Heart of the Matter Treatment for Gum Disease Could Affect Cardiovascular Health

Scientists at University College London (UCL) have conducted the first clinical trial demonstrating that an intensive treatment for periodontitis, or gum disease, directly improves the health of blood vessels.

This study, conducted in conjunction with Maurizio Tonetti, a UConn professor, and reported in the New England Journal of Medicine, may have relevance for the prevention of heart attacks and stroke, researchers say.

Periodontitis is a common inflammatory disease of the gums, affecting up to 40{06cf2b9696b159f874511d23dbc893eb1ac83014175ed30550cfff22781411e5} of the world’s adult population. The condition is a bacterial infection of the tissue that supports the teeth in the mouth. Left untreated, it can cause progressive bone loss around the teeth, and eventually tooth loss.

Some established scientific evidence already exists linking inflammation (the body’s natural response to infection or injury) with the arterial changes that underlie stroke and heart attack. However, the UCL clinical trial is the first to demonstrate that relief of inflammation in the mouth, through intensive treatment of periodontitis, can result in improved function of the arteries.

A Study with Teeth

Dr. Francesco D’Aiuto, project leader and a therapist with UCL Eastman Dental Institute, explained the method behind the research.

“Middle-aged subjects with severe periodontitis, but no evidence of cardiovascular disease, were randomly allocated to dental treatments of two levels of intensity,” he said. “After six months, those who received the more intensive periodontitis treatment, which resulted in a marked improvement in their gum disease, also demonstrated a significant restoration of blood vessel function.”

The intensive treatment, he continued, involved removal of plaque through scaling and root-planing techniques, as well as extraction of teeth that could not be saved, which initially resulted in some inflammation and dysfunction of the blood vessels and arteries. “However, that was short-lived, and six months later, the treatment led to an improvement in both oral health and arterial function,” D’Aiuto said.

Senior author John Deanfield, a professor with the UCL Institute of Child Health, added that previous studies have shown an association between periodontitis and blood vessel dysfunction, heart attack, and stroke.

“However, a clinical trial was required to test whether these links could be causal,” he explained. “This is the first time that a direct link has been made between treatment for gum disease and improved circulatory function, which is relevant to some of our biggest killers: heart attack and stroke.”

Dr. Aroon Hingorani of the UCL Division of Medicine, a co-author on the study, set the findings in context.

“Elevations in blood pressure and cholesterol, as well as smoking and diabetes, are recognised as the main risk factors for cardiovascular disease, and these can be effectively treated,” Hingorani said. “Nevertheless, heart attacks and stroke remain a major cause of disability and death. Intriguing links have emerged between inflammation and heart disease, and so it is important to better understand the nature of this connection, and whether it could lead to the development of new treatments. The current study points to disease of the gums as a potential source of this inflammation.”

Making the Connection

The mechanism by which periodontitis affects function in the body is still uncertain. The gum disease involves a bacterial infection that invades the tissue around the teeth, so one possibility is that the bacteria disturb function in the heart wall directly, since some bacteria can enter the bloodstream. Alternatively, the periodontitis might trigger a low-grade inflammatory response throughout the body that has a detrimental effect on the vascular wall.

Deanfield noted that the findings potentially have implications for public health.

Still, he said, “further studies are required to determine whether the treatment of severe periodontitis could directly contribute to the prevention of disease of the arteries, stroke, and heart attacks.”