence of heart disease was confirmed by a cardiologist. Following discharge from the hospital, patients were examined by a periodontist to determine periodontal status. These patients were then asked to bring a friend their age to the clinic for cardiovascular and periodontal examination. Approximately 30 of these patients qualified as heart healthy controls, and another 30 control patients were recruited for a total of 63. As expected, a majority of heart disease patients had elevated C-reactive protein levels, with an average score for the group of 18.4 and a range of scores from 0.3 to 109.0. A score over 2.0 was found in 79% of this group. In health, C-reactive protein is undetectable in the blood or found at levels below 0.6 mg/l. The mean C-reactive protein level score for the control group was 2.5 with scores ranging from 0.2 to 6.4. A score over 2.0 was found in 41% of this group. Periodontitis was indicated by bone loss and bleeding, although full periodontal records were taken. Bleeding upon probing levels were higher for those with heart disease compared to the control group. Interproximal alveolar bone loss as measured on radiographs was higher in the heart disease group. All the heart disease patients had bone loss of 4 mm or more distance from the CEJ to the bone, and 94% of subjects had 30% of sites measuring 4 mm or more of bone loss. High white blood cell counts were also associated with heart disease, but failed to differentiate those with and without periodontal disease. Control subjects with periodontal disease did have elevated white blood cell counts. Clinical Implications: Perhaps in the future, blood tests will be requested for patients with periodontitis to determine C-reactive protein levels and white blood cell counts. Determining if these two markers can be lowered as a result of periodontal therapy will be the subject of future studies. Such findings may support the role of treating periodontal disease as a way to reduce the risk of heart disease.
Persson G., Pettersson T., Ohlsson O., Renvert S.: High-Sensitivity Serum C-Reactive Protein Levels in Subjects With or Without Myocardial Infarction or Periodontitis. J Clin Perio 32: 219–224, 2005. Volume 17, Number 7. dentaltown.