Public Health Implications of Chronic Periodontal Infections in Adults

Potential Public Health Implications of Periodontal Disease and Cardiovascular Disease Relationships
James Beck, MS, PhD, Distinguished Professor, Dental Ecology and Research,  and Steve Offenbacher, DDS, PhD, Professor, Periodontology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina

Periodontitis is a destructive disease that affects the supporting structures of the teeth including the periodontal ligament, cementum, and alveolar bone. Periodontitis represents a chronic, mixed infection by gram-negative bacteria, such as Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Actinobacillus actinomycetemcomitans, and gram positive organisms, such as Peptostreptococcus micros and Streptococcus intermedius. Due to periodic changes in concepts of periodontal disease pathogenesis and restructuring and renaming periodontal disease types, actual prevalence and incidence estimates for periodontal disease have been debated for decades. It is generally thought that in developed countries, 44% to 57% of adults have moderate periodontitis, and about 7% to 15% have advanced periodontitis. Partly because of uncertainty about the public health importance of this disease and partly because primary prevention depends on personal oral hygiene behavior and professional services, public health programs to prevent periodontal disease are underdeveloped.

Since 1989, a number of cross-sectional, case-control, and longitudinal studies have reported that the clinical signs of periodontitis may be associated with cardiovascular events; other studies have reported no significant association. Several basic science and animal studies also have reported systemic effects of periodontal infection. Cardiovascular disease is the top cause of death in the United States for men and women and carries with it considerable morbidity. In addition, total costs for cardiovascular disease in 2003 were estimated to reach almost $352 billion. This presentation assumes that periodontal disease will be shown to be a risk factor for cardiovascular disease. Because periodontal and cardiovascular diseases are highly prevalent in the United States population, periodontal disease also becomes a public health problem worthy of attention, even though the strength of the association may be only moderate.

As a result of this link with cardiovascular disease, interest in periodontal disease prevention and treatment is likely to intensify in the private and public health sectors and in the general public. One consequence of this link is that dentists and physicians may need to focus more on primary prevention of infection by periodontal pathogens and, in patients with disease, they may need to focus more on secondary prevention. End-points for secondary prevention will involve eliminating periodontal pathogens and reducing inflammation, while pocket reduction, tooth retention, and regenerative procedures may become less important. Controlling inflammation and infection may create an increased need for anti-infective and anti-inflammatory pharmacological strategies for high-risk patients.

Other actions likely to be needed are (1) educating health professionals and the public about the relationship between periodontal and cardiovascular diseases; (2) restructuring benefits for public programs to provide infection control services to Medicaid and Medicare recipients; (3) advocating for medical insurance coverage of periodontal services; and (4) establishing a surveillance program to monitor periodontal disease trends in the population and identify high-risk groups to target with intervention programs. Finally, coordinating efforts with groups that are active in reducing other cardiovascular disease risk factors, such as smoking, diabetes, and obesity, may be a useful strategy.

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Historical Document
Page last reviewed: February 2, 2005
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion