Fall 2009

Research links oral health
and cardiovascular disease

Following up with the Spring 2009 BlueLine article, Focus attention on oral health link to overall health, current research now indicates that infections from the mouth may be a factor in heart disease and stroke. There are one and one half million heart attacks and approximately 600,000 strokes in the United States each year. Half of these individuals will have known risk factors for heart disease and stroke while the other half will appear to be healthy with normal or low cholesterol levels. This has led to an investigation of other factors that may be involved with heart disease and stroke that were not previously identified.

Heart disease is related to a thickening of the walls of the arteries in the body, a condition called atherosclerosis. The thickening of the arteries is believed to be aggravated by damage to the artery wall caused by an inflammatory process leading to the development of an atheroma or plaque. These atheromas may rupture leading to a heart attack or stroke in the individual or simply narrow the opening of the blood vessel. One hypothesis is that this process may be aggravated by bacteria from the mouth which make their way into the bloodstream and contribute to this inflammation.

This connection between oral health and coronary artery disease through the inflammatory process appears to be supported by the literature. A cumulative analysis of all studies done to date suggests that periodontal disease is an independent risk factor for coronary artery disease, raising the additional risk by approximately 30% independent of other factors.

This association has caused the American Journal of Cardiology and the Journal of Periodontology to issue a consensus statement to their respective members recommending treatment and referral guidelines to their patients with either or both conditions. The position paper can be found at http://www.joponline.org/doi/pdf/10.1902/jop.2009.097001. These guidelines are meant to make dentists and physicians co-therapists in oral health management of their patients at risk for heart disease.

Look for the following warning signs of gum disease to help determine if you or your patient is someone at risk:

• Bleeding and tender gums
• Bad breath
• Receding gums or spaces developing between the teeth
• Changes in the bite or tooth mobility

Over the last year, Blue Cross and Blue Shield of Florida, Inc. (BCBSF) and its affiliate, Florida Combined Life Insurance Company, Inc. (FCL), has developed an outreach program to educate our members at-risk for heart disease and diabetes of the connection between improving oral health and reducing risks for heart disease and stroke. Stay tuned for future updates about this exciting program.