By Bruce Goldfarb
Published: June 2005 vol.2 no.6 9
Brushing and flossing could do more than just maintain healthy teeth and gums; they also could help prevent cardiovascular disease (CVD) in people with diabetes.
Inflammatory processes may be the key to an emerging link between periodontal disease and an increased risk of mortality among people with type 2 diabetes, recent research suggests.
“The teeth may be a window into the heart,” says investigator Robert G. Nelson, MD, PhD, of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Ariz. “It isn’t that rotten teeth are causing the heart to fail; they’re just reflecting different elements of the same inflammatory process.”
A prospective longitudinal study of 626 people reported in Diabetes Care shows that the risk of mortality from ischemic heart disease and diabetic nephropathy among those with severe periodontal disease is more than three times that of their counterparts with normal oral health.1
With colleagues from the University at Buffalo and the University of Michigan, Nelson studied residents of the Gila River Indian Community in Arizona. Participants were 35 years of age or older and were examined every 2 years for 11 years.
Researchers found that, when adjusting for age, sex, duration of disease, and other factors, participants with no or mild periodontal disease had 3.7 deaths per 1,000 person-years of follow-up, while the rate for those with severe disease was 28.4 per 1,000. One person-year is one person observed for 1 year, or two people observed for a half-year each, and so on.
The association between periodontal disease and mortality may be more than coincidental. Studies suggest that periodontal disease may influence the occurrence and severity of coronary artery disease and increase the risk of heart attack or stroke.
According to a recent report in the Journal of Periodontology, 91% of patients with CVD have moderate to severe periodontitis, compared with 66% among non-cardiac patients.2
One possible explanation, according to Eric H. Rompen of the University of Liege, Belgium, is that periodontal pathogens could invade blood vessel walls and trigger atherosclerosis. Other possible connections include higher levels of inflammatory markers such as C-reactive protein, fibrinogen, or several cytokines associated with periodontal infection.
“Just having periodontal disease by itself causes a cascade of inflammatory response that could damage other organ systems,” Nelson says.
Whether preventing or treating periodontal disease can reduce the death rate from diabetes or CVD remains to be seen, according to researchers.
In the meantime, Nelson recommends that people with diabetes maintain good oral hygiene with regular brushing and flossing. Primary care providers should include an assessment of oral health along with routine exams of patients with diabetes.
“We make a point of looking at the feet and examining the eyes of every diabetic patient that comes in the office,” Nelson says. “We should make a point to make sure patients see their dentist once a year as well.”
1 Saremi A, Nelson RG, Tulloch-Reid M, et al.: Periodontal disease and mortality in type 2 diabetes. Diabetes Care 28: 27-32, 2005.
2 Geerts SO, Legrand V, Charpentier J, et al.: Further evidence of the association between periodontal conditions and coronary artery disease. J Periodontol 75:1274-1280, 2004.