New Report Links Periodontitis With Increased Risk For Cardiovascular Disease And Diabetes, UK

A new expert report published in the journal Current Medical Research and Opinion examines the potential link between oral hygiene, associated gum disease and other systemic diseases involving inflammatory processes such as cardiovascular disease (CVD) and diabetes. The authors conclude that current evidence suggests periodontitis (a chronic inflammatory disease of the gums) is associated with an increased risk for CVD and diabetes.1 Primary care practitioners are encouraged within the report to educate their patients about the importance of maintaining a healthy mouth for conferring potential public health benefits.


For the first time in the UK, a multidisciplinary group of experts in the fields of cardiology, endocrinology and periodontology reviewed the latest clinical evidence to examine the emerging evidence for an association between periodontitis and systemic conditions. In addition to finding a link between periodontitis and increased likelihood of CVD, the group found that periodontitis is also often more severe in subjects with diabetes mellitus, a group already at increased risk for cardiovascular events.


Dr Ray Williams, a leading periodontist in the US at the University of North Carolina School of Dentistry and lead author of the report said, "There is an urgent need for dentists and physicians to work more closely together in understanding and improving patient health. The promotion of good oral health, as part of better overall health care should be seen as a natural extension of current healthy lifestyle messages around diet, exercise and the cessation of smoking, which are designed to help reduce the burden of CVD and diabetes."


The infectious and inflammatory burden of chronic periodontitis (which affects not only the gums, but also the ligament and bone holding the teeth in place) is thought to have an important systemic impact on overall health. The exact reasons are unknown, but may be the result of oral bacteria entering the bloodstream and/or the systemic inflammatory reaction produced in response to the oral bacteria. Further research to determine the inflammatory pathophysiology of periodontitis, CVD and diabetes and the oral bacteria cascade, should identify potential links between the conditions.


Dr Roger Gadsby a leading UK GP from Warwickshire and one of the report's authors continued; "With diabetes on the increase, every effort should be taken to ensure that people with diabetes take every step to effectively manage their diabetes to reduce their risk of developing cardiovascular complications. Maintaining good oral health may be an additional part of reducing this risk."


"We have known for years that patients with CVD and diabetes are much more likely to present with gum disease," commented Mark Davis, a GP and occupational physician with a special clinical interest in cardiology from Leeds, and one of the authors of the report. "I am pleased that the link is being recognised by healthcare professionals in the UK. It is now time to take action to confirm the importance of this link and to educate patients about the importance of good oral health."















Within the last decade periodontitis has attracted much interest as a potential risk factor not only for CVD and diabetes, but also for its association with adverse pregnancy outcomes, respiratory disease, kidney disease and certain cancers. The idea that oral infection and inflammation within the mouth can reach distant sites and organs in the body, or the 'focal infection theory', was a popular concept in the 1920s but interest waned. Then in 1989, with compelling reports from Finland of the link between CVD and periodontitis, there has been a major effort to elucidate the relationship of oral health to general health The emerging position of periodontal disease in cardiovascular and metabolic disease research has been recognised by the World Heart Federation and by the American Diabetes Association congress committees as a topic for inclusion within recent and forthcoming international congress programmes.


The new report, 'The Potential Impact of Periodontal Disease on General Health' represents the first time that such a broad group of UK experts has convened to explore the growing body of research into this important area. This meeting was funded by Colgate-Palmolive as a service to medicine.


Reference


1. Williams RC et al. The potential impact of periodontal disease on general health: A consensus view. Curr Med Res Opinion 2008; 24(6):1635-1643


The expert consensus group comprising both physicians and dentists, met in January 2008. Members included:


- Dr Ray C. Williams, University of North Carolina, School of Dentistry, Chapel Hill, NC, USA

- Professor A. Barnett, University of Birmingham and Heart Of England NHS Foundation Trust, Birmingham, UK

- Dr N. Claffey, Dental School and Hospital, Trinity College, Dublin, Ireland

- Dr M. Davis, Moorfield House Surgery, Garforth, Leeds, UK

- Dr R. Gadsby, Warwick Medical School, University of Warwick, Warwick, UK

- Dr M. Kellett, University of Leeds, Leeds Dental Institute, Leeds, UK

- Prof G.Y.H. Lip, University Department of Medicine, City Hospital, Birmingham, UK

- Dr S. Thackray, Castle Hill Hospital, East Yorkshire, UK

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