Oral Bacteria Linked to Cardiovascular Disease

MedicalResearch.com Interview with:
Bradley F. Bale, M.D.

Texas Tech Health Science Center
School of Nursing, Lubbock, Texas
1002 Montrose Drive
Gallatin, TN 37066

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It has been known for some time that periodontal disease is associated with higher risk for arterial disease.  It was shown decades ago that the germs in the mouth frequently seed into our blood stream with simple activities such as chewing and brushing our teeth.  During the last decade, it was discovered certain high risk periodontal pathogens are associated with various cardiovascular (CV) risk factors such as blood pressure, lipid levels, insulin resistance and endothelial dysfunction.  These studies elucidated that the CV risk stems from the bacteria involved in the periodontal disease and not the clinical signs such as pocket depth, bleeding of gums and loose teeth.

The above knowledge demonstrated that high risk periodontal pathogens can adversely influence two of the three elements in the atherogenic triad.  Those factors are concentration of apoB and endothelial inflammation and dysfunction.  Then approximately two years ago it was published that the high risk pathogen Porphyromonas  gingivalis (P.g.) can enhance the third element.  This portion is the transformation of contractile smooth muscle cells (SMCs) in the medial layer of artery into migratory secretory SMCs.  These morphed cells enter the deep layer of the intima and enrich it with proteoglycans which are the ‘velcro’ that traps cholesterol particles in the arterial wall and initiates the formation of arterial disease.  At that point, there was solid evidence that the high risk pathogens boost every element in the triad to create atherosclerosis.  With that knowledge these pathogens must be considered a contributory cause of arterial disease.  When a condition is causal it demands diagnosis and management to reduce the disease risk.

MedicalResearch.com: What should readers take away from your report?

Response: CVD is still the number one cause of death and disability along with being the number one healthcare expenditure.  Periodontal disease is extremely common being found in ~ 50% of adults 30 to 64 years of age and ~70% in those 65 and older.  Therefore, by diagnosing and managing high risk periodontal pathogens, the opportunity exists to have a significant impact on CVD.  It is well known there is substantial residual CV risk beyond cholesterol, hypertension and smoking.  It is exciting to realize there is another modifiable risk factor, namely periodontal disease, which can mitigate CV risk.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: The average person on the street needs to realize that periodontal disease can be due to germs that cause arterial disease.  They need to discuss this with their dentist and hygienist.  Periodic oral DNA testing for the bacteria should be performed.  They also need to realize if some are found their ‘significant other’ should be tested and treated.  Good health starts with a healthy mouth.  Hygienist and dentists are in a position to impact significantly CVD; the number one cause of death and disability.  We hope the American Heart Association catches up with this science and gives the oral-systemic connection the attention it deserves.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.


High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis Bradley Field Bale,1 Amy Lynn Doneen,1 David John Vigerust
Bale BF, et al. Postgrad Med J 2016;0:1–6. doi:10.1136/postgradmedj-2016-134279

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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April 9, 2017 Thoughts from Co-Author Dr. Amy Doneen

Your oral health can have a powerful effect on your risk for heart attacks or strokes, according to a peer-reviewed Bale Doneen study published in Postgraduate Medical Journal.  Using level A scientific evidence, the research is the first to reveal that periodontal disease (PD) due to certain high-risk bacteria can be a contributing cause of cardiovascular disease (CVD), the leading killer of men and women.

Also known as gum disease, PD is a chronic oral infection that affects the majority of Americans over age 30, many of whom are undiagnosed and unaware of their cardiovascular danger. Here is a closer look at the research and heart-smart steps the Bale Doneen Method recommends to keep your teeth and your ticker healthy.

Why is this study considered landmark?

Earlier research, including a scientific statement by the American Heart Association, has shown a strong, independent association between PD and CVD (which is also called heart disease). Indeed, a 2016 analysis of studies involving more than 7,000 people found that those with periodontitis were 2.5 times more likely to suffer heart attacks than those with healthy gums!

However, there is a key difference between one condition being associated with another disease versus being causal. Even optimal care for an associated condition may not have any impact on the end disease, while such management of a causal condition for CVD could be potentially lifesaving, by helping people avoid heart attacks and strokes.

What are the symptoms of gum disease?

In the early stages, PD often has no obvious symptoms. As a result, millions of people don’t realize they have a serious oral infection that can result in tooth loss, if untreated, and has now been shown to cause CVD.

Warning signs of PD include red, swollen or tender gums, bleeding when you brush or floss, loose or sensitive teeth and persistent bad breath. To find out if you have PD, as your dental provider to do a painless exam, using a mirror and periodontal probe to check for signs of oral infection.

How can I find out if I have high-risk oral bacteria?

There are companies that measure Oral Pathogens through DNA analysis.  Some include: OralDNA, OraVital, and Hain Diagnostics.

What’s the best treatment for PD?

While the results of the DNA pathogen tests can help guide personalized treatment for gum disease, there is no therapy proven to be 100% effective for getting rid of high-risk oral bacteria. Available treatments include more frequent cleaning, laser therapy, improved home care, prescription mouthwashes, dental trays with antibacterial gel (PerioProtect) and sometimes short courses of oral antibiotics.

No matter which treatment is prescribed, the Bale Doneen Method recommends repeating the DNA pathogen test afterwards to see if it worked.

What are the best ways to avoid PD–and lower heart attack risk?

If you smoke, here’s even more motivation to snuff out the habit: It’s a leading risk for developing gum disease.  We also advise these measures to optimize your oral health:

  • Brush and floss twice a day. Although you may have seen headlines claiming there’s not much science to support flossing, in a nine-year study of 5,611 older adults, people who never flossed had a 30% higher death rate than those who flossed daily!
  • Go to bed with a clean mouth. The study found that never brushing at night raised mortality risk by 25%, versus nightly brushing. Since your mouth produces less saliva to wash your teeth and gums when you’re sleeping, it’s particularly crucial to floss and brush thoroughly before bed. We recommend brushing with a sonic toothbrush for best results.
  • Get a dental cleaning every 3 months, or as advised by your dental provider. The study also found that people who hadn’t gone to a dentist in the previous year had a 50% higher mortality rate than those who went 2 or more times annually, leading the researchers to conclude that good oral health promotes longevity by helping people avoid lethal systemic diseases sparked by infections and chronic inflammation, such as CVD.
  • Share the PMJstudy with your dentist and hygienist. Because this science is so new, your dental provider may not be aware of it yet. Download or read the study online at http://pmj.bmj.com/content/93/1098/215?etoc. Use it to encourage him or her to join your heart attack and stroke prevention team!

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on April 13, 2017 by Marie Benz MD FAAD