Understanding the intricate relationship between oral health and systemic health unveils a complex interplay that extends beyond mere dental concerns. As research continues to unravel the profound connections between the two, it becomes increasingly evident that oral health serves as a window into one's overall well-being. The correlation between periodontal disease and cardiovascular health conditions like atherosclerosis stands as a significant illustration of the interconnection between oral and systemic well-being.
What is periodontal disease?
Periodontal disease, commonly known as gum disease, refers to a variety of conditions that impact the tissues surrounding our teeth. If not addressed, it can lead to severe and irreversible consequences. The two main types of gum disease are gingivitis and periodontitis. Gingivitis marks the initial stage, characterized by inflammation of the gingiva (gum tissue), resulting from the accumulation of bacteria and plaque along the gum line. Symptoms include visible plaque, bad breath, and swollen gums that bleed during brushing or flossing. Luckily, with proper dental care, gingivitis can be reversed, restoring our gum health to normal.
However, if left untreated, gingivitis can progress into periodontitis, a more severe form of gum disease. Periodontitis involves inflammation and damage that extend beyond the gums, affecting structures crucial for the support of our teeth, like bone. This can lead to gum recession, bone loss, and in severe cases, tooth loss. The repercussions of periodontitis can extend beyond dental health, impacting overall well-being. Recent studies suggest a potential link between periodontal disease and atherosclerosis.
What is atherosclerosis?
Atherosclerosis is the buildup of plaque in our arteries. It begins when particles in the blood called low-density lipoproteins (LDLs) travel through the inner lining of previously damaged blood vessels. This damage can result from factors like high blood pressure and smoking. When LDL encounters harmful molecules containing oxygen, known as oxygen free radicals, it undergoes a chemical change and becomes oxidized LDL, sparking an inflammatory cascade. Specialized immune cells called macrophages engulf oxidized LDL and transform into foam cells that release substances and attract even more immune cells. Over time, a scar tissue layer, called a fibrotic cap, forms over the plaque, while foam cells die, leaving behind a center where calcium can accumulate, causing hardening. As arteries narrow due to plaque buildup, it can reduce blood flow to different body parts, resulting in symptoms like leg pain (claudication) and chest pain (angina). In severe cases, plaques can weaken artery walls, leading to bulges called aneurysms or the formation of blood clots (thrombosis), which can block blood flow and cause tissue death (infarction).
So, what’s the link between the two?
The connection between gum and heart disease lies in the inflammatory response triggered by periodontitis. When gum disease occurs, bacteria in the mouth can lead to inflammation in the gums. Inflammatory mediators and cytokines can spread throughout the body, contributing to systemic inflammation.1 Systemic inflammation can affect the lining of blood vessels, making them more prone to damage. As we have learned, when blood vessel walls are damaged, it creates opportunities for substances like cholesterol to accumulate and form plaque.
When subjected to periodontal pathogens, rodent models of human atherosclerosis displayed an acceleration in atherogenesis. This acceleration was characterized by “increased plaque progression, greater infiltration of macrophages, elevated levels of inflammatory markers, lipid buildup in the arterial wall, formation of foam cells, and other proatherogenic indicators.”2 It has even been demonstrated that periodontal bacteria can travel through systemic circulation, triggering bacteremia and inflammation.3 Conversely, studies have importantly demonstrated that treatment of periodontitis reduced inflammation (marked by decreased serum CRP) and had positive effects on atherosclerosis.4
While our current health system often treats oral health and systemic health separately, it's becoming increasingly clear that they are deeply interconnected. Maintaining good oral health through practices like proper dental hygiene and regular check-ups is crucial. Not only does this help prevent gum disease, but it also plays a vital role in reducing the risk of developing atherosclerosis and related cardiovascular complications. By recognizing the integral link between oral health and overall well-being, we can adopt more holistic approaches to healthcare that prioritize both dental and systemic health.
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