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The Globe and Mail

Link between gum disease and heart risk not thoroughly understood

We ask the experts to settle common questions we've all wondered about.


Is there much evidence to support claims that poor dental hygiene can lead to infections that contribute to heart disease? And if that's the case, how important is it to floss and brush daily?

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Poor dental hygiene can lead to cavities, gum disease (periodontal disease) and tooth loss. Mild periodontal disease or gingivitis, if not treated, can progress to "periodontitis" a condition in which the gums pull away from the teeth and form "pockets" that become infected.

Periodontitis occurs in approximately 15 per cent of adults between 21 and 50 years old and 30 per cent of adults over 50. Symptoms of periodontal disease are often not noticeable until the disease is advanced. They include red or swollen gums, which may be tender and bleed, painful chewing and loose teeth. The main cause of periodontal disease is bacterial plaque - a sticky, colourless film that constantly forms on the teeth, but smoking and genetic factors also play a major role.

Increasingly, studies have shown that periodontal disease is associated with a number of other diseases, including heart attack and stroke. Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease and 25 per cent more likely to have a heart attack than those without periodontal disease. Despite this apparent link, a cause and effect relationship between periodontal disease and heart disease has not been established. Both diseases are complex and share some of the same risk factors including smoking, genetics, increasing age and stress. Even when factors such as smoking and age are taken into account, however, the association between the two diseases remains.

These findings have led to a great deal of research to try to understand the basis for the connection. The emphasis of the current research is on the role of inflammation - the body's response to infection, injury or irritants. While inflammation is a protective response of the body, chronic inflammation can cause a number of diseases and serious health problems. Periodontitis is a chronic infection that not only destroys the gum tissues and bone that support the teeth, but also increases the inflammation level throughout the body. Inflammation is now known to play a critical role in many chronic diseases that are not usually classified as inflammatory diseases, including heart disease.

Further research is needed to understand the complex mechanisms of inflammation in chronic diseases and the nature of the link between periodontal disease and heart disease. In the meantime, periodontitis is a serious disease which can lead to pain and tooth loss. It should be diagnosed and treated as early as possible. Risk factors for heart disease should be reduced through a healthy diet, regular exercise and control of any conditions that increase risk, such as diabetes, high cholesterol or high blood pressure. Quitting smoking is important in preventing both periodontal disease and heart disease. While flossing as well as regular brushing may not prevent a heart attack, it will help to prevent dental disease and costly dental treatment.

Dr. Susan Sutherland is chief of dentistry at Sunnybrook Health Sciences Centre and assistant professor at the University of Toronto.

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