The Missing Link Between Gum Disease and Heart Disease

April 19, 2012

It’s medical dogma that having gum disease can cause heart disease. The most common explanation is that bacteria from your mouth can spread through the bloodstream and infect your heart valves (called endocarditis). The problem with this explanation is that endocarditis is a tiny fraction of people who have heart disease. Just because there’s an association, it doesn’t mean that one causes the other.

The American Heart Association recently reviewed 537 articles on this subject and published a review, stating that there’s no scientific evidence that gum disease causes heart disease, heart attacks, or stroke. Past studies were mainly observational, and not based on prospective studies. They also state that there’s no evidence that treating periodontal disease can prevent heart disease.

What’s the missing link? You guessed it: Obstructive sleep apnea. We know that obstructive sleep apnea can cause reflux and inflammation in the mouth. Mouth breathing due to craniofacial narrowing and inflammation also dries out saliva, which helps to protect your mouth from pathogens. If you’re missing teeth, then your mouth gets smaller, narrowing your airway even further. We also know that obstructive sleep apnea significant increases your risk of heart disease, heart attack, stroke, and death.

So it makes sense that if you treat sleep apnea, you’ll have less gum disease, and less heart disease. Obviously a prospective, randomized, placebo-controlled, double-blinded study is needed to prove this point.

4 Responses to “The Missing Link Between Gum Disease and Heart Disease”

  1. Christopher on April 29th, 2012 4:26 am

    A coincidence? I queried my dentist on morning this blog was posted. Sleep deprivation can reduce the routines of hygeine. Less time to get ready, oral attention is limited. Flossing, brushing twice or three times a day was outside the parameters of priority and accomodation.

  2. Dr. Deb on May 1st, 2012 4:42 pm

    here’s another one:
    Maternal periodontitis as a risk factor for prematurity. Apparently, according to the authors, you can reduce your risk for having a premature infant by simply flossing your teeth. One of the other causes for prematurity listed here was pre-eclampsia. We know the incidence of OSA in pre-eclampsia is 82%.

    they need to do a comparison study where one group of women with periodontitis has CPAP for the pregnancy, another group simply flosses their teeth, plus a control group that does nothing, and compare outcome. This might be faster than a study on heart disease. Then maybe the scientists who believe gum disease causes heart disease might think again.

  3. Michael Nelson on November 18th, 2012 11:58 pm

    Dr. Park,

    A point floating around our sleep apnea/dental discussion group is that 85% of patients with periodontal disease have OSA.

    Have you seen a study linking the two that we could cite? I agree with the logic above, but would also appreciate any references you might be aware of.

  4. Steven Park on November 19th, 2012 6:27 am

    Michael Nelson,

    Sorry, but there are no studies that I’m aware of that associate obstructive sleep apnea with periodontal disease. Since most physicians still think it’s the other way around, no one will do studies to contradict medical and dental foundations. One aspect of OSA that I didn’t mention in my blog is the role of reflux, which is extremely common with OSA. Stomach contents can include acid, digestive enzymes, and bacteria, which can aggravate periodontal disease and cavities, especially if you mouth breathe. Note that Weston Price reported on “primitive” cultures that had no dental crowding, excellent teeth and periodontal status despite not having modern dental hygiene methods. The wider the jaws, the less airway crowding, with less apneas and reflux.

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