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Not only is periodontitis risk greater in patients with diabetes, but a new study also strengthens the link between chronic periodontitis and cardiovascular disease (CVD). Treating severe periodontal disease improves the blood flow and gives arteries much-needed elasticity, according to researchers at the Eastman Dental Hospital in London.1
An initial effect of treatment was inflammation among the 120 participants, but 6 months later, there was an improvement in endothelial function, researchers note. Regular tooth cleaning was compared with intensive periodontal treatment, including scaling, root planing, antibiotics, and tooth extraction where necessary.
"In recent years, there's been numerous hypotheses linking periodontal infections to atherosclerosis. This study validates the effectiveness of intensive periodontal treatment in affecting vascular health," says Maurizio Tonetti, DMD, PhD, head of the department of oral health and diagnostic sciences at University of Connecticut Health Center in Farmington.
Brachial artery dilation in participants getting intensive treatment was 2% wider after 6 months than in those getting ordinary treatment, which was significant, researchers say. "This study adds a lot to a growing database [indicating] that there is some sort of link" between periodontitis and CVD risk, says Preston Miller Jr., MD, president of the American Academy of Periodontology. "The study increases the link between local inflammation and inflammation of the coronary vessels that is extremely important," he adds. Miller is clinical professor of dentistry at University of Tennessee College of Dentistry in Memphis.
Critics, however, point out that the study fails to include other factors that may contribute to CVD. Factors such as diet, exercise, and general health were not factored in, says Daniel Meyer, DDS, associate director of the American Dental Association's science division. "What the study looked at is one aspect of a very complicated disease," he adds.
BACTERIA COULD BE TO BLAME
The study adds significantly to the body of evidence linking periodontitis to vascular disease, notes Moise Desvarieux, MD, associate professor of epidemiology at Columbia University Mailman School of Public Health in New York. In a study published in 2005, Desvarieux and colleagues found that higher proportions of four types of bacteria in the mouths of older adults were linked to thicker carotid arteries.2 The study marked the first direct link between CVD and bacteria involved in periodontitis, which affects 200 million Americans in varying degrees each year, according to the American Academy of Periodontology.
One question remains, however. "It's impossible to know which comes first, the periodontal disease or thickening of the carotid artery," says Desvarieux. The answer will be fundamental to establishing causality and determining whether chronic inflammation or infection could lead to atherosclerosis of the carotid arteries.
Desvarieux plans to re-examine the study participants by next year, whereby
a progression of atherosclerosis and development of periodontitis can be
established, he notes. 
References
2. Desvarieux M, Demmer R, Rundek T, et al.: Periodontal microbiota
and carotid intimamedia thickness: The Oral Infections and Vascular Disease
Epidemiology Study (INVEST). Circulation 111: 576–582, 2005.
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