The heart of the matter



The heart of the matter 1

Filippo Graziani, past president of the EFP, explains why periodontal treatment is beneficial for cardiovascular health.

What have gum disease and cardiovascular disease got in common?

More than it seems. Both issues link as common, widely spread, chronic non-communicable diseases (NCDs) around the world, particularly in adults, as in both cases prevalence increases with age.

Both are prone to trigger or aggravate each other, and both often go undetected as people do not always turn their information about them into decisive action to keep them at bay.

Also, there are common lifestyle factors that aggravate both gum and CV diseases, including:

  • Smoking
  • Stress
  • Obesity
  • Diabetes
  • An unbalanced diet.

In recent years, both have attracted a lot of scientific research and a growing interest from oral healthcare professionals as well as the general public.

On the bright side, they share a final trait. When dealing with both kind of diseases, let’s remember the importance of prevention and early diagnosis for the patient’s overall health. And sometimes co-management of both diseases by dentists and physicians is advisable.

What are the main publications of the Perio & Cardio campaign?

In scientific terms, the core of the Perio & Cardio campaign is the consensus report, built upon the contribution of more than 20 world-leading experts from the two-leading scientific organisations in the world of gum health (European Federation of Periodontology [EFP]) and cardiovascular health (World Heart Federation [WHF]). This scientific consensus report was originally published in the EFP’s Journal of Clinical Periodontology and provides the basis for the other Perio & Cardio publications.

With a more audience-oriented approach, we have edited three recommendation brochures, each of which sums up the main conclusions for the oral healthcare team, for medical professionals and pharmacists, and for the general public.

The other Perio & Cardio publications make an effort to make this scientific knowledge as digestible as possible to a variety of target audiences. They include infographics and an animation, which we have made available not only in English but in 10 languages.

What prompted the Perio & Cardio report and campaign?

First and foremost, we felt that it was time to compile, systematise, and update the growing scientific evidence on the links between gum and cardiovascular diseases.

These links have been attracting more attention lately. It has become one rising star of periodontal medicine. The promising area studying how gum infection and inflammation impact extraoral health. Today, periodontitis is suspected to have links to dozens of systemic conditions.

In this effort, we looked for the leading international organisation in the field of heart and CV health, so we decided to work together with the World Heart Federation (WHF), the global benchmark organisation – just as we did previously with ORCA (European Organisation for Caries Research, which actually is not European anymore) for the Perio & Caries campaign, and with the International Diabetes Federation (IDF) for the Perio & Diabetes campaign.

How was it set up?

The Perio & Cardio campaign is based on evidence-based science and the outcomes of the Perio-Cardio Workshop, a high-level scientific meeting held in Madrid in February 2019, under coordination of Mariano Sanz, and, jointly organised by the EFP and the WHF with an unrestricted grant from Dentaid.

The scientists worked in working groups and produced the science, and then the EFP has made an educational effort to turn that input into ‘actionable awareness tools’, with a number of communication experts following the guidance of four scientific experts: Paula Matesanz, Hady Haririan Henrik Dommisch, and myself.

What were the main outcomes?

Perio & Cardio highlighted some significant changes in the previous perceptions. Firstly, there was an important acknowledgment on the impact of oral status on cardiovascular disease risk. I believe this to be of uttermost importance.

Importantly, it highlights how crucial the impact of periodontal treatment is. Also the importance of good oral hygiene conditions in the prevention of cardiovascular diseases. Altogether, this represents a call to action for better health for patients.

Why are they important?

Because cardiovascular and periodontal diseases potentially affect us all. They are pervasive non-communicable diseases, which do not always announce their presence. Among gum diseases, periodontitis by itself is one of the most common inflammatory diseases. It globally affects almost 800 million people in its most severe forms. In general terms, gum disease is estimated to affect half of adults over 30 years in developed countries.

Equally, cardiovascular diseases are the leading cause of death and disability worldwide. Its impact is considerable everywhere, but particularly in western countries.

Timely treatment of gum disease is not only beneficial for oral health and tooth retention but it also constitutes an important determinant of the overall health of the patient. Particularly their cardiovascular health.

By considering gum disease and CV disease together, we may be activating or speeding up the cycle of prevention, early detection, and early treatment. This is always positive, and in extreme cases can save lives.

What are the key take-away messages?

Non-surgical periodontal treatment is beneficial for cardiovascular health. It is associated with the improvement of the endothelial function, systolic blood pressure, improvement of lipid profile, and arterial stiffness.

When a dentist is treating periodontitis, they are also taking care of their patients’ cardiovascular and systemic conditions. At the end of the day, the dentist is also part of the healthcare team.

How can dental professionals help?

By supporting their patients in dealing with their periodontal issues. Also, at the same time, increasing their awareness in their daily life in practice on the links among oral and systemic health.

Moreover, I really foresee the dental practice as a health hub. A place where patients may get more information on other systemic diseases and their prevention. After all, the dental team is one of the few medical professionals the patients visit even if they are not ill.

What’s next? Is there more research to be done?

Always. Periodontal medicine, treatment of gum disease… we are always trying to push the knowledge frontier, even if the EFP does not research itself directly.

From our side, we recently launched a new phase of our Perio & Caries campaign with an educational animation.

We are disseminating our new guidelines on the treatment of stages I to III of periodontitis. This is based on the outcomes of our meeting Perio Workshop 2019. As well as the new classification of periodontal and peri-implant diseases. Also, a set of recommendations to keep dental practices safe despite the COVID-19 pandemic.

The Perio & Cardio project:

Perio & Cardio scientific consensus report:

Perio & Cardio recommendation documents:

Perio & Cardio infographics:

This article first appeared in Dentistry magazine. You can read the latest issue here.

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