“Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease.”
Source: Circulation 2008 Apr1;117(13):1688-74
Authors: Dietrich T, Jimenez M, Krall Kaye EA, Vokonas PS, Garcia RI
Summary of research:
• Recognize the relationship between periodontitis and coronary heart disease (CHD), (angina, myocardial infarction or fatal CHD) in men.
• Significant association between periodontitis and CHD among men <60 years of age independent of diabetes, blood pressure, smoking, cholesterol etc.
• No such association found among men > 60 years of age.
Results and conclusions:
• Chronic periodontitis is associated with incidence of coronary heart disease among younger men (<60), independent of established cardiovascular risk factors.
Key take-away
• Male patients with chronic periodontal disease who are below the age of 60 have a higher risk of angina, heart attack or fatal coronary heart disease compared to men over the age of 60.
Implementation strategies:
• During routine risk assessment with all male patients under the age of 60 the clinician should make a statement (see sample below) regarding this research and comment about the importance of ongoing periodontal evaluation at each dental hygiene appointment.
Scenario One:
The patient (Albert) is in the office today for a new patient appointment. Albert is a 47 year old computer specialist in good health. Albert reports that his last dental visit was about 2.5 years ago and at that time he was told he had some problems with his gums. He did not follow through with treatment at that time. Albert is recently married and moved to your community. When asked if his gums bleed, Albert reports yes – almost everyday.
Clinician: “Albert, before I begin your exam today, which includes a periodontal evaluation, I would like to share a piece of research with you from the medical journal ‘Circulation’. This research suggests that men in your age group with chronic periodontal disease were found to have a significant risk for coronary heart disease. While I can’t be sure you will be affected, I treat all my patients with the same standard of care. Once I have completed your exam and screenings, you and I and the Doctor will discuss any treatment you may need. I am very glad you have chosen our practice. You are in good hands; we will take great care of you.”
Albert: “I had no idea there was a connection at all, let alone at my age. It sounds to me like I could be at risk because my gums bleed.”
Clinician: “Past research has supported the connection, but this study looked specifically at age groups most affected. Since this research is more recent, we are taking a very proactive stand. Dr. Brown is very committed to not only your dental health but your general health and wellness. Once we have completed the exams, we will review any treatment suggestions Dr. Brown has for you. Shall we go ahead and get started?”
Please note: Since we know that Albert is a computer specialist, he is most likely quite analytical which is why we can confidently make a reference to the medical journal.
Scenario Two:
The patient (William, 55 years old) is in the office today for a periodontal maintenance visit. He has been on a 12 week interval and has been in disease remission for about 9 mos. Today, following his screenings and exam, it is noted that William has several areas of moderate bleeding and no increase in pocket depths.
Clinician: “William, now that I have completed your periodontal evaluation let’s talk about what you saw going on in your mouth. I am concerned about these areas that have started to bleed again, how about you? Let me make a couple of recommendations. You will need some additional periodontal therapy and for you this is quite important. Recently the medical research indicates an increased risk for CHD in men who are <60 and have chronic periodontal disease. You fit both of those categories; however, you have been in remission for about 12 months which is very much in your favor. Can you tell me what has changed? Why do you think your gums have started to bleed again?
William: “I just got out of my home care routine. After going on vacation to Hawaii, I got out of the habit.”
Clinician: “I understand William, it happens to the best of us. So here is what I suggest you do: today’s visit can become a periodontal therapy appointment to get started with your treatment and I suggest you return for 1-3 additional appointments of periodontal therapy. Step up that home care and let’s work together to reverse the infection and get you back into remission. Keep in mind that your periodontal disease may put you at greater risk for CHD. Would you like me to proceed? At this point I need to have Dr. Brown come in and give you a diagnosis. You have made a good choice to turn this around as soon as possible.”
Scenario Three:
The patient, (Bruce) has been on a 6 mos. recall for (prophy only) about the last 2 years in spite of the fact he has been repeatedly told his bleeding gums are a problem. Bruce is one of those patients who only will do what his insurance will cover in full. After his periodontal charting today you sit him upright and begin your discussion.
Clinician: “Bruce, I am concerned about what you saw in your mouth today. What do you think?
Bruce: “I think my gums have always bled. Why is it such a big deal now?”
Clinician: “I know we talk about this every time you come in and Doctor has indicated the need for periodontal therapy in the past. Today more than ever this is a big deal because there is some important medical research that has found a strong association between CHD and periodontal disease in men under the age of 60. The fascinating thing is that the risk is independent of risk factors we all are aware of such as smoking, diabetes, high cholesterol, high blood pressure and others. The only qualifiers are age and periodontal disease and you have both. It is more important than even I previously understood, to have the periodontal treatment that Dr. Brown has recommended. What would you like to do Bruce?”