(By Dr. Joseph D. Lim and Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI)
THERE IS a “firm association” between oral health and atherosclerotic cardiovascular disease, according to a systematic review and meta-analyses of studies published between 2005 and 2015. The review supports an association between periodontal or gum disease and atherosclerotic cardiovascular disease, the narrowing of the arteries due to a build-up of fats that reduce the blood flows and cause blood clots that, when left untreated, can lead to heart failure.
However, there is little or no evidence to support any links between oral health and other forms of cardiovascular disease that is non-atherosclerotic such as hypertension, arrhythmias or irregular heartbeats, and heart failure.
“There is high quality evidence to support an association between cardiovascular disease and oral health,” says T. Dietrich, Professor and Head of Oral Surgery, The School of Dentistry, University of Birmingham, United Kingdom, who led the review. “This evidence is mainly related to the association between chronic periodontitis and atherosclerotic heart disease.”
Cardiovascular disease (CVD) is a major cause of morbidity and mortality worldwide. CVDs include atherosclerotic cardiovascular disease (coronary, cerebrovascular and peripheral vascular disease); valvular heart disease; heart failure and cardiomyopathies; arrhythmias; infective and autoimmune conditions (including infective endocarditis); and hypertension.
The review shows limited evidence for an association between chronic periodontitis and both the risk of recurrent cardiovascular events in patients with established atherosclerotic disease and peripheral vascular disease, respectively.
“There is no evidence to support or refute a causative relationship between cardiovascular disease and oral health,” says Dietrich. However, an association between periodontitis and hemorrhagic stroke has been found stronger in males, obese patients and non-diabetics.
“In summary, the evidence suggests that the incidence of atherosclerotic cardiovascular disease is higher in patients with periodontitis compared to those without,” the review concludes.
It also suggests that tooth loss is associated with an increased risk of cardiovascular disease, in particular the risk of coronary heart disease and stroke. “Although the cause of tooth loss is unclear, the evidence suggests that patients with fewer teeth are more likely to suffer cardiovascular disease and cardiovascular-related death.”
The systematic review highlights that stroke patients have poorer oral health-related quality of life and oral function. Oral health-related quality of life of stroke patients is significantly worse than those who have not suffered stroke.
Patients with stroke have significantly higher caries prevalence than those who are healthy. In summary, “there is some evidence that dental caries and disease associated with infections from dental caries or periodontal tissues are associated with incidence of cardiovascular disease.”
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Dr. Joseph D. Lim, Ed. D., is the former Associate Dean of the College of Dentistry, University of the East; former Dean, College of Dentistry, National University; Past President and Honorary Fellow of the Asian Oral Implant Academy; Honorary Fellow of the Japan College of Oral Implantologists; Honorary Life Member of the Thai Association of Dental Implantology; and Founding Chairman of the Philippine College of Oral Implantologists. For questions on dental health, e-mail jdlim2008@gmail.com or text 0917-8591515.
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Dr. Kenneth Lester Lim, BS-MMG, DDM, MSc-OI, graduated Doctor of Dental Medicine, University of the Philippines, College of Dentistry, Manila, 2011; Bachelor of Science in Marketing Management, De la Salle University, Manila, 2002; and Master of Science (MSc.) in Oral Implantology, Goethe University, Frankfurt, Germany, 2019. He is an Associate Professor; Fellow, International Congress of Oral Implantologists; Member, American Academy of Implant Dentistry and Fellow, Philippine College of Oral Implantologists. For questions on dental health, e-mail limdentalcenter@gmail.com./PN
