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Monday, April 30, 2012

Not Again... Twice in One Month!

I don't know if every one's patients are as up on dental news as mine are but this month has been full of discussions about x-rays and heart disease.

Just as the waters seem to be settling on the new finding on x-rays the following study emerges and muddies the waters on gum disease.

A doctor I work for made this comparison:
"Studies show that drinking red wine reduces your chance of heart disease. But it is impossible to tell if it is the red wine or other factors in the life style of someone who drinks red wine (as compared to someone who drinks beer...) that is actually responsible for the lower risk." B.R.

Below is a summary of the AHA findings, followed by a statement released by The Canadian Dental Association.

No proof that gum disease causes heart disease or stroke
 April 18, 2012 
Statement Highlights: There is no convincing evidence that proves gum disease causes heart disease or stroke, or treating gum disease reduces the risk of those diseases. Gum and heart disease share common risk factors, including smoking, age and diabetes, which is possibly why the diseases often occur in the same person.
 EMBARGOED UNTIL 3 pm CT/4 pm ET, Wednesday, April 18 DALLAS, April 18, 2012 —
 Despite popular belief, gum disease hasn’t been proven to cause atherosclerotic heart disease or stroke, and treating gum disease hasn’t been proven to prevent heart disease or stroke, according to a new scientific statement published in Circulation, an American Heart Association journal.

 Keeping teeth and gums healthy is important for your overall health. However, an American Heart Association expert committee -- made up of cardiologists, dentists and infectious diseases specialists -- found no conclusive scientific evidence that gum disease, also known as periodontal disease, causes or increases the rates of cardiovascular diseases. Current data don’t indicate whether regular brushing and flossing or treatment of gum disease can cut the incidence of atherosclerosis, the narrowing of the arteries that can cause heart attacks and strokes. Observational studies have noted associations between gum disease and cardiovascular disease, but the 500 journal articles and studies reviewed by the committee didn’t confirm a causative link. “There’s a lot of confusion out there,” said Peter Lockhart, D.D.S., co-chair of the statement writing group and professor and chair of oral medicine at the Carolinas Medical Center in Charlotte, N.C. “The message sent out by some in healthcare professions that heart attack and stroke are directly linked to gum disease, can distort the facts, alarm patients and perhaps shift the focus on prevention away from well known risk factors for these diseases.” Gum disease and cardiovascular disease both produce markers of inflammation such as C-reactive protein, and share other common risk factors as well, including cigarette smoking, age and diabetes mellitus . These common factors may help explain why diseases of the blood vessels and mouth occur in tandem. Although several studies appeared to show a stronger relationship between these diseases, in those studies researchers didn’t account for the risk factors common to both diseases. “Much of the literature is conflicting,” Lockhart said, “but if there was a strong causative link, we would likely know that by now.” A large, long-term study would be needed to prove if dental disease causes heart disease and stroke, he said. Such a study isn’t likely to be done in the near future, and it’s most important to let patients know “what we know now, and what we don’t know,” Lockhart said.

 For more than a century, doctors have proposed that infected gums lead to systemic problems like heart disease, and we know that mouth bacteria frequently enter the blood stream during dental procedures and during naturally occurring events such as tooth brushing. “We already know that some people are less proactive about their cardiovascular health than others. Individuals who do not pay attention to the very powerful and well proven risk factors, like smoking, diabetes or high blood pressure, may not pay close attention to their oral health either” Lockhart said. Statements that imply a cause and effect relationship between periodontal disease and cardiovascular disease, or claim that dental treatment may prevent heart attack or stroke are “unwarranted,” at this time, the statement authors said. The American Dental Association Council on Scientific Affairs agrees with the conclusions of this report. The statement has been endorsed by the World Heart Federation.

 The statement’s writing group was co-chaired by Ann F. Bolger, M.D. Other co-authors are Panos N. Papapanou, D.D.S., Ph.D.; Olusegun Osinbowale, M.D.; Maurizo Trevisan, M.D.; Matthew E. Levison, M.D.; Kathryn A. Taubert, Ph.D.; Jane W. Newburger, M.D., M.P.H; Heather L. Gornik, M.D., M.H.S.; Michael H. Gewitz, M.D.; Walter R. Wilson, M.D.; Sidney C. Smith Jr., M.D.; and Larry M. Baddour, M.D. Author disclosures are on the manuscript.

 Learn more about how a healthy lifestyle and healthy eating are important steps toward good health. Take these free risk assessment quizzes and find your personal risk of heart attack, high blood pressure and diabetes. Visit the American Stroke Association site for comprehensive info on stroke. ### The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association’s science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at . NR12-1061 (Circ Statement/Lockhart) Additional resources, including multimedia, is available on the right column of this link: For Media inquiries: (214) 706-1173 Maggie Francis: (214) 706-1382; Bridgette McNeill: (214) 706-1135; Julie Del Barto (broadcast): (214) 706-1330; For Public Inquiries: (800) AHA-USA1 (242-8721) and

 The Canadian Dental Association reaffirmed on Friday their position after consulting with the Canadian Medical Association and CHA: 
 Association between Periodontal Disease and Systemic Disease The Canadian Dental Association recognizes the impact of systemic diseases, such as diabetes and immuno-compromised states on the periodontal tissues. A report on oral health (‘Oral Health in America: A Report of the Surgeon General’) released May 25, 2000 supports the possible association between periodontal disease and systemic disease. This report suggests that the signs and symptoms of life-threatening diseases may appear in the mouth long before they show up in other parts of the body. The Surgeon General’s report highlights a bi-directional interaction between oral and systemic health. Systemic conditions noted to occur with oral manifestations include diabetes, cutaneous diseases, hereditary disease, joint disease, immuno-compromised states and osteoporosis. Recent evidence presented in this report, primarily from epidemiological studies, now suggests that there may be an association between periodontitis and certain systemic disorders, notably cardiovascular disease (artherosclerosis, heart attacks and strokes) and complications of pregnancy (pre-term birth and low birthweight infants). While a number of interactions have been identified, other reviewers suggest no or limited relationship. Therefore, additional research is needed to evaluate disease pathogenesis, relationships to the oral cavity and possible therapeutic interventions. Dentists and dental specialists are constantly looking for signs and symptoms of these diseases, which can be detected during regular oral health and physical examinations. The Canadian Dental Association recognizes the Surgeon General’s report but recommends that further emphasis should be placed on research and educating dentists, physicians, students, residents, other healthcare professionals and most importantly, patients regarding the importance of these possible relationships. This report places oral health in the perspective of systemic health and suggests that the dental and medical professions need to develop even closer ties in the future. Approved CDA Board of Directors February 2005


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