There is growing evidence that hardening of the arteries, or atherosclerosis, is somehow related to infection and inflammation.

"There's a strong indication that periodontal (gum) disease is a risk factor for formation of atherosclerotic plaques in the coronary arteries," says Jack Caton, DDS, president of The American Academy of Periodontology and professor of periodontology at the University of Rochester Eastman Dental Center in New York. Caton considers gum disease a worldwide problem, plaguing almost everyone.

Gum Disease

The primary form of periodontal disease occurs when bacteria invade the gums, bones, and tissue that support the teeth. Many adults suffer from periodontal disease, but most do not realize it until substantial damage has already occurred. Often painless, gum disease progresses relentlessly. Gums separate from teeth, pockets form and deepen, and bacteria-produced toxins destroy tissue. While in its earliest stage, known as gingivitis, professional dental care and good oral hygiene can reverse the periodontal siege.

For hundreds of years, people have recognized a connection between oral infections and systemic conditions. More recent investigations have found an association between gum disease and cardiovascular disease, low birth-weight babies, respiratory infections, and diabetes. One study found people with periodontal bone loss had twice the chance of fatal heart disease. The exact mechanism that increases cardiovascular risk remains murky, but experts believe bacteria from the chronic gum infection enter the bloodstream and cause white blood cells (which fight infections) to release inflammatory chemicals that create a build-up of fatty deposits and clots in the arteries. Studies have shown that chronic infections in other parts of the body can cause a similar response.

"An overall part of having a healthy body and heart is to make sure there are no chronic infections in the body, including periodontitis and gingivitis," Caton explains.

Prevention

"Preventing periodontal disease or reducing its extent or severity may also reduce the risk of coronary artery disease," Caton says. "Improved oral hygiene and frequent dental cleanings are both associated with periodontal health. Periodontal health is associated with a lower incidence of coronary artery disease and stroke."

To minimize your risk:

• Brush inner, outer, and chewing surfaces at least twice daily with a soft-bristled brush held at a 45° angle. Some people find electric brushes easier to use.
• Floss at least once daily, gently guiding the floss between teeth. While holding floss taut and curved around each tooth, slide the floss up and down. Use a clean section of floss for each tooth.
• Obtain professional dental cleaning every six months, more often if you are prone to plaque or gingivitis. "It's probably the best investment an adult can make in terms of preventing periodontal disease and decay," Caton says.
• Ask for an annual periodontal screening and assessment of the degree to which gum tissue has pulled away from teeth.

Risk Factors

Several factors can place you at increased risk for periodontal disease.

• Hormones

  Birth control pills, hormone replacement therapy, pregnancy, puberty, and menstrual cycles all raise estrogen levels. "The receptor cells on periodontal tissues are sensitive to estrogen, which causes an exaggerated reaction to bacteria left after brushing," Caton explains. What this means is that you should be scrupulously attentive to tooth brushing and flossing under these conditions.

• Medicines

  Some blood pressure medicines and epilepsy drugs create an overgrowth of gum tissue, especially in people with an existing gum condition. Bacteria can easily accumulate in the enlarged gums and start to destroy the tissues that support the teeth.

• Smoking

  Scientists have accumulated overwhelming evidence that smoking increases the risk of periodontal disease. In addition, a study at the University at Buffalo School of Dental Medicine found passive, in-home exposure to tobacco smoke increased the risk of gum detachment and bleeding as well as severe periodontal disease by 70%.

• Alcohol

  The same university found heavy drinking upped the odds. Senior researcher Sara G. Grossi, DDS, says the risk of periodontal disease increased from 10% to 20%, 30%, and then 40% as alcohol consumption rose from five drinks per week to 10, 15, and 20.

• Diet

  The body has a harder time fighting infection without proper nutrients. University at Buffalo researchers discovered that low levels of antioxidant vitamins increased periodontal risk, attributing the findings to the body's need for antioxidants to maintain homeostasis and control bacterial damage.

• Stress

  Keeping emotions on an even keel will help, too. People confronted with stressful situations often become distracted and cut corners on hygiene habits. In addition, not coping with stress reduces the normal functioning of the immune system

Symptoms

Although insidious at first, gum disease will steadily become worse without treatment. The American Academy of Periodontology says symptoms include:

• Gums pulling away from the teeth
• Swollen, red, or tender gums
• Gums that bleed with brushing or flossing
• Bad breath
• Loose or missing teeth
• A change in bite or the fit of partial dentures
• Pus between the tooth and gum

If you notice any of these symptoms, contact your dentist for a referral or call a periodontist directly.

Treatment

In its earliest stages, good oral hygiene and frequent professional cleaning will clear up the condition. If not, a periodontist can remove plaque from below the gum line and smooth or plane the tooth root to enable the gum to reattach. With more advanced cases, surgery may be required to clean up the infected area and rebuild damaged bone.

Often, periodontists will add a course of antimicrobial therapy—pastes, gels, or polymers applied topically, or antibiotic pills to eliminate more aggressive bacteria. The specialists may also order Periostat, a pill that decreases the concentration of destructive enzymes called collagenases around the teeth and protects the tissue from additional damage. Treatment can prevent further deterioration associated with periodontal disease.

"What we don't know is if you clear up the periodontal disease, whether you decrease the risk for coronary artery disease," says Caton, explaining that additional intervention studies are under way. Preliminary studies suggest that periodontal treatment can lower the blood “high sensitivity C-reactive protein” (hsCRP). Elevated blood levels of hsCRP are regarded as an important risk factor for coronary artery disease. While researchers determine if treatment can reduce the cardiac risk, professional care will minimize tooth loss. Tooth loss is clearly associated with risk of heart disease. The best bet for oral health remains prevention and minimizing periodontal risk factors.