Chronic gum disease is also known as periodontitis. It causes swollen and painful gums and loss of the bone that supports the teeth. ‘Chronic’ is a label that means the disease has continued for some time without treatment.
There may be a link between periodontitis and heart disease. The treatment for chronic periodontitis gets rid of bacteria and infection and controls inflammation. It is thought that this may help prevent the diseases of the heart and blood vessels. We wanted to find out whether treating chronic gum disease could help prevent death or reduce the likelihood of heart attacks or strokes.
What was the research?
A systematic review to examine whether treatments for chronic gum disease can prevent or manage heart disease.
Who conducted the research?
The research was conducted by a team led by Wei Liu of the West China Hospital of Stomatology, Sichuan University, China. Yubin Cao, Li Dong, Ye Zhu, Yafei Wu, Zongkai Lv, Zipporah Iheozor-Ejiofor and Chunjie Li were also on the team.
What evidence was included in the review?
We searched for scientific research studies known as ‘randomised controlled trials‘, up to 17 September 2019. In this type of study, participants are assigned in a random way to an experimental or control group. People in the experimental group receive the treatment being tested, and people in the control group usually receive either no treatment, placebo (fake treatment), another type of treatment or routine care.
We found two studies to include in our review. One study assessed 165 participants who did not have heart disease but had a combination of risk factors for heart disease. These risk factors can include obesity, high blood pressure, and high blood sugar. Together these risk factors are known as metabolic syndrome. This study compared treating gum disease by removing plaque from the teeth and tooth roots with removing plaque and giving antibiotics.
The other study had 303 participants who had heart disease. One group in this study had plaque removed from their teeth and tooth roots, and were given instructions on how to keep their teeth clean. The other group had instructions on how to keep their teeth clean, and were given x-rays of their mouth and told to follow up with a dentist.
What did the evidence say?
For people who have metabolic syndrome but no heart disease, we were unable to determine whether treating chronic gum disease reduced the risk of dying or having heart attacks or a stroke.
For people with heart disease and chronic gum disease, we found no reliable evidence about the effects of treating gum disease. This is because after a year, only 37 participants were assessed and so we thought the results were not reliable enough to be used.
How good was the evidence?
We classified the evidence as ‘very low certainty’. We are uncertain about the findings because there are only two small studies at high risk of bias. Overall, we cannot draw any reliable conclusions from the findings.
What are the implications for dentists and the general public?
There is very limited evidence assessing the impact of treating chronic gum disease on the prevention of heart disease. Further trials are needed before reliable conclusions can be drawn
What should researchers look at in the future?
There is a need for more randomised controlled trials examining the effects of treating gum disease on preventing heart disease. Researchers could look at including more people with conditions like high blood pressure and diabetes. The trials should be followed up for a much longer period of time so that long-term effects are reported.
Link
Liu W, Cao Y, Dong L, Zhu Y, Wu Y, Lv Z, Iheozor‐Ejiofor Z, Li C. Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis. Cochrane Database of Systematic Reviews 2019, Issue 12. Art. No.: CD009197. DOI: 10.1002/14651858.CD009197.pub4.
This post is an extended version of the review’s plain language summary, compiled by Anne Littlewood at the Cochrane Oral Health Editorial Base.
Cochrane Oral Health 