its link with heart health ORAL HEALTH:
The jury’s still out, but studies are pointing to a link between gum disease and heart health. Linda Music helps you suss out the facts.
Over the past few years there has been considerable hype about the link between gum health and heart disease. Many scientific studies have shown significant correlations, but not everyone is convinced.
THE RESEARCH
In 2016 a Swedish study examined 805 patients under the age of 75 who had suffered their first acute myocardial infarction (AMI), also known as a heart attack. The study also examined 805 matched controls who had no history of heart problems. Gum disease was more common in patients who had had a heart attack than in the control group. In fact, the study concluded that there was a 49 per cent increased risk of AMI among the patients with periodontitis (gum disease). Even after the researchers made adjustments for other variables, such as smoking, the risk remained significantly higher (29 per cent).
While statistics like these may have you heading straight to your dentist in the hope of fixing your heart, it’s not as simple as that. In 2017, Chinese researchers looked at 22 research studies into the link between gum disease and heart disease. Across the 22 studies, results from a total of 129,630 participants were analysed. While the research showed gum disease is associated with an increased risk of future heart disease, a causative relationship between the two could not be established.
THE EXPERTS
Dr Fritz Heitz, president of the Australian Society of Periodontology, agrees. Dr Heitz argues that just because there are statistical correlations between the two diseases, it does not mean periodontitis causes heart disease or vice versa. Neither does it mean that fixing one disease will fix the other.
“Going to your dentist or a periodontist won’t fix your heart problems,” says Dr Heitz.
The Australian and New Zealand Academy of Periodontists holds a similar view. Despite research showing an association between gum disease and heart disease, they stress the nature of this link is not clear. They explain that heart disease could be caused (at least in part) by gum disease or “it may be that having gum disease is just a marker for increased risk of also having a systemic illness”.
Dr Heitz says the reason gum disease is often seen in people with heart disease may be because both conditions are inflammatory in nature.
“Rather than a direct causal link, what I suspect is that there may be a third factor that predisposes you to both diseases. That third factor is a predisposition to a hyperinflammatory state,” says Dr Heitz. He explains that it isn’t the bacteria directly that cause gum disease but rather how the body reacts to the presence of these bacteria (see box, right). “It is the body’s own overexcitable inflammatory response that causes gum disease,” he argues.
“I t may be that having gum disease is just a marker for increased risk of also having a systemic illness.”
WHAT IS GUM DISEASE?
Dr Fritz Heitz says gum disease can be divided into two different diseases: gingivitis and periodontitis. Signs of gingivitis include swelling, redness and bleeding gums.
“In severe cases, bleeding can be spontaneous, but more often bleeding is only noticed when cleaning the teeth,” he says.
WHAT CAN YOU DO ABOUT IT?
FLOSSING IS KEY Gingivitis can be reversed but, if left untreated, can lead to a more serious form of gum disease known as periodontitis. The symptoms of periodontitis include teeth becoming loose or drifting out of position. Despite common beliefs, Dr Heitz stresses pain is not usually a symptom of periodontitis.
“This is part of the problem. Many people rely on pain to be an indicator of disease thinking ‘no pain’ equals ‘no problem’. Thus, gum diseases can sneak up on you,” he says.
Preventing gum disease is simple enough: clean your teeth well. However, cleaning doesn’t just mean brushing. Dr Heitz stresses if you’re just brushing your teeth, you’re only doing half the job. Cleaning in between your teeth as carefully as on the surface is critical as this is where most of the disease happens.
“If we could get people to floss with as much effectiveness as brushing, a lot of the dental problems we see would disappear,” Dr Heitz claims. TACKLE IT AS A TEAM He also stresses the importance of working with your dentist and dental hygienist as a team.
“Don’t just let them clean your teeth: get them to coach you how to keep your teeth and gums clean at home,” he advises.
So while the jury is still out about the links between gum disease and heart disease, ensuring your teeth and gums are in good shape is a key component in looking after your overall health.
“Many people rely on pain to be an indicator of disease... Thus, gum disease can sneak up on you.”