AAP supports ADA: further studies needed to determine causality between periodontal disease and cardiovascular disease
The American Academy of Periodontology (AAP) supports the American Heart Association's (AHA) scientific statement "Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?" recently published in Circulation. The statement concludes that observational studies to date support an association between periodontal disease and cardiovascular disease, independent of shared risk factors. The AHA's statement confirms the conclusions of the statements published by the AAP and The American Journal of Cardiology in 2009 and the U.S. Preventive Services Task Force in 2008.
While current research does not yet provide evidence of a causal relationship between the two diseases, scientists have identified biologic factors, such as chronic inflammation, that independently link periodontal disease to the development or progression of cardiovascular disease in some patients.
The lack of causal evidence should not diminish concern about the impact of periodontal status on cardiovascular health. According to Pamela McClain, DDS, president of the American Academy of Periodontology and a practicing periodontist in Aurora, Colo., "Periodontal disease and cardiovascular disease are both complex, multifactorial diseases that develop over time. It may be overly simplistic to expect a direct causal link. The relationship between the diseases is more likely to be mediated by numerous other factors, mechanisms, and circumstances that we have yet to uncover. However, as the AHA statement points out, the association is real and independent of shared risk factors. Patients and health-care providers should not ignore the increased risk of heart disease associated with periodontal disease just because we do not have all the answers yet."
The AAP believes additional long-term interventional studies are needed to better understand the specific nature of the relationship between periodontal disease and cardiovascular disease. Patients' periodontal status should also be added to future longitudinal studies of cardiovascular disease. The AAP hopes that the American Heart Association's statement brings attention to the association between the two diseases and the need for additional research in this area.
Dr. McClain encourages physicians and dentists to communicate the association between cardiovascular disease and periodontal disease to patients. "It is not as simple as telling a patient that brushing and flossing will ward off a heart attack," says Dr. McClain. "Patients should be aware that by maintaining periodontal health, they are helping to reduce harmful inflammation in the body, which has been shown to reduce the risk of cardiovascular disease."
Patients should expect to receive a comprehensive periodontal evaluation from their dental professional at least once a year, adds Dr. McClain. This includes a detailed examination of the teeth and gums, and an assessment of risk factors such as smoking, age, and overall health status. In addition, patients diagnosed with periodontal disease should be sure to inform their general health care provider and/or cardiologist to encourage better integration of their care.
"There is no compelling evidence to support that treating periodontal disease will reduce cardiovascular disease at this time," says Dr. McClain, "but we do know that periodontal care will improve your oral health status, reduce systemic inflammation, and might be good for your heart as well."
For more information about periodontal disease, visit perio.org.
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 8,400 members worldwide.
