Gum disease does not cause heart disease

heart attack

Links between gum and heart disease have been noted for over 100 years, but  in recent years there has been a surge of interest in this topic as evidenced by the increasing numbers of papers published since the late 1990s. A selection of some of the reviews published since 2000 is listed below.  The aim of this latest review from the American Heart Association (AHA) was to assess the weight and scope of evidence for an association or causality of periodontal disease (PD) and atherosclerotic vascular disease (ASVD).

A detailed review of the available evidence was undertaken and their main finding was

Observational studies to date support an association between PD and ASVD independent of known confounders. They do not, however, support a causative relationship. Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD or modify its outcomes.

The findings are not unsurprising given that the two disorders share several common risk factors, including cigarette smoking, age, and diabetes mellitus and they are both common diseases.

The key issue here is that people understand the difference between association and causation and readers may want to check out the following article in the Evidence Based Dentistry Journal.

Causes, associations and evaluating evidence; can we trust what we read? David R Moles  and Isabel dos Santos Silva  ( this issue of EBJ has other articles related to this topic which may be of interest).

The statement has been welcomed by a the American Dental Association, the American Association of Periodontology is  however calling for continued long term research  “to better understand the specific nature of the relationship between periodontal disease and cardiovascular disease”

Read the AHA abstract and full statement

Lockhart PB, Bolger AF, Papapanou PN, Osinbowale O, Trevisan M, Levison ME, Taubert KA, Newburger JW, Gornik HL, Gewitz MH, Wilson WR, Smith SC Jr, Baddour LM; on behalf of the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young, Council on Epidemiology and Prevention, Council on Peripheral Vascular Disease, and Council on. Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?: A Scientific Statement From the American Heart Association. Circulation. 2012 Apr 18. [Epub ahead of print] PubMed PMID: 22514251.

Related references

1: Beck JD, Offenbacher S. The association between periodontal diseases and cardiovascular diseases: a state-of-the-science review. Ann Periodontol. 2001 Dec;6(1):9-15. PubMed PMID: 11887476.

2: Joshipura K. The relationship between oral conditions and ischemic stroke and peripheral vascular disease. J Am Dent Assoc. 2002 Jun;133 Suppl:23S-30S. Review. PubMed PMID: 12085721.

3: Jin LJ, Chiu GK, Corbet EF. Are periodontal diseases risk factors for certain systemic disorders–what matters to medical practitioners? Hong Kong Med J. 2003 Feb;9(1):31-7. Review. PubMed PMID: 12547954.

4: Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 May;95(5):559-69. PubMed PMID: 12738947.

5: Cunha-Cruz J, Nadanovsky P. [Does periodontal disease cause cardiovascular disease? Analysis of epidemiological evidences]. Cad Saude Publica. 2003 Mar-Apr;19(2):357-68. Epub 2003 May 15. Review. Portuguese. PubMed PMID: 12764451.

6: Scannapieco FA, Bush RB, Paju S. Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review. Ann Periodontol. 2003 Dec;8(1):38-53. Review. PubMed PMID: 14971247.

7: Dietrich T, Garcia RI. Associations between periodontal disease and systemic disease: evaluating the strength of the evidence. J Periodontol. 2005 Nov;76(11Suppl):2175-84. PubMed PMID: 16277591.

8: Loos BG. Systemic effects of periodontitis. Int J Dent Hyg. 2006 Sep;4 Suppl 1:34-8; discussion 50-2. PubMed PMID: 16965532.

9: Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C-reactive protein levels: a systematic review and meta-analysis. J Periodontol. 2006 Oct;77(10):1635-42. Review. PubMed PMID: 17032104.

10: Fardi A, Papadimitriou D. Periodontal and atherosclerosis-induced diseases.Int Angiol. 2007 Sep;26(3):197-205. Review. PubMed PMID: 17622199.

11: Mustapha IZ, Debrey S, Oladubu M, Ugarte R. Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis. J Periodontol. 2007 Dec;78(12):2289-302. Review. PubMed PMID: 18052701.

12: Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008 Apr;35(4):277-90. Epub 2008 Feb 20. Review. PubMed PMID: 18294231.

13: Davé S, Van Dyke T. The link between periodontal disease and cardiovascular disease is probably inflammation. Oral Dis. 2008 Mar;14(2):95-101. Review. PubMed PMID: 18302669.

14: Williams RC, Barnett AH, Claffey N, Davis M, Gadsby R, Kellett M, Lip GY, Thackray S. The potential impact of periodontal disease on general health: a consensus view. Curr Med Res Opin. 2008 Jun;24(6):1635-43. Epub 2008 Apr 30. Review. PubMed PMID: 18452645.

15: Humagain M, Nayak DG, Uppoor AS. Periodontal infections and cardiovascular disease: is it a mere association? Kathmandu Univ Med J (KUMJ). 2006 Jul-Sep;4(3):379-82. Review. PubMed PMID: 18603938.

16: Kinane D, Bouchard P; Group E of European Workshop on Periodontology. Periodontal diseases and health: Consensus Report of the Sixth European Workshop on Periodontology. J Clin Periodontol. 2008 Sep;35(8 Suppl):333-7. PubMed PMID: 18724860.

17: Tonetti MS. Periodontitis and risk for atherosclerosis: an update on intervention trials. J Clin Periodontol. 2009 Jul;36 Suppl 10:15-9. Review. PubMed PMID: 19432627.

18: Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC; American Journal of Cardiology; Journal of Periodontology. The American Journal of Cardiology and Journal of Periodontology editors’ consensus: periodontitis and atherosclerotic cardiovascular disease. J Periodontol. 2009 Jul;80(7):1021-32. PubMed PMID: 19563277.

19: Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC; American Journal of Cardiology; Journal of Periodontology. The American Journal of Cardiology and Journal of Periodontology Editors’ Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol. 2009 Jul 1;104(1):59-68. PubMed PMID: 19576322.

20: Blaizot A, Vergnes JN, Nuwwareh S, Amar J, Sixou M. Periodontal diseases and cardiovascular events: meta-analysis of observational studies. Int Dent J. 2009 Aug;59(4):197-209. Review. PubMed PMID: 19774803.





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Derek Richards

Derek Richards is a specialist in dental public health, Director of the Centre for Evidence-Based Dentistry and Specialist Advisor to the Scottish Dental Clinical Effectiveness Programme (SDCEP) Development Team. A former editor of the Evidence-Based Dentistry Journal and chief blogger for the Dental Elf website until December 2023. Derek has been involved with a wide range of evidence-based initiatives both nationally and internationally since 1994. Derek retired from the NHS in 2019 remaining as a part-time senior lecturer at Dundee Dental School until the end of 2023.

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