Michael Eiffert, M.D.
Published: April 27, 2009
The connection between dental and overall health is arguably underappreciated. This short series of articles attempts to underscore the relationship between dental care and cardiovascular health.
Inflammation is under intense scrutiny as a common denominator in many disease processes. Atherosclerosis is now understood to be an inflammatory process, which includes coronary artery disease. Thus, there has been a great emphasis on antioxidants and their potential to tamp down inflammation. While the role of antioxidants in inflammation is undergoing further investigation, preventing inflammation from taking hold in the first place would seem to be a wise approach.
So why care about dental health so much when it comes to cardiovascular health? Tonetti, et al, reported in a 2007 New England Journal of Medicine article about the relationship between periodontitis (think gum disease) and endothelial (innermost lining of a blood vessel) dysfunction as measured by dilatation of the brachial artery (1). Without going into great detail, two groups of volunteers with periodontitis were randomized between aggressive periodontal treatment (treatment group) and less aggressive treatment (control group). Brachial artery dilatation was measured via ultrasound before and after clamping with a blood pressure cuff. One would expect artery dilatation and reactive hyperemia once the cuff was deflated. Data on brachial artery dilatation as well as blood levels of inflammatory markers, such as C-reactive Protein (CRP), were collected before treatment, immediately after treatment and at periodic junctures over the next 6 months. The treatment group, in general, experienced higher flow-mediated brachial artery dilatation and lower levels of some inflammatory biomarkers than the control group with the exception of just after aggressive treatment when the CRP level spiked. The spike in CRP correlated with a decrease in the normal brachial dilatation response after relaxation of the cuff. As the study progressed, falling levels of neutrophils and E-Selectin in the treatment group reflected the positive effects of aggressive treatment. In the control group, higher levels of neutrophils and E-Selectin measured later in the study were associated with decreased vascular dilatation. Higher levels of inflammatory markers appear to have corresponded to higher vascular tone, thus less compensatory dilatation.
CRP levels are known to be elevated in individuals with periodontitis when compared to healthy controls (2). Lakoski, et al, in a 2005 American College of Cardiology article, reported that across ethnic groups elevated CRP levels are associated with hypertension when compared to their non-hypertensive counterparts (3). Hypertension is associated with countless negative cardiovascular outcomes, including coronary heart disease, kidney disease and strokes. If we connect the dots between these studies, periodontitis leads to higher circulating levels of inflammatory biomarkers, such as CRP. This in turn could play a significant role in elevated blood pressure, possibly by increasing vascular tone.
So, while going to the dentist might raise your blood pressure acutely, it’s an important part of your long-term health maintenance regimen. Consider adding Listerine ® or equivalent to your brushing and flossing regimen. Questions or comments are welcomed in the section below.
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