UB Faculty Experts

UB’s chair of periodontics and endodontics, Sebastian Ciancio, DDS, responded to questions about the American Heart Association’s recent statement that although observational studies support an association between periodontal disease and atherosclerotic vascular disease, they don’t support a causative relationship.

You have been involved in many studies of the relationship of periodontal disease and CVD. What do you say to this claim?

The problem with the press release of the AHA statment is that the press release does not accurately reflect what the statement says. The actual statement is scientifically correct and reports tht there is an assciation between periodontal disease and cardiovascular disease but no causal relationship. Periodontal researchers are generally in agreement that there is an association between periodontal disease and cardiovascualar disease but that a cause and effect relationship has not been established. However, the press release is written in such a way as to suggest that there is no association as well as no causal relationship.

It is noteworthy that a large body of research suggests that periodontal disease is linked to cardiovascular disease, independent of shared risk factors. As a matter of fact, the statement by the American Heart Assn. states “ Statistical adjustment for smoking in studies of the association between periodontal disease(PD) and atherosclerotic cardiovascular disease (ASVD) does not preclude the possibility for residual confounding; however, recent evidence seems to indicate that the observed association between PD and ASVD may be independent of smoking. It has been shown, both in cross sectional and longitudinal studies that PD and ASVD are associated in never smokers as well.”

The press release is also misleading in that it states that “500 journal articles and studies reviewed by the committee didn’t confirm a causative link.”

However the article only addresses data from 79 studies.

What would you like for the public to know about this?

I would like the public to realize that there are a number of studies which show an association between periodontal disease and cardiovascular disease and in 2009, the editor of the American Journal of Cardiology joined with the editor of the Journal of Periodontology joined together to publish an article Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. In that article they state: “It seems reasonable, however, on the basis of current data, to acknowledge that because untreated or inadequately controlled moderate to severe periodontitis increases the systemic inflammatory burden, periodontitis may independently increase the risk for CVD (Cardiovascular Disease).

I am agreement with these editors and their review and summary comments. Therefore I would like the public to realize that there is an association between CVD and periodontal disease and that good oral health is important not only for retaining teeth but also for having an impact on their general health. Studies have not only suggested a relationship between periodontal disease and CVD but also with diabetes severity, respiratory infections, rheumatoid arthritis, and pre-term low birth weight babies. Although proof of a cause and effect relationship has not been clearly established in these conditions, a strong association with these conditions has been demonstrated.

Therefore my advice to the public is to maintain your mouth in as healthy a condition as possible because there is good reason to believe that a healthy mouth is important for a healthy body.

Is there anything you could add?

The best way to have a healthy mouth is by thorough brushing twice daily with an antiseptic toothpaste, flossing at least once a day, and rinsing twice daily with an antiseptic mouth rinses. Mouth rinses and toothpastes accepted by the American Dental Association for the management of plaque and gingivitis are definitely the most effective on the market and consumers are advised to use these products to get the best value for their oral care expenditures. In addition, professional tooth cleaning and dental examinations are important at least twice a year.

The UB School of Dental Medicine is a valuable resource for our community and new patients are welcome as are subjects interested in being in our many dental studies. Visit our website, at dental.buffalo.edu to learn more about our school, our treatment programs and our research programs.