Periodontitis acquired its “official” standing as a cardiovascular risk factor in 2012 thanks to the European Heart Journal and its guidelines promoted by the European Society of Cardiology (ESC) for cardiovascular disease prevention in clinical practice.
In its 2012 publication, the ESC suggests that periodontitis be considered as a risk factor for cardiovascular disease development, for which its prevention and treatment are recommended. This is not the first time periodontitis has been associated with cardiovascular diseases, as extensive scientific and clinical evidence previously existed in regard to the negative impact this oral disease has on CVD. But, this recommendation by the ESC officially endorsed gingival infection prevention and management as the standard therapeutic strategy for preventing harmful consequences on a cardiovascular level.
Dr. Mariano Sanz, Dean of the School of Dentistry at the Universidad Complutense of Madrid points out that this recommendation is a milestone for promoting periodontal health, as it positions periodontitis on the same level as other diseases that have been proven to clearly impact cardiovascular health, such as diabetes and hypertension.
These guidelines warn that periodontitis is associated with endothelial dysfunction, with atherosclerosis and with an increased risk for myocardial infarction and stroke. They also stress that “periodontitis may be considered a risk indicator for achieving a low status of cardiovascular health”, and therefore it states that “its treatment is indicated, as is managing other underlying cardiovascular risk factors”.
What evidence exists?
Both cardiologists and dentists have agreed that diseases affecting the gums are a risk factor for coronary events, some with serious repercussions, such as myocardial infarction.
Similarly, the Spanish Society of Periodontology and Osseointegration (SEPA) and the Spanish Society of Cardiology (SEC) have created a manual on “Periodontal and Cardiovascular Diseases: their interrelationship and implications for health,” which aims to become a reference for Spanish specialists and Primary Care physicians.
Finally, it has been found that the association between periodontal disease and diabetes is bidirectional. That is, not only does diabetes mellitus (DM) increase the risk of periodontal disease, but periodontal disease can also affect DM (impacting glycaemic control).
Periodontal disease is the leading cause of tooth loss, affecting a large part of the population worldwide. In Spain, it is estimated that only 14.8% of adults between the ages of 35 and 44 have healthy gums, 59.8% have gingivitis and 25.4% have periodontitis. The situation is even worse for those between the ages of 65 and 74: 10.3% have healthy gums while the rest have some form of periodontal disease (51.6% gingivitis and 38% periodontitis).