Abstract
Recent data showcases the relationship between oral and systemic diseases, with cardiovascular disease and periodontal disease being linked due to the multifactorial commonalities. Periodontal disease, the inflammation of gum tissue, contributes a lot in the development and inception of cardiovascular disease as well as the worsening of the existing cardiovascular issues. A review of the literature was completed to explore the correlation between periodontal and cardiovascular disease. Three studies evaluated similar screened populations to determine the link between periodontal and cardiovascular disease with the aim of study differentiating. Strengths were seen throughout the reviewed literature, including the in-depth background information along with a structured layout. However, the direct influence of inflammation was not provided from the majority of the studies. In conclusion, substantial evidence did not confirm the direct link that correlates periodontal disease with cardiovascular disease.
Among the causes of death in the United States, the cardiovascular disease tops the list. Heart disease, as it is normally referred to, incommodes a combination of heart ailments such as the coronary heart disease (CHD), the rheumatic and congenital heart disease, and atherosclerosis, just to name a few. Cardiovascular disease can be caused by many different factors, but one factor, in particular, has brought about the possibility of an oral-systemic connection. Periodontal disease is a condition that involves the inflammation of the gum tissue and, if left untreated, can lead to the loss of tissue and bone that support the teeth. According to the CDC, one out of every two American adults has some form of periodontal disease. The early stages begin with bacterial growth within the mouth, known as gingivitis, and can sometimes progress to periodontitis without proper treatment. Recent studies have drawn a connection between the periodontal disease and the cardiovascular disease, with the bacteria and inflammation being responsible for the association. They have also shown that periodontal disease can also aggravate existing heart conditions. The theory is that bacteria accumulation as well as the resultant inflammation of the tissues and gums results in the modification of the blood vessels where they become narrower and at times block. The oral cavity is very vascular, and whenever it is inflamed, it allows a cascade of bacteria to flow systemically throughout the body, causing damage to the heart. The bacteria ultimately travel through the bloodstream, where they cause the blood vessels to become inflamed or hardened, which results in a stroke or heart attack. Many of the same risk factors can be associated with poor oral health and cardiovascular disease, including smoking, genetics, and even obesity. Patients with cardiovascular disease are more likely to have periodontal disease due to multifactorial risk factors, bacteria associated, and the presence of inflammation.
Review of Literature
The research gathered showcased the relationship between periodontal disease and cardiovascular disease. To further investigate, studies that focused on the inflammation link and the bacteria associated were used. Each aimed to discover the association, prevalence, and impact of the above factors on patients with some form of cardiovascular disease. Taslim et al. (2017) carried out a study involving two clinics concurrently. The two clinics were Haparan Kita National Cardiovascular Center Hospital and other three periodontal clinics. The Haparan Kita National Cardiovascular Center Hospital was utilized to obtain the data on patients suffering from the coronary heart disease. The data for the control group was obtained from the following entities: Periodontology Specialist Clinic, Dental Teaching Hospital, Faculty of Dentistry, and the University of Indonesia. The group that was composed of the coronary heart disease patients consisted of both male and female participants. The cohort age lied between 40-74 years old and they were all suffering from stable angina. In total, 106 patients (66 CHD and 40 control patients) were chosen to participate in the study. Edentate, pregnant or any patient with an underlying systematic condition or disease were not included in the study.
Secondly, Safitri et al.’s (2017) carried out a clinical a clinical-laboratory study. The study stood much in semblance to the excursion by Taslim et al. To carry out the study, [patients aged between 40-74 years were utilized. They comprised of 66 participants who were suffering from the coronary heart disease as well as stable angina. The control cohort was made up of 40 participants who were not suffering from the coronary heart disease. The selection of the gropus was based on the data and the attendees of the periodontology clinic. Those exempted from the study included: edented patients, expectant patients, and the presence of another underlying conditions and diseases. Lastly, Wojtkowska et al. (2021) utilized a similar study group consisting of 111 patients. The study group was made up of a total of 71 patients, male and female, aged 65 years or less, all suffering from myocardial infarction. The patients and the participants were obtained from the Cardiology Department of the Medical University of Lublin. The sampling group was composed of 40 patients, male and female, aged 65 years or less with no history of CHD. The patients in the control group were recruited from the Cardiology Clinic at the Department of Cardiology to diagnose CHD. The following patients were excluded from the study: less than six teeth, those who had neoplasms, autoimmune disease, chronic kidney diseases stages four and five, and history of cerebrovascular accident.
Despite the many similarities, the aim of study for each varied. Taslim et al. (2017) sought to analyze the difference in the quantity of Streptococcus sanguinison (S. sanguinison) on dental plaque between patients who suffered from the coronary heart disease and those who were free from the cardiovascular heart disorder. Supragingival microbial samples were collected from the gingival margin and the samples secured in microtubes which would be examined by the Oral Biology Laboratory Faculty of Dentistry of Indonesia. The amount of the IS. Sanguinis I bacteria was the determined quantitatively in relation to the periodontal disease. Wojtkowska et al. (2021) set out to establish the relationship between the occurrence of periodontics for the individuals suffering from acute myocardial infarction. An oral examination of each patient was performed while putting the following into keen consideration: the number of teeth preserved, plaque index score, bleeding on probing, pocket depth, and clinical attachment loss. After each assessment, the AAP classification was determined. Lastly, Safitri et al. (2017) analyzed the relationship between the S, sanguinis count in the saliva of the patients with the corornary heart disease and for those without. Each patient disposed of saliva into a centrifuge tube using a funnel. A minimum of 1 mil was collected, and analyzed to help determine the relationship between the S. sanguinis count. The periodontal status on the patients was carried out by the use of the Spearman’s test.
Despite assessing different avenues within each study, collectively, the correlation between cardiovascular disease and periodontal disease was addressed. The results of the Taslim et al. (2017) study indicated that there wasn’t a notable in the amount of S. sanguinis on dental plaque between the patients suffering from the coronary heart disease and those who did not. There was a decrease in the number of S. sanguinis in CHD patients, which they associated with the consumption of medication used to treat cardiovascular disease. The study also determined the unavailability of any clear link between the quantity of S. sanguinis in coronary heart disease cases and non-CHD related patients with periodontal status backed upon on the plaque index, bleeding on probing, and pocket depths. However, Safitri et al. (2017) noticed a significant difference between S. sanguinis. In accordance to the study, the saliva of the patients suffering from the coronary heart disease possessed a fewer content of the S. sanguinis. . They determined this instance occurred because patients with CHD are more aware of the importance of oral hygiene and its effect on their systemic disease. Lastly, Wojtkowska et al. (2021) concluded that patients suffering from acute myocardial infarction suffered an extensive and aggravated periodontal disease situation status than people without. High plaque score indices and many areas presenting bleeding on probing are associated with myocardial infarction. Ultimately, they concluded that periodontitis is a risk factor for myocardial infarction and that there is an inflammatory link between cardiovascular and periodontal disease.
Methods and Procedures
Topic Selection
The topic selected was the correlation between periodontal disease and cardiovascular disease. As we have begun to see patients in the clinic, we must be knowledgeable about systemic diseases and the association with the oral cavity to educate our patients accordingly. With my aunt having cardiovascular disease, I felt the need to find out more information on the chosen topic. Since cardiovascular disease is the prime cause of the deaths in the United States and the prevalence of periodontal disease is highly reported, one may question whether the two have a significant influence on the other. Brainstorming included the following questions that needed to be answered. Does periodontal disease affect patients with cardiovascular disease? Does cardiovascular disease cause periodontal disease? What kind of periodontal disease is more commonly seen in the cardiovascular patient? Many related studies were discovered, which confirmed to continue researching and ultimately formulating a literature review on the topic.
Resource Search and Selection
Careful considerations and reviews on the relevant literature works was carried out in the aim of establishing the correlation between periodontal disease and cardiovascular disease. The search was narrowed to cardiovascular disease, prevalence, and periodontal disease, eliminating the possible searches to only 143. A review of the abstracts was the carried out and three articles suitable articles were settled upon for the study..
Libraries/search engines and databases used.
A number of databases were utilized for this study among them being; (a) ProQuest, (b) eBook Subscription Collection (EBSCOhost), and (c) Google Scholar. Foundations of Periodontics for the Dental Hygienist textbook was used for background information on the correlation between periodontal disease and systemic diseases.
Search terms.
Several search terminologies were utilized in order to get the necessary search results on the web. The search terms included; periodontal disease, heart disease, and cardiovascular disease. This search resulted in 2,319 articles. Filters were used to narrow down the search: scholarly journals within the last five years and full text.
Boolean strings.
Two Boolean strings attached to this work were the periodontal disease and cardiovascular disease; periodontal disease and heart disease.
Age of the Sources.
The significance of conciseness meant that the sources utilized for the study stem back in periods not exceeding 5 years.
Discussion
The collective outcome of the study included three different aims from each of the researchers. Coming to an almost similar conclusion from three different routes to establish the connection between periodontal disease and cardiovascular disease highly impacted the efficacy of the result and the affirmation and validation of the assumption. For instance, the case study with Taslim et al. (2017) based their study on the Streptococcus sanguison ( S. sanguison) on the dental plaque obtained from CHD and non-CHD cases. The analysis on the S. sanguison in the Oral Biology Laboratory Facility of Dentistry of Indonesia aimed at examining the quantitative analysis of the bacteria to show the relationship between the two. The comparisons between the patients with CHD and the non-CHD patients brought about the basis for concluding their relatedness.
On top of this, Wojstkowska et al. (2021) sought to explore the relationship between the two diseases by analyzing the link between the presence and extent of periodontitis in patients suffering from acute myocardial infarction. In addition to the varying processes utilized to reach their conclusions, Safitri et al. (2017) utilized the analytical differences on the count of the bacteria S. sanguinis in the patients with periodontal disease as well as those suffering from the coronary heart disease. Therefore, the varying methodologies applied by the different sources add to the credibility of the solutions and conclusions offered.
However, the literature review presented some cracks, among them being the variations in results and conclusions to link the two diseases. For instance, Taslim et al. (2017) ‘s study results stated that there was a negligible difference in the amount of the S. sanguinis bacteria between the participants who had the coronary heart disease and those who didn’t. In contrast, Safitri et al. (2017) established that there was a significant difference in the S. sanguinis count in the saliva of the CHD and the non-CHD patients, with the fewer bacterial load found in the CHD patients. To further complicate the stand of the studies on the relationship between these two diseases, Wojtkowska et al. (2021) concluded that the patients with acute myocardial infarction suffered greater periodontal status compared to the people without. Therefore, the conclusions between the three studies lacked a common ground in terms of the results on the concluded research activities.
It is important, however, to quantitatively determine the reasons as to why the results varied across the three pieces of literature. With the studies by Wojtkowska et al. (2021) and Saftri et al. (2021) sharing the conclusion of having the existence of a composite relationship between periodontal disease and cardiovascular disease, it seems quite unlikely that the methodology and the execution of Taslim et al. (2017) were conducted with errors. This thus breeds the question of the contradiction between the studies. The future essence for the studies to link the two diseases should be set upon the elimination of any contravening results. This gives rise to many questions: exactly the S. sanguinis bacteria could produce varying results between the dental plaque and their actual numbers in saliva. A major concern also is as to why the connection between the S. sanguinis bacteria showed such clear variations on CHD patients despite being evaluated using different methods. This should be as well as identifying the incidence of occurrence of the periodontal disease on the patients with cardiovascular issues. This is due to the occurrence of the connection in myocardial heart disease and the CHD patients in one instant with lack of evidence in other samples of CHD patients.
Conclusion
The correlation between periodontal disease and cardiovascular disease, as explored by the three literature reviews, proves for further exploration. With the various studies trying to evaluate the connection between the two and the execution of the activity, the matter still stands in contention. The relationship between the S. sanguinis bacteria in dental plaque and saliva needs to be re-established to explain the disparity in the findings. On top of this, there need to be further studies to explore the interrelation between myocardial heart disease CHD and periodontal disease; despite two of the studies agreeing that the existence of a connection between periodontal disease and cardiovascular disease, there is the need for further research and studies to prove the relationship between the two diseases.
References
Safitri C. I., Soeroso Y., Sunarto H., Pontoh D. S., Bachtiar B. (2017). Association of Salivary
Count of Streptococcus sanguinis with the Periodontal Status of Coronary Heart Disease Patients: A Quantitative Study. Journal of International Dental and Medical Research
Practice, 10 (Special Issue):785-788. Retrieved from https://search.proquest.com/index?accountid=89121
Taslim S., Soeroso Y., Sunarto H., Pontoh D. S. (2017). The Relationship between the Quantitative Measurement of Streptococcus sanguinis Dental Plaque with the Periodontal Status of Patients with Coronary Heart Disease. Journal of International and Medical Research Practice, 10 (Special Issue): 689-695. Retrieved from https://search.proquest.com/index?accountid=89121
Wojtkowska A., Zapolski T., Wysokinska-Miszczuk J., Wysokinski A. P. (2021). The inflammation link between periodontal disease and coronary atherosclerosis in patients with acute coronary syndromes: a case-control study. BMC Oral Health. Retrieved from http://search.proquest.com
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