Periodontal
therapy may lower heart disease risk
By Rabia Mughal, Contributing Editor
November
25, 2009 -- Heart disease could be the major cause of death in developing
countries by 2020, according to a study in the New England Journal of Medicine
(June 2004, Vol. 350, pp. 2438-2440). But improving oral health in these
countries could alter this prediction.
The
association between periodontal disease and heart disease has elevated the
importance of oral health in developing nations with a high prevalence of
periodontal disease. This prompted researchers from the
CRP,
fibrinogen, and WBC counts are all markers of serum inflammation, and their
systemic levels have been associated with CHD risk. The researchers found that
treating gum disease can lower these inflammatory markers, which, in turn,
could reduce the risk of CHD in patients from a developing country.
Although
epidemiological studies have extensively reported the association between
periodontal infections and cardiovascular disease, few have observed the
outcome of eliminating periodontal infections on systemic inflammation, said
lead author S. Akhtar Hussain
Bokhari, associate professor at the
"The
important finding of this study is that if periodontal infection is removed,
there will be an improvement in systemic health that may reduce the risk of
coronary heart disease," he added. "The uniqueness of this study may
be that it is the first intervention study conducted on oral-cardiac diseases
relationship on the population of a developing country."
Significant
reduction
Dr. Bokhari and colleagues looked at 27 patients with CHD and
18 patients without the disease, all between the ages of 40 and 50. Periodontal
disease was measured through bleeding on probing (BOP), and probing depth (PD).
All the patients received nonsurgical periodontal
therapy that included oral hygiene instructions and subgingival scaling and
root planing. Systemic levels of inflammatory markers
(CRP, fibrinogen, and WBC counts) were measured prior to and one month after
periodontal therapy.
Eventually,
17 patients with CHD and 11 without the condition completed the study. The CHD
group saw a 59% reduction in BOP, while the other group saw a 34% reduction. As
for PD, there was a 41% reduction for the CHD group and a 35% reduction for the
group without CHD.
Both
groups saw a significant reduction in CRP, fibrinogen, and WBC counts (21% to
40%).
"CRP,
fibrinogen, and WBC counts, nonspecific markers of systemic inflammation
associated with an increased risk for cardiovascular events, can be reduced as
a result of mechanical periodontal therapy in a population from a developing
country," the authors wrote. "This may result in a decreased risk for
CHD in the treated patients."
These
findings may help spur the World Health Organization and other agencies to
develop a program promoting oral health in developing nations, explained Dr. Bokhari. The prevalence of periodontal disease in
developing nations is quite high compared to developed nations, he added. Also,
the dentists' role in developing nations is more important and challenging, as
the level of awareness about oral health is low and people lack health
information.
Larger
studies needed
While
other researchers agree that lowering these inflammatory markers could reduce
the risk of CHD, they point out that the size of the study makes the findings
less definitive.
"Decreasing
the WBC counts, CRP, and fibrinogen suggests that control of periodontal
inflammation may help decrease the risk for cardiovascular disease, but is not
definitive since a larger, better designed study would be necessary to prove
it," said John Grbic, D.M.D., professor at the
Columbia University College of Dental Medicine. "So although positive, I
would remain cautious about over-interpreting the results of this study."
Dentists
can tell their patients that scaling and root planing
may have the additional benefit of reducing the levels of CRP, which has been
shown to be a risk factor for cardiovascular disease, noted Dr. Grbic. However, they should also tell them that continued
recalls may be necessary to maintain the potential beneficial effects of these
therapies.
Dr. Bokhari acknowledges the need for larger studies to further
establish this link, noting that this was a pilot study. He and his colleagues
recently completed a follow-up randomized, controlled trial involving 246 CHD
patients in
"This
will possibly be the largest such trial to be reported from Pakistan, maybe
even South Asia and Eastern Mediterranean Regional countries," Dr. Bokhari said.