Research Finds a Link Between Gum Disease
and Acute Heart Attacks

Studies have shown that people with severe gum disease might be more likely to have precursors to heart disease than those with milder forms of the disease, known as periodontitis.

The disease in which bacteria infect the gums and bones supporting the teeth can cause gums to separate from the teeth and from pockets. Scientists had thought that periodontitis was a risk factor for heart disease; now researchers have linked the severity of the condition to the likelihood of symptoms.

The American Academy of Periodontology (AAP), Chicago - June 18, 1997 , is concerned about new research linking gum disease to a heart attack or stroke. According to Dr. Timothy Rose , AAP President, this new study supports accumulating research that identifies gum disease as significantly increasing the risk for heart disease. The AAP believes emerging research in this area may establish periodontal disease as a risk factor for cardiovascular disease.

The study presented at the American Association for the Advancement of Science meeting suggests that the bacteria present in gum disease may trigger blood clots which can contribute to a heart attack or stroke.

The academy urges people who are at-risk for cardiovascular disease or have signs of gum disease to consult with a dentist experienced with treating periodontal disease. Regular periodontal screening and evaluations, treatment and professional maintenance are critical to long term management of periodontal disease.

The American Academy of Restorative Dentistry (AARD) studied the effects of bacteria to possible links between gum and heart disease. By exposing human blood platelets to samples of bacteria taken directly from patients' mouth, researchers at Temple University Schools of Dentistry and Medicine have further confirmed a possible link between periodontal bacteria and heart disease. Temple 's study is the first to take a large number of dental plaque bacteria directly from the mouths of patients with severe periodontal disease and test their affect on blood platelets.

"Almost immediately after we exposed human blood platelets to the dental plaque bacteria the platelets began to clump together" said Dr. Eugene Whitaker , Associated Professor of Dentistry and lead investigator. In addition, "out of all the periodontal bacteria we tested, porphyromanas gingivitis was the only one to cause this clumping, which is a key step in formation of bloodstream thrombi (blockage)."

Additionally, research from the University of North Carolina at Chapel Hill (UNC-CH) ( 11-13-2000 ) also finds a link between gum disease and acute heart attacks. Their studies showed that heart attack survivors who suffer advanced gum disease show significantly higher levels of a protein in their blood called C-Reactive Protein (CRP) than such patients without gum disease.

Findings presented (November 12, 2004) during a news conference at the annual American Heart Association meeting in New Orleans, suggest that the presence of gum disease might increase the risk of second heart attack in people with a risk of heart disease.

"Not only did the heart attack patients with periodontal disease have higher levels of CRP than those without gum disease, but the CRP levels were directly related to the severity of the gum disease," said Dr. Efthymios N. Deliargyris , an interventional cardiologist and a member of the Center for Oral and Systemic Diseases at UNC-CH. "The more severe the gum disease, the higher the CRP levels." Besides Deliargyris, also an instructor in medicine at the UNC-CH School of Medicine, study investigators included Drs. Steven Offenbacher , Professor of Periodontology and Center Director, James D. Beck , Professor of Dental Ecology and Dr. Sidney C. Smith Jr. , Chief of Cardiology and past president of the American Heart Association.

"We know a lot of risk factors for heart attacks, including high blood pressure, high cholesterol, diabetes and cigarette smoking, but all of those combined only explain about two-thirds of the heart attacks," Deliargyris said. "Since about a third of people who suffer from heart attacks don't have those risk factors, there is a wide search going of for other conditions that may contribute to increased risk.

Studies at UNC-CH and elsewhere have linked periodontal disease - an advanced form of gingivitis - with increased risk of heart attacks, but it has been unclear what the two (2) conditions have in common, the physician said. "One thing we know, the two conditions share is that they tend to initiate an immune response also called an inflammatory response in the body," He said. The most common marker for this response is the CRP, which is considered predictive of future adverse events like heart attack." To learn how common severe gum disease was in heart attack victims, the UNC-CH team conducted their pilot study of heart attack patients and matched them with a comparable group of other people without known heart disease. Research found a high percentage of the former had periodontal disease - 85 percent - as compared with only 29 percent of the controls.

One interesting observation was "that among people with a heart attack, those with periodontal disease had much higher CRP levels than those with a heart attack but no periodontal disease" Deliagyris said. "It seems that the presence of periodontal disease on top of a heart attack has a synergistic effect and a very accentuated CRP release."

"This gives us an insight into possible mechanisms underlying the association between gum disease and heart disease, Deliagyris said. "Now we believe that patients with a heart attack and periodontal disease have an exaggerated inflammatory response with higher CRP levels that might put them at risk for future heart attacks. This work also raises the possibility that by treating severe gum disease in people with heart attacks, we might be able to reduce their CRP levels and their risk of another heart attack."