Shutting up about gum disease puts heart, brain at risk
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Judy Siegel-Itzkovich, THE JERUSALEM POST Feb. 8, 2005
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Opening your mouth and saying "ahhh" to your dentist may be better than
doing it for your doctor if you want an early diagnosis and even a way
to reduce your risk of atherosclerosis - a narrowing of blood vessels
that can lead to stroke or heart attack.
A new study by researchers at Columbia University Medical Center in New
York claims to provide "the most direct evidence so far" that preventing
gum disease could significantly improve your chances of avoiding
vascular problems.
But while the new study, which appears in Tuesday's edition of the
American Heart Association's prestigious journal, Circulation, connects
the microbiology of periodontal infection to atherosclerosis, gum
examinations are not included in the Israeli basket of health services.
The fact that dental treatment is an out-of-pocket expense not covered
by national health insurance is one reason many adults neglect diseased
gums, which now seem more clearly linked to vascular disease.
"I definitely think that periodontal examinations from the age of 30 or
35 should be included in the basket," Prof. Ayala Stabholz, a
periodontics expert at the Hebrew Hadassah-University School of Dental
Medicine and chairman of the Israel Periodontal Society, told The
Jerusalem Post. "Even if these won't actually prevent or reverse
atherosclerosis, at least they will sound the alarm."
Bacteria that cause inflammation and infection in the mouth can appear
elsewhere in the body and cause trouble, including in the blood vessels
in the heart and brain, she said. She criticized the Health Ministry for
"stressing only the prevention of tooth decay in children while doing
very little to ensure that adults get checked early for periodontal
disease." While chronic gum infections have a major impact on the body's
health, cavities - though very important to prevent and treat to
minimize tooth loss - do not, she said.
"Now interventional studies are needed on patients who have gum disease
and have had heart attacks or other vascular problems: We want to see
whether treating their periodontal problems reduces their risk of
further heart attacks and strokes," said Stabholz.
She and Prof. Chaim Lotan, chief of the cardiology division at
Hadassah-University Medical Center in Jerusalem, have received a
$250,000 grant and intend to conduct such an interventional study on 200
heart attack patients (some stable and others after acute coronary
syndrome) whom they examined for periodontal diseases and followed up
for two years. They found almost identical results in their
as-yet-unpublished research - even though they studied middle-aged and
elderly heart patients, unlike the healthy individuals examined by the
Columbia researchers.
The Columbia study, while very important, has not yet proven a direct
cause-and-effect relationship and that treating periodontal disease can
prevent heart attacks and stroke, added Stabholz. "We intend to give our
study group periodontal treatment to see whether they have a lower risk
of recurrent heart attacks. Smoking, diabetes and getting older put one
at higher risk for atherosclerosis, but there is no absolute proof that
one causes the other or whether they developed at the same time or
periodontal disease came before vascular disease."
Stabholz strongly endorsed the idea that Israeli researchers of various
disciplines organize a first-ever interdisciplinary conference on
connections between periodontal disease and systemic conditions from
cardiovascular problems to miscarriages.
Previous studies have suggested a relationship between periodontal
disease and vascular disease, but they have relied on surrogate markers
for periodontal disease, such as tooth loss or pocket depth.
"This is the most direct evidence yet that gum disease may lead to
stroke or cardiovascular disease," said Moise Desvarieux, assistant
professor of epidemiology at Columbia's School of Public Health and lead
author of the paper.
Desvarieux and his team showed that atherosclerosis is associated
specifically with the type of bacteria that causes periodontal disease,
and not with other oral bacteria. One possible explanation for the link
is that the bacteria that cause the gum disease may migrate throughout
the body via the bloodstream and stimulate the immune system, causing
inflammation that results in the clogging of arteries.
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