Treating chronic gum disease – can it help to prevent heart disease?

Gum disease (periodontitis) is a common chronic or persistent condition that can get worse over time. It involves inflammation of the gums, which surround and support the teeth, causing swollen and painful gums and in severe cases loss of the bone that supports the teeth. Clinical investigations have shown that there might be a link between chronic, ongoing gum disease and heart and blood vessel disease (cardiovascular disease). Some investigators believe that the treatment for gum disease, which gets rid of bacteria and infection and controls inflammation, might prevent the occurrence or recurrence of heart disease.

What was the research?

A systematic review of the evidence to assess whether or not treatment for moderate to severe gum disease (periodontitis) also has an effect on the prevention or management of heart and blood vessel (cardiovascular) disease.

Who conducted the research?

The research was conducted by a team led by Chunjie Li, on behalf of the Cochrane Oral Health Group. Zongkai Lv, Zongdao Shi, Ye Zhu, Yafei Wu, Longjiang Li, Zipporah Iheozor-Ejiofor were also on the team.

What evidence was included in the review?

Data was extracted from only one randomised controlled trial. A total of 303 people participated in the trial. All of the participants had to have had a blockage of one coronary artery or a coronary event within the last three years (but not the last three months). The trial looked at scaling and root planing with community care, followed up for six to 25 months.

What did the evidence say?

At present there is only one suitable study looking at this issue. The study had problems with its design. Based on this evidence it was not possible to determine whether or not treatment for gum (periodontal) disease has any effect on the occurrence or recurrence of heart disease in people with chronic gum disease.

How good was the evidence?

The one identified study was at high risk of bias due to deviation from the protocol, treatment allocation and lack of follow-up data. No data on deaths (all-cause or heart disease-related) were reported. The study did not assess cardiovascular risk factors, other blood test results, heart function parameters or revascularisation procedures.

What are the implications for dentists and the general public?

We found very low quality evidence that was insufficient to determine the effect of periodontal treatment on cardiovascular disease (CVD) in patients with chronic gum disease.

What should researchers look at in the future?

There is a need for more randomised controlled trials (RCTs) examining the effects of treatment for chronic gum disease. Periodontal treatment can be a single- or multi-regimen of scaling and root planing (SRP). Since the included study only offered a single regimen, new studies could focus on the effect of multi-regimen SRP in controlling gum disease. Multiple kinds of host modulation drugs could also be tested. There is need for more studies reporting on all-cause or heart disease-related deaths and cardiovascular events observed after long-term follow-up of one year or more. Most of the studies identified with our search strategy were excluded on the basis of inadequate follow-up period. For future research, it is important to stratify study participants according to the severity of the periodontitis together with the number of remaining teeth. Confounding factors should be carefully considered and controlled for, such as acute inflammation, smoking and diabetes mellitus. Limitations of the included study were due to non-compliance with the protocol, incomplete follow-up and lack of blinding of participants and personnel. In future studies, lack of compliance with the study protocol and incomplete follow-up of the participants can be reduced, as suggested by PAVE 2008, if patients are followed up by a cardiologist.

Link

Li C, Lv Z, Shi Z, Zhu Y, Wu Y, Li L, Iheozor-Ejiofor Z. Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis. Cochrane Database of Systematic Reviews 2014 , Issue 8 . Art. No.: CD009197. DOI: 10.1002/14651858.CD009197.pub2