August 01, 2014
Disheartening Dental News
Be Well

Disheartening Dental News

by John Swartzberg, M.D.  |  

Many studies have found that those with gum—periodontal—disease are at higher risk for heart disease. And some companies have promoted their toothpastes and dental devices as being good for the heart.

The Wellness Letter, too, when reporting on these studies, has sometimes advised that taking good care of your teeth and gums may help prevent heart disease.

However, the American Heart Association (AHA) reviewed hundreds of papers and studies and, in a Scientific Statement, concluded that so far there’s no conclusive evidence that gum disease contributes directly to heart disease.

The American Dental Association concurred. As with so many findings from observational studies, association or correlation doesn’t always equal causation. Future research may still prove cause and effect, but maybe not.

Still, the idea that dental problems can play a role in systemic disorders like cardiovascular disease is biologically plausible. For one thing, oral bacteria can enter the bloodstream and affect the heart. And the inflammation involved in gum disease could conceivably trigger the inflammation that plays an important role in atherosclerosis.

On the other hand, diseases of the mouth and blood vessels share many risk factors, notably smoking, age and diabetes, and that may explain why they often occur in the same people. Thus, the two conditions may occur at the same time because of the same underlying factor—say, smoking—but that doesn’t mean that one caused the other. Despite researchers’ attempts to adjust the data to control for these shared factors, the evidence overall doesn’t prove the theory that gum disease contributes to heart disease, according to the AHA.

Many doctors and dentists were probably attracted to the theory, in part, because they hoped it would encourage people to take better care of their teeth and gums. Prevention is always better than treatment, and this is especially true with dental care. Like medical costs, the cost of dental treatment has skyrocketed. But most people have little or no dental insurance (Medicare doesn’t cover routine dental care). Nearly 50 million Americans live in rural or poor areas where very few dentists practice. Many end up in the emergency room with severe dental problems that keep them from eating, cause embarrassment, limit social interaction and can possibly even kill them. Dental disease is the leading chronic childhood disease.

We’ve made great progress against dental decay and tooth loss in recent decades, thanks largely to fluoride in toothpaste and drinking water. But large segments of the U.S. population have dental problems as serious as those common a century ago. It’s a scandal. It shouldn’t take fear of heart disease to motivate us to take better care of our teeth and, as a nation, to improve access to dental care for everyone.