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Overview
Accumulating evidence suggests that periodontal, or gum, disease may be associated with a number of systemic disorders, such as cardiovascular diseases, diabetes, stroke and adverse pregnancy outcomes. However, after adjusting for confounding factors such as smoking, some studies have found no association between oral and systemic diseases. Possible reasons for the variable results may include different study designs and evaluation of periodontal disease, and the complexity of confounding variables, particularly smoking history.
In the July 5, 2005 issue of Circulation , 1 Dr. James Beck and colleagues presented a study where both clinical signs of periodontal disease and systemic exposure to periodontal pathogens were evaluated to determine if periodontal disease is associated with coronary heart disease (CHD). They found that clinical signs of periodontal disease, including probing depth and clinical attachment level, were not associated with CHD, regardless of smoking history. In contrast, systemic exposure to periodontal pathogens, as measured by antibody levels to oral microorganisms, was associated with CHD. Interestingly, the investigators found that the systemic exposure to specific periodontal pathogens that correlate with CHD differed among ever smokers (current and former) and never smokers (Table 1).
The authors conclude that current measures of detecting clinical signs of periodontal disease may not represent the actual systemic exposure to oral pathogens. The quality and quantity of the host response to oral bacteria may be a more accurate measure of the systemic burden of periodontal pathogens, and systemic exposure to oral pathogens may be related to CHD.
Although this study supports previous peer-reviewed studies that report a possible association between oral infections and other health conditions, a proven cause-and-effect relationship has not yet been established. As noted in its Research Agenda, the American Dental Association encourages additional research to clearly establish whether, and to what extent, these relationships exist, and how to use that knowledge to improve patients’ oral and systemic health.
What is evident is that smoking adversely affects oral and systemic
health. Dentists can have a positive impact on patients’ overall
health and quality of life by taking an active role in providing
information about the health hazards associated with smoking and
promoting smoking
cessation.
Table 1. Associations between systemic exposure to oral pathogens, as measured by high antibody levels, and coronary heart disease (CHD) stratified by smoking status.
| Table 1 |
| Smoking Status |
Oral Pathogens |
| Ever smokers (current and former) |
T. denticola, P. intermedia, C. ochracea, V. parvula |
| Never Smokers |
P. nigrescens, A. actinomycetemcomitans, C. ochracea |
Footnote
1 Beck JD, Eke P, Heiss G, Madianos P, Couper D, Lin D, Moss K, Elter J, Offenbacher S. Periodontal disease and coronary heart disease: a reappraisal of the exposure.  Circulation 2005;112(1):19-24.
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Science in the News is a service by the American Dental Association (ADA) to present current information about science topics in the news. The ADA is a professional association of dentists committed to the public's oral health, ethics, science and professional advancement; leading a unified profession through initiatives in advocacy, education, research and the development of standards. As a science-based organization, the ADA's evaluation of the scientific evidence may change as more information becomes available. Your thoughts would be greatly appreciated.
Document Posted August 2005
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