There is no compelling evidence that poor dental health leads to clogged arteries, heart attack or stroke, and treating diseased gums will not reduce the risk of cardiovascular disorders, a medical panel said Wednesday.
The panel's findings comprise the American Heart Association's new stance on the matter, altering a position many experts had accepted as gospel.
For decades, the provocative notion that gum problems -- periodontal disease -- are linked to clogged arteries has been at the very core of the so-called Germ Theory of cardiovascular disease. Bacteria and inflammation associated with gum problems lead to dangers elsewhere the theory posits.
Aside from cardiovascular disorders, diseased gums have also been linked to miscarriages, Alzheimer's and some forms of cancer.
But a team of cardiologists, dentists and infectious disease specialists assembled by the heart association, reanalyzed more than 60 years of research -- 500-plus studies -- and found none produced a causative link between periodontal and cardiovascular disorders.
"Much of the literature is conflicting," said Dr. Peter Lockhart, the panel's co-chair. "If there was a strong causative link, we would likely know that by now.
"The message sent out by some in the health care professions that heart attack and stroke are directly linked to gum disease can distort the facts," he said.
Doctors have long known that smoking, elevated cholesterol, hypertension and obesity explain a vast number of heart attacks and strokes -- but not all. The periodontal link seems to fit, some experts say, because risk factors associated with gum disease are involved in heart disorders.
Also, dental plaque, which must scraped off teeth, contains a veritable rogues gallery of microbes that colonize the teeth, invade beneath the gumline and are maintained in place by a tough biofilm.
Some microbes associated with gum disease are also found in arterial plaque, but no one knows if they're causative agents or merely innocent bystanders in heart attacks and strokes.
Dental experts not associated with the heart association say more research needs to be conducted.
"What we have here is a very rigorous analysis," said Dr. Ronald Burakoff, chairman of dental medicine at Long Island Jewish Medical Center in New Hyde Park. "But it's possible that further research into periodontal and heart disease could explain the biological possibility of one causing the other."
Dr. David Paquette, a professor and associate dean at Stony Brook University's School of Dental Medicine, said the panel has taken "a cautionary stand."
Earlier research, Paquette noted, has also shown that C-reactive protein, a biological marker for inflammation, is high in the blood of people with gum disease and those with cardiovascular problems.
More research could shed more light on the protein's role in both, he said.
Meanwhile, the Stony Brook team is leading a nationwide analysis of 500 people that is exploring whether periodontal disease is linked to diabetes. That could confirm periodontal problems play a role in heart disease because diabetics are at elevated risk for heart attacks and strokes, he said.
Paquette acknowledged the panel's analysis seems to prove there is no causal relationship. "But," he added, "I would say the discussion is not over yet."