CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 17 • Number 1 • Fall 2004

Return to index of articles

Cardiovascular Disease and an Association with Gum Disease

Recent articles in peer-reviewed journals have documented a potential association between periodontal infection (gum disease) and coronary heart disease and stroke. This emerging body of evidence suggests that, in addition to being a major cause of tooth loss in adults, severe periodontitis (loss of the supporting gum and bone tissue) may be a contributing risk factor for these systemic diseases.^{1, 2}

Periodontitis is a chronic infectious disease that affects approximately 34% of the American population over age 30 (about 36 million people). About 5%–15% of adults have a severe form of periodontitis, which often leads to tooth loss. The disease begins as an acute inflammation of the gum tissue known as gingivitis; its major symptom is bleeding, especially upon tooth brushing. In susceptible individuals, particularly in the absence of recommended professional and self-care, gingivitis can progress to periodontitis, in which the destructive inflammatory process extends into the underlying bone.

Several systemic responses to chronic periodontal infections may increase risk for atherosclerosis, which, in turn, can precipitate a heart attack or stroke. People with severe periodontal infections often have elevated levels of serum C-reactive proteins (CRP), a biomarker for systemic inflammation. Experimental and observational studies (including cross-sectional and prospective studies) from inside and outside the United States have linked periodontal infections with coronary heart disease and stroke. This link is consistent with other evidence suggesting chronic infections may play an etiologic role in cardiovascular diseases.

Periodontitis and cardiovascular diseases share several common risk factors, in particular, smoking. Some researchers suggest that the two diseases may be comorbid conditions that result from smoking. A 2000 CDC study found that current cigarette smokers were four times more likely than nonsmokers to have periodontitis.³ Thus, smoking cessation is key both to prevention and treatment of periodontitis.

In April 2003, CDC convened health researchers, state dental directors, professional association members, and other public health professionals to discuss public health implications of chronic periodontal infections in adults. Presentations focused on the existing science regarding associations between periodontal infections and cardiovascular diseases, respiratory infections, diabetes, and poor reproductive outcomes such as preterm delivery. Proceedings of the conference will be published in the Fall 2004 issue of the Journal of Public Health Dentistry and will be available on the CDC Oral Health Web site at http://www.cdc.gov/OralHealth.

Although a number of studies have investigated the relationship between periodontal and cardiovascular diseases, results have been mixed— some studies reported a relationship and others, none. That inconsistency may stem from differences in study designs, outcome measures of cardiovascular disease, and case definitions of periodontal disease.

“Methods currently used to assess periodontal disease are very labor-intensive. Typically, they involve multiple clinical measures, up to six per tooth, and require a dental professional to estimate in millimeters the cumulative loss of supporting tissue,” stated Dolores M. Malvitz, DrPH, a CDC oral health researcher. “This gold standard limits our ability to determine disease prevalence in selected population groups.”

To respond to this need for measures that can be used more broadly, CDC has collaborated with the American Academy of Periodontology (AAP); a work group was convened, chaired by Robert Genco, DDS, PhD, Professor and Director of the Periodontal Disease Research Center, State University of New York at Buffalo and Editor of the Journal of Periodontology. During its 2-year life, the work group will identify reliable and valid self-reported surveillance measures for periodontal infections, as well as possible sentinel sites, events, providers, and payers. At the group’s second meeting last October, work group members presented findings from existing research on potential self-reported measures for periodontal infections. Currently, work group members are evaluating these candidate measures. “Better surveillance of periodontal disease will allow state oral health programs to develop and target preventive interventions, including education in self-care; such efforts should improve the oral health of adults,” stated Dr. Malvitz.

¹Lowe GD. The relationship between infection, inflammation, and cardiovascular disease: an overview. Annals of Periodontology 2001;6(1):1–8.

²Beck JD, Offenbacher S. The association between periodontal disease and cardiovascular diseases: a state-of-the-science review. Annals of Periodontology 2001;6(1):9–15.

³Tomar SL, Asma S. Smoking-attributable periodontitis in the United States: findings from NHANES III. Journal of Periodontology 2000;71:743–751.

Return to index of articles

Privacy Policy | Accessibility

Home | Contact Us

CDC Home | Search | Health Topics A-Z

This page last reviewed August 30, 2004

United States Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion