Monday, May 31, 2010

Your teeth, CVD and Inflammation

In a recent 8 year study published in the British Medical Journal (Cesar et al 2010) adults who brushed their teeth less than once a day were 70% more likely to suffer cardiovascular disease than those who brushed twice daily. In a subgroup analysis, poor oral hygiene was also linked to elevated C-reactive protein and fibrinogen levels indicating inflammation. The authors say their findings suggest "a possible role of poor oral hygiene in the risk of cardiovascular disease via systemic inflammation,".

Over the past two decades, there has been a growing body of scientific evidence linking dental disease, specifically periodontal disease, and cardiovascular disease through inflammation. Inflammation plays an important role in the pathogenesis of atherosclerosis, and markers of low-grade inflammation have been consistently associated with a higher risk of cardiovascular disease. Periodontal disease, a chronic infection of the tissue surrounding the teeth is one of the most common chronic infections and is associated with moderate inflammation, such as raised concentrations of C reactive protein and other inflammatory biomarkers. The theory is that oral infections and the associated inflammation might add to the inflammatory burden of the individual and result in increased levels of cardiovascular risk. A little bit of extra inflammation on topic of someone who is already at risk with underlying inflammation, appears to be the straw that breaks the camels back.

The study authors suggest that periodontal disease seems to be associated with a 19% increase in the risk of future cardiovascular disease. This increase in relative risk is more prominent (44%) in people aged under 65. Interestingly the relative risk benefits of cholesterol lowering drugs is in the same order of magnitude, around 20% to 40%. Shouldn’t we recommend cleaning your teeth instead of drugs. Don’t get confused between relative risk and absolute risk. Both these process save only one life in 100, around 1% absolute risk. But tooth brushing is a lot cheaper and no negative side effects.

The message from this research is the need for good oral hygiene and that CVD is an inflammatory disease not a cholesterol imbalance.

De Oliveira, Cesar, Richard Watt, Mark Hamer, Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ 2010;340:c2451

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