BY LORY LAUGHTER, RDH, BS
Getting a clear and definite answer to any query can be time consuming, especially on the Internet where opinions abound yet are often presented as scientific fact. Seeking solid studies, transparent in funding sources and possible bias, is more difficult than you can imagine. Even among topics we consider studied and answered, there is still conflicting research and opinions.
I was a bit shocked recently to see an ADA news article that downplayed the relationship between periodontal disease and cardiovascular disease. The press release posted at ada.org states that the ADA agrees with the American Heart Association that no causative link exists between periodontal disease and heart disease or stroke. The word "causative" makes a big difference in the validity of the statement, but in the print version of the April 23, 2012, article, that word is not a focal point.
The American Association of Periodontology also addresses the AHA report at perio.org. The AAP article focuses on observational studies showing an association between periodontal disease and cardiovascular disease. In my opinion, the ADA article attempts to downplay the relationship between oral and heart disease, while the AAP states, "The lack of causal evidence should not diminish concern about the impact of periodontal status on cardiovascular health."
My concern is not with the data or statements to the dental community about the AHA findings, but rather how it is being presented to the public. While we understand the difference between an association and a cause and effect relationship, our patients are simply reading the headlines. On the KTVQ news site at ktvq.com, the story is touted as "Heart Association: No link between gum disease and heart disease." For many people, the reading ends right there.
Redorbit.com has a similar bold headline -- "Study shows no link between gum disease and heart attack or stroke." The title gives no indication of the definite association between periodontal disease and cardiovascular disease, leading the public to believe oral health is not related to overall health.
As health-care providers, we rely on scientific research from credible sources to make treatment decisions. Unfortunately, many patients rely on easily accessible media and popular television health shows. For this reason, the recent headline on the Dr. Oz site should be of concern. Those visiting the site saw in large print, "Breaking News: No Link Between Gum Disease and Heart Disease." Dr. Oz has devoted time on his show in the past to encourage good oral hygiene for overall health, so when the search engine took me to doctoroz.com, it was a bit of a surprise.
Educating the public on the association between periodontal disease and cardiovascular disease is even more important with the confusing information available. Elevated C-reactive protein is a known risk factor for cardiovascular disease, and studies show this elevation in patients with periodontal disease. Several studies available on PubMed demonstrate the C-reactive protein connection between oral and heart diseases. A study by researchers from India (ncbi.nlm.nih.gov/pubmed) concludes with a strong statement, "Findings of the present study indicated that periodontitis should be of particular concern in younger individuals, where elevated levels of CRP may contribute to early or more rapid cardiovascular disease in susceptible patients."
Another interesting piece on PubMed shows oral bacteria present in atherosclerotic arteries of patients with acute myocardial infarction. The conclusion states that three species of periodontal bacteria were present in arterial plaque removed from patients who experienced acute myocardial infarction, and may play a role in plaque inflammation and instability.
With all the conflicting information available, getting the appropriate message to patients is an essential role of all dental hygienists. Aids are available to help open the door for conversation and provide further information. The National Institute of Dental and Craniofacial Research provides free brochures on their website at nidcr.nih.gov. Under the Oral Health tab, you can find free publications in both English and Spanish. The Gum Disease pamphlet at the same site is easy for patients to read and understand. You can also direct patients to the site to read articles and information on a variety or oral health topics.
Tricare Dental, an insurance carrier for military families, provides brochures you can print from their site, tricaredentalprogram.com. The pamphlet entitled "Your Oral Health and Heart Disease" provides useful information with no advertising for products or services. A quick search for "oral health brochures" guides you to several sources that provide low cost or free publications for patients and the public.
Dental hygienists are educated professionals with the knowledge and ability to sort out the information available and reach an evidence-based conclusion. When confusion and disagreements in science arise, do not hesitate to weave the web for clarification, education, and even a bit more controversy and uncertainty. RDH