Collaboration between Periodontists and Cardiologists Dentistry and Medicine Work Together to Improve Patient Care 1

Outline of Presentation Periodontal Disease: An Overview Cardiovascular Disease: An Overview What is Inflammation? Inflammation and the Perio-Cardio Link The American Journal of Cardiology and the Journal of Periodontology Editors’ Consensus Paper Clinical Recommendations The Impact on Your Practice Questions and More Information 2 2

Periodontal Disease: A Quick Overview Periodontal disease is a chronic inflammatory disease that destroys the bone and gum tissues that support the teeth. The American Academy of Periodontology (AAP) estimates that 3 out of 4 Americans are affected by periodontal disease, ranging from mild gingivitis to more severe periodontitis. If left untreated, mild cases of gingivitis can lead to periodontitis.

Cardiovascular Disease: A Quick Overview Cardiovascular disease generally refers to conditions that involve narrowed or blocked blood vessels that can lead to a heart attack, chest pain (angina), or stroke. Inflammation is major risk factor for cardiovascular disease- as much or more than cholesterol. The American Heart Association reports that cardiovascular disease is the leading killer of men and women in the United States.

A large body of research has indicated that periodontal disease and cardiovascular disease may be related. The basis for this relationship is thought to be inflammation.

What is Inflammation? Inflammation is the body’s first response to an injury. The first phase (acute inflammation) includes redness, swelling, heat and altered function. It is self-perpetuating. Though inflammation can be helpful under certain conditions, uncontrolled inflammation, also called chronic inflammation, is harmful and causes tissue loss. Chronic inflammation can negatively affect all organs and tissues of the body. There are several biological markers of inflammation in your blood, including C-reactive protein.

Inflammation and the Perio-Cardio Link Chronic inflammation occurs when there is a sustained infection, like periodontitis or cardiovascular disease. Inflammation appears to be a common link between chronic diseases of aging - including periodontitis and cardiovascular disease. Research has suggested that managing the inflammatory burden of one disease may help reduce the risk for the other. More research is needed to better understand the relationship between cardiovascular disease and periodontal disease.

Periodontists and Cardiologists Partner for Patient Care A January 2008 Workshop on Inflammation, sponsored by the AAP, brought together more than 80 leading experts to expand and advance the understanding of inflammation and its role in the progression of disease. Following this workshop, The American Journal of Cardiology approached the AAP to collaborate on a consensus paper on the connection between cardiovascular disease and periodontal disease. This partnership marked the first time the periodontology and cardiology communities worked together to summarize the scientific evidence linking the two diseases and provide clinical recommendations for patient treatment.

The American Journal of Cardiology The AJC is an independent, peer-reviewed journal designed for cardiovascular disease specialists and internists with a subspecialty in cardiology. Original published articles focus on the clinical approach to the diagnosis and treatment of cardiovascular disease. It is circulated to 30,000 cardiologists worldwide.

Journal of Periodontology The JOP is official journal of the American Academy of Periodontology, the professional membership organization for periodontists. Periodontists are specialists in the prevention, diagnosis, and treatment of diseases affecting the gums and supporting structures of the teeth. They are also dentistry’s experts in the treatment of oral inflammation. Original published scientific articles support practice, education, and research in the dental specialty of periodontics.

AJC-JOP Editors’ Consensus Paper Experts in the fields of periodontology and cardiology met in January 2009 to develop a consensus paper on the relationship between periodontal disease and cardiovascular disease, as well as to devise clinical recommendations for periodontists and cardiologists to use when treating patients. The resulting paper was published simultaneously in both The American Journal of Cardiology and Journal of Periodontology in June 2009.

AJC-JOP Editors’ Consensus Paper, continued The consensus paper helps to confirm that there is a connection between periodontal disease and cardiovascular disease. The underlying biologic and inflammatory mechanisms that may be the basis for the connection are explained. Clinical recommendations for treating patients with periodontal disease or cardiovascular disease are also included in the consensus paper.

Clinical Recommendations Dental professionals are asked to consider their patients’ heart health during an examination. Assess risk factors for cardiovascular disease such as smoking and family history of cardiovascular disease. Physicians are asked to consider their patients’ periodontal health and risk for periodontal disease. Assess symptoms such as tooth loss or bleeding and swollen gum tissue. All health professionals are asked to educate their patients on inflammatory diseases, including periodontal disease and cardiovascular disease. Dental professionals and physicians are also asked to work together to help ensure their patients’ health.

The Impact on Your Practice Familiarize yourself with the consensus paper and share with your local dental and medical professionals. Teach all patients about inflammation and the connection to other diseases - including heart disease. Using the clinical recommendations outlined in the paper, assess your patients’ risk for heart disease. Educate your referring colleagues about the perio-cardio connection, and offer yourself as an expert in treating periodontal disease. Forge relationships with cardiologists/physicians in your area to assure your patients’ health. Look through other resources on perio.org for additional information.

With this information about inflammation’s role in the link between cardiovascular disease and periodontal disease, it is now more important than ever for dental health professionals to work together with medical professionals.

The cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce the risk and instance of these two inflammatory diseases.

Questions? For more information visit perio.org To view additional supporting studies or references visit joponline.org Contact the American Academy of Periodontology’s Public Affairs Department at: (312) 573-3242 or (800) 282-4867 ext. 3242 PublicRelations@perio.org