Periodontal Disease and Cardiovascular Disease: Association or Causal?

Many epidemiological studies report the relationship between periodontal disease (PD) and cardiovascular disease (CVD).  The majority of Americans age 30 and older are affected by PD. CVD is the number one cause of morbidity and mortality in the United States.  PD is increasingly regarded as a risk factor for CVD.  The mechanism by which periodontal disease affects coronary heart disease has not been established, though there are numerous theories, ranging from the actions of periodontal pathogens in the coronary arteries or endothelium leading to systematic inflammation, with subsequent detrimental effects on cardiovascular health. The current position of the American Heart Association and the American Dental Association is that while periodontal disease and heart health have an association, additional research is needed to establish whether one causes the other.

Most recently, the work of Drs. Bradley Bale and Amy Doneen in the Postgraduate Medical Journal * claim that PD resulting from high risk periodontal pathogens should be considered causal of CVD.  Their studies show that the inflammatory response of this periodontal infection which causes destruction of the periodontium (bone and attachment) and eventual tooth loss, promotes the systemic effect that leads to CVD.  Bale-Doneen claim that treatment and management of PD will result in a favorable effect on the prevention of CVD.  They have developed the Bale-Doneen Method (BDM), which is a comprehensive protocol to establish and maintain arterial health, thus preventing heart attacks and strokes in our patients with PD (see next article). 

*  Bale BF, et al.,Postgrad Med J 2017; 93:215-220