Periodontal Heart Disease

Can periodontal disease increase my risk for heart disease?

Over the years research has shown periodontal disease may have an association with the onset of many systemic diseases including heart disease. Periodontal disease occurs due to the formation of plaque, which contains bacteria. If the bacteria enter the bloodstream they may secrete chemicals that cause the immune system to respond the same way as it would to other illnesses like pneumonia or infected cuts.

The presence of periodontal disease, which ia left untreated, may place you at a much greater risk of cardiovascular disease. Research is finding increasing evidence that the presence of chronic bacterial infection (periodontal disease) may put a person at increased risk of heart disease and increase the risk of a fatal heart.

There are several theories to explain how this can happen. One theory is that when bacteria from the mouth enter the bloodstream, they are able to accumulate in the blood vessels and heart tissues. This thickens the artery walls, which is a characterization of Coronary Artery Disease. These bacteria also contribute to the formation of blood clots. The combination of the formation of blood clots and thickening arteries tends to restrict the normal flow of blood which in turn restricts the oxygen and nutrients required for the heart. Another theory is that periodontal disease causes inflammation, because of the increased plaque build-up, which may contribute to the swelling of the arteries.

Periodontal disease can also aggravate existing conditions. If a person is at risk of infective endocarditis, antibiotics may be required prior to dental procedures being done. Your cardiologist and your periodontist will inform you if your condition requires this antibiotic pre-medication prior to treatment.

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What is Periodontal Disease?

Periodontal disease (gum disease) is an infection of the tissues, which surround and support the teeth. If left untreated periodontal disease will lead to damage to the supporting structures, bone, and tissue, and may lead to tooth loss.


Periodontal disease is caused by plaque, which accumulates at or beneath the gum line. This plaque contains bacteria, which may damage the gums, by causing swelling and inflammation. When this occurs the gums separate from the teeth, forming pockets. These pockets are spaces around the teeth where bacteria and other debris can accumulate, leading to further inflammation and eventual bone loss. In many cases, periodontal disease is painless and as such, most people are unaware that the disease may be present in their own mouths. Periodontal disease is the leading cause of tooth loss in adults. Once the bone has been lost, it usually cannot be regenerated, however, if it is diagnosed early, treatment may help in preventing the disease process from becoming worse.

Stages of Periodontal Disease:

  1. Healthy gums – firm, and pink
  2. Gingivitis – inflamed, red, puffy, and bleeding gums
  3. Early periodontal disease – continued inflammation causing the gums to pull away from the teeth. Formation of pockets around the teeth and the beginning stages of bone loss.
  4. Moderate periodontal disease – continued spread of infection-causing further bone loss, resulting in loose and shifting teeth, and recession of the gum tissue.
  5. Advanced periodontal disease – a chronic infection that can result in painful abscesses around the teeth, destroying bone and tissue. The teeth can no longer be supported and may be lost.

Periodontal disease progresses at a slow rate in most individuals and may be undetected for months or years. In many cases, due to the lack of pain, individuals are not aware of the presence of the disease. The best prevention is visiting your dentist for routine checkups and cleanings. Being aware of the warning signs and symptoms can help you detect the problem early on and seek treatment.


  1. Bleeding
  2. Inflamed gums (red, swollen, and tender)
  3. Pus is visible around the teeth when you press the gums
  4. Receding gums makes teeth look longer
  5. Exposed roots causing sensitivity to hot and cold
  6. Teeth that feel loose when touched with tongue or finger
  7. Open space between teeth that were not there before
  8. Persistent bad taste or breath
  9. Changes in your bite
  10. Changes in how your partial dentures fit

If you suspect that you have periodontal disease, see your dentist. Maintaining regular dental visits can help detect problems early on and keep your mouth healthy and disease-free.

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Tissue Grafting Procedures

There are two types of tissue around teeth – attached tissue and mucosal tissue. The attached tissue is the firm, pink tissue close to the teeth, and is vital in maintaining health around the teeth. The mucosal tissue is loose, thin, and located further away from the teeth. When the gums recede, there is a loss of the attached tissue. This can compromise the health of the tissue and lead to bone problems around the teeth.

Treatment of loss of attached tissue is most commonly done using a tissue graft. Soft tissue grafts can be used to cover roots or develop gum tissue where it has been lost due to excessive gingival recession. This procedure involves taking attached tissue from another part of the mouth (most commonly the roof of the mouth), and moving it to the area where the tissue defect exists. The area which donates the tissue will heal and fill back in with more attached tissue. This procedure helps rebuild some of the lost tissue to maintain the health of the gums and teeth.

A soft tissue graft can reduce further recession and bone loss. In some cases, it can cover exposed roots to protect them from decay. This may reduce tooth sensitivity and improve the aesthetics of your smile.

Bone Grafting

Bone grafting is generally required in areas where the bone has been lost, in an attempt to generate enough bone for the placement of implants or to recontour bone in areas where the bone has been lost during dental extractions. Bone grafting may also be performed around teeth that have localized bone defects caused by periodontal disease.

The amount of bone required will determine the type of grafting materials to be used. If the area to be grafted is relatively small, biocompatible bone products can be used (called an Allograft). If the area to be grafted is larger, a bone from the patient is used (called an Autograft).

Bone grafting is a routine procedure that can be used in a variety of treatment situations, and may help rebuild lost bone and improve the appearance of your smile.

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Treatment of Periodontal Disease

Periodontal (gum) disease is one of the leading causes of tooth loss. Plaque and tartar that build up on the teeth contain bacteria, which cause tissue inflammation and destroy the supporting bone around the roots of the teeth. Periodontal disease can be treated by either a surgical or non-surgical approach, depending on how advanced the disease process is.

Initial Phase

In most cases, removal of this bacteria using a non-surgical approach is the initial step in treatment. This initial phase in the treatment of periodontal disease is scaling and root planing. Scaling involves the removal of the bacteria and other debris from the crown and root surfaces of the teeth. Root planing involves smoothing the root surfaces of the teeth, in areas where they have become rough due to tartar. Antibiotics are sometimes used in addition to this non-surgical therapy and may be given in oral-systemic doses or can be placed directly into the gum pocket.

Depending on the severity of the disease process, some individuals require a local anesthetic for the scaling and root planing appointment. This treatment involves a deep and thorough cleaning around the roots of the teeth, and although this deep cleaning cannot restore the lost bone and tissue, it can prevent the disease process from advancing and help to prevent tooth loss. Once the teeth have been thoroughly cleaned, the disease process is slowed, however, proper home care is a vital component of successful treatment.

Surgical Phase

If advanced bone and tissue destruction have occurred from periodontal disease, or if the initial scaling and root planning have not adequately removed all the bacteria, plaque, and tartar from the tissue pockets around the teeth, periodontal surgery may be required.

Flap surgery is performed to further clean the roots of the teeth and to reduce the depth of the tissue pockets that may exist around the teeth with advanced bone loss. Flap surgery involves pushing back the gum tissue away from the supporting bone and teeth, to allow the dentist to gain access to the root of the tooth for the removal of plaque, calculus, and diseased tissue. The gum is then carefully sutured back into place. This is done with a local anesthetic.

Guided tissue regeneration (GTR) may be performed to help rebuild tissue that has been lost. This is usually performed in conjunction with flap surgery and may be performed in an attempt to restore or regenerate missing bone and tissue around teeth subjected to longstanding gum disease.

GTR refers to procedures that attempt to regenerate lost bone, periodontal ligament and connective tissue that support our teeth. This is accomplished using biocompatible membranes, often in combination with bone grafts and/or tissue stimulating proteins.

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What is a Periodontist?

A periodontist is a dentist who specializes in the diagnosis, prevention and treatment of periodontal gum disease. In addition to the latest techniques for diagnosing and treating gum disease, a periodontist can perform the surgical placement of dental implants, tissue grafting procedures and cosmetic gum procedures.

Periodontists receive three additional years of extensive training beyond dental school in a graduate program. General dentists often refer patients to a periodontist for the treatment of periodontal disease or for tissue-related procedures. Some individuals who have advanced or uncontrolled periodontal disease may require the advanced knowledge and training that a periodontist has, to provide the necessary treatment.

Periodontal disease is one of the leading causes of tooth loss. If you suffer from periodontal disease, a periodontist may be able to help you save your teeth.

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