Many of you may have received the e-mail Issue Alert from the ADA about the link between gum disease and heart disease. According to a recent scientific statement published in Circulation, a journal of the American Heart Association, gum disease has not been proven to cause atherosclerotic heart disease or stroke.

This may seem like an about face by the AHA and the ADA but we have seen this before. How many times have guidelines for the prevention of infective endocarditis changed? When I graduated the number of indications, dosage and frequency of the prophylaxis was completely different from the most recent guidelines published in 2008.

The public is used to these types of changes in recommendations as well. One day coffee or wine is bad and the next day it's good. As we speak there are millions of cariogenic (and calorie-filled) dark chocolate bars being sold with health claims due to the antioxidants contained in the bar!

Keep our patients healthy

As dentists we know that keeping our patients healthy contributes to overall wellness; however, the link from gum disease to heart disease and stroke turns out to not be as strong as originally perceived.

The expert committee for the American Heart Association was made up of cardiologists, dentists and infectious disease specialists. The committee reviewed more than 500 journal articles and reviews and the group did not find conclusive scientific evidence that periodontal disease causes or increases the rate of cardiovascular disease.

While Dr. Peter Lockhart, co-chair of the statement writing group, indicates that there is conflicting information from the literature, he also says that if there was a causal link it would be evident by now. He also says a larger long-term study is needed, but it isn't likely to happen in the near future.

Much confusion exists

The group's statement is significant, in that for years in the medical community it was simply a given that the link was proven. If there is this much confusion among those practicing dentistry and medicine, imagine what it must seem like from the point-of-view of our patients.

Whenever perception and reality conflict, people often jump to conclusion. I think we need to be careful in the future with such issues. It's important to give people reasons to stay healthy but it is also important not to step over that invisible line.

Patients who are already reluctant to seek treatment for their oral health may put it off if they feel their ailments can't lead to other illnesses. However, we have a responsibility to educate our patients on the reasons the treatments we recommend are required and what neglect could legitimately lead to down the road.

Are your patients asking you about this statement?

Are they confused? More importantly, do you feel that this brings up an issue of trust between patient and doctor? What can we do to clear up the confusion? Let us know your thoughts.


Commenter's Profile Image Jody
April 24th, 2012
The article says that gum disease doesn't "cause" heart disease. I never really thought it "caused" it but I did believe those that are more prone to gum disease are also more prone to cardiovascular disease (and diabetes). Perhaps there should be more clarification on this issue. Perhaps there is a genetic predisposition to the two types of diseases or lifestyle issues but they definitely seem to go hand in hand even if the causative link isn't there.
Commenter's Profile Image Martin
April 24th, 2012
Jody, good point. See below directly from the ADA press release. I think the issue is whether or not we should be telling patients that the dental treatment proposed should be accomplished for reasons other than oral health. I.E. you should have scaling and root planing because it may cause heart disease. "Although there is a body of research showing that gum disease is associated with several health conditions such as heart disease, stroke, and diabetes; just because two conditions are associated with each other does not mean that one causes the other. Both heart disease and gum disease share common risk factors, such as smoking and diabetes, which play a role in the development of both diseases."