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On Balance – The Scales of Evidence
There has, for a long time, been a known loose association between gum disease and heart disease that cannot be explained by the common risk factors. For quite a while it looked as though the evidence was compelling for a direct link between the two diseases with the enormous implication that we should be informing patients with periodontitis that they were putting cardiac health at risk. This was given a knock in 2012 when the American Heart Association issued a Scientific Statement saying there is no definitive evidence at the present time that proves gum disease causes heart disease or stroke, or treating gum disease reduces the risk of those diseases. They said more evidence was needed to address whether periodontal disease can cause atherosclerotic heart disease. The scales dipped a little to the negative.
Now, the publication of a new study has tipped the scales back the other way a bit. The new study published in the Journal of the American College of Cardiology suggests that steps taken to reduce gum disease may also reduce inflammation in the arteries and vice versa, in that Statins, commonly prescribed medications for lowering cholesterol, also reduced inflammation associated with gum disease. The study authors concluded that the research provides further evidence of a link between periodontal disease and atherosclerosis and demonstrates that treatments aimed at reducing inflammation in one of these conditions may produce improvements for the other. The authors also raise the possibility that improved oral hygiene to reduce inflammation of the gums may lead to reduced inflammation of the arteries.
This was a well conducted study that met the standards for providing good evidence. The problem is what do we do with this information? My opinion is that we should at least be raising the issue with patients who are attending with chronic periodontitis or who are scoring BPE figures high enough to present concerns about a possible deteriorating gum problem. The long term worry is that patients can later complain that we didn`t tell them enough about these concerns if they are later diagnosed with heart problems. It is highly likely that there will be some litigious patients around in 10, or even 5 years time.
It is a bit like growing up though, we are now entering the `big boys` territory and are likely to have a hugely increased involvement in treating and preventing serious life-threatening conditions.
Dr John Shapter - QCS Expert Dental Contributor