Periodontal bacteria and cardiovascular disease: Causality between mouth and body at last!

In his “Making the Oral-Systemic Connection” blog on DentistryIQ, Dr. Richard H. Nagelberg says, “It was only a matter of time until causality was demonstrated between periodontal bacteria and cardiovascular disease.” He explains why it is so critical to identify bacteria by salivary testing, reduce the bacterial population, and then retest. Once we know what we’re fighting and preventing, the race seems all the more worth the effort.

Feb 28th, 2017
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Dr. Richard H. Nagelberg says, “It was only a matter of time until causality was demonstrated between periodontal bacteria and cardiovascular disease.” He explains why it is so critical to identify bacteria by salivary testing, reduce the bacterial population, and then retest. Once we know what we’re fighting and preventing, the race seems all the more worth the effort.


It was only a matter of time until causality was demonstrated between periodontal bacteria and cardiovascular disease. A recently published journal article states: “There is scientific evidence that PD (periodontal disease) caused by the high-risk pathogens can influence the pathogenesis triad in an adverse manner. With this appreciation, it is reasonable to state PD, due to high-risk pathogens, is a contributory cause of atherosclerosis. Distinguishing this type of PD as causal provides a significant opportunity to reduce arterial disease.” (1)

The pathogenesis triad refers to the three criteria necessary to determine causality for atherosclerosis (arteriosclerotic vascular disease or ASVD), specifically serum lipoprotein concentration, endothelial permeability, and lipoprotein binding in the intima. If a medical condition or other agent influences all of these elements, it can be concluded that it is a contributory cause of ASVD.

The article states that the periodontal pathogens Aggregatibacter actinomycetemcomitans(Aa), Porphyromonas gingivalis(Pg), Tannerella forsythia (Tf), Fusobacterium nucleatum (Fn), and Treponema denticola(Td) are causal for ASVD by affecting the triad in a manner favoring the development of atherosclerosis. (1)

The authors further stated: “From a clinical perspective there is a significant difference between being associated with versus being causal of a disease. Optimal management of an associated condition may not impact the end disease, whereas such management of a causal condition would have a favorable effect on the end disease.” (1) Their conclusions included the following: “PD due to these high-risk microbes must be treated effectively to reduce the risk of ASVD.” (1)

The primary takeaway is the critical need to identify the bacteria by salivary testing, reduce the bacterial population, and then retest. Diminishing the likelihood of a cardiovascular event, such as a heart attack or stroke, from atherosclerosis is an enormous opportunity and now our responsibility as dental professionals.


READ MORE OF DR. NAGELBERG’S BLOGS . . .


Reference

1. Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J. 2016. doi: 10.1136/postgradmedj-2016-134279. [Epub ahead of print].


Richard H. Nagelberg, DDS, has practiced general dentistry in suburban Philadelphia for more than 30 years. He is a speaker, advisory board member, consultant, and key opinion leader for several dental companies and organizations. He lectures on a variety of topics centered on understanding the impact dental professionals have beyond the oral cavity. Contact Dr. Nagelberg at gr82th@aol.com.


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