Title	The Link Between Periodontal Disease And Coronary Heart Disease
Clinical Question	Is a patient with established periodontal disease at greater risk for coronary heart disease than a patient without periodontal disease?
Clinical Bottom Line	Periodontal disease appears to be a risk factor or marker for CHD that is independent of traditional CHD risk factors, including socioeconomic status. Further research in this important area of public health is warranted. (See Comments on the CAT below)
Best Evidence
PubMed ID Author / Year Patient Group Study type (level of evidence) 18807098 Humphrey/2008 men and women with periodontal disease Systematic Review/Meta-analysis Key results Several studies found periodontal disease to be independently associated with increased risk of CHD. Summary relative risk estimates for different categories of periodontal disease (including periodontitis, tooth loss, gingivitis, and bone loss) ranged from 1.24 (95% CI 1.01–1.51) to 1.34 (95% CI 1.10–1.63). Risk estimates were similar in subgroup analyses by gender, outcome, study quality, and method of periodontal disease assessment. Significant heterogeneity was detected across studies (P=0.04) and incorporated into the combined estimate based on the random effects approach.
Evidence Search	Search “Coronary Heart Disease"[Mesh] Search "Periodontal Disease"[Mesh] Search Coronary Heart Disease"[Mesh] AND Search "Periodontal Disease"[Mesh] Limits: Meta-Analysis
Comments on The Evidence	The article was not a systematic review of randomized control trials. One of the difficulties with the included studies is the highly varied way both periodontal disease and heart disease were measured. For example, edentulism and tooth loss are considered as measures of periodontal disease. However, the article selection criteria included a large number of articles and used a very comprehensive and detailed search to find the most relevant. The article was a meta-analysis and covered seven cohort studies that included a total of 175 to 170,000 men and women with periodontal disease. Each study was assessed for validity.
Applicability	The meta-analysis evaluated a very important topic facing dentistry and is applicable in a dental practice. Periodontal disease is very prevalent in the US and understanding if there is a link between it and coronary heart diseases could help promote the prevention of both.
Specialty	(General Dentistry) (Periodontics) (Dental Hygiene)
Keywords	Periodontal Disease, Coronary Heart Disease
ID#	778
Date of submission	03/17/2011
E-mail	crossland@livemail.uthscsa.edu
Author	Cassie Allison
Co-author(s)
Co-author(s) e-mail
Faculty mentor	Thomas Oates, DMD, PhD
Faculty mentor e-mail	OATES@uthscsa.edu
Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?) None available
Comments and Evidence-Based Updates on the CAT (FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Brad DeGroot (San Antonio, TX) on 07/09/2012 While searching PubMed regarding this topic in July 2012, I found a more recent article, published in both the American Journal of Cardiology and the Journal of Periodontology (PMID: 19576322). It reviews the current literature and comes to the conclusion that while periodontitis and CHD risk are often related, periodontitis is a weak risk factor for CHD. More studies need to be done to determine a definitive mechanism and relationship between the two diseases.