Oral Hygiene and Patient Self-Reports as Risk Indicators for Cardiovascular Disease


Surveillance Spotlight: Current Concepts in Oral–Systemic Health

The International Centre for Oral–Systemic Health, based at the University of Manitoba's faculty of dentistry, was launched in January 2008. The centre is proud to partner with JCDA to provide summaries of contemporary literature and news in oral–systemic health that may affect modern dental practice.

The relationship between periodontal disease and cardiovascular disease has been investigated for more than 2 decades.1 Because chronic systemic inflammation plays an important role in the pathogenesis of atherosclerosis, and because periodontitis has been shown to contribute to the overall level of systemic inflammation, there have been increasing calls for early interventions that would eliminate oral inflammation and reduce the overall systemic inflammatory burden.2

Recent guidelines established by the Journal of Periodontology and the American Journal of Cardiology for the co-management of patients with cardiovascular disease and periodontitis confirm the importance of oral inflammation as a component of cardiovascular risk.3 Therefore, it is important for all health professionals to assess oral inflammation as a risk factor for cardiovascular disease and to activate the dental team as part of the patient care plan. This interprofessional approach will have the twofold benefit of establishing more comprehensive individual risk reduction strategies and improving overall public health outcomes.4

Non-dental health professionals, family members and caregivers are not trained to use traditional clinical indices (i.e., bleeding on probing, pocket depth, plaque index) to assess overall oral health or the severity of periodontitis. For this reason, there has been a push to establish reliable and user-friendly surrogate methods that can serve as indicators of oral inflammation. Two recent studies have broken new ground in this area.

The first study demonstrated convincingly that self-reported toothbrushing behaviour is associated with systemic inflammation and cardiovascular disease.5 The research indicated that patients who reported poor oral hygiene (i.e., never or rarely brushed their teeth) had elevated levels of systemic inflammatory biomarkers and an increased number of cardiovascular disease events. The study used stringent controls to account for other factors that might contribute to systemic inflammation and poor cardiovascular health in these patients.

The second study showed that a validated self-report questionnaire is more sensitive and reliable than traditional clinical indices for establishing the presence of periodontitis.6 The results indicated that a basic set of 8 questions (e.g., "Do your gums bleed after toothbrushing?", "How many times a day do you brush your teeth?", "Have any teeth become loose on their own?") predicted the presence of periodontal disease with greater accuracy and reliability than a traditional clinical screening examination.

These surrogate methods for measuring oral inflammation, with their wider availability and use, represent a powerful new tool for dental professionals as they seek to establish collaborative relationships with their fellow health professionals. As more interprofessional practice models continue to emerge, the dental team can encourage other health professionals to adequately evaluate oral health as part of comprehensive care plans for patients with, or at risk for, chronic inflammatory diseases or adverse pregnancy outcomes.

Because oral inflammation is an easily modifiable risk factor in public health, the dental team should promote these surrogate tools and lead the effort to develop new health care models that reduce or eliminate sources of whole-body inflammation and improve overall health outcomes.


Dr. Iacopino is dean and professor of restorative dentistry, and director of the International Centre for Oral–Systemic Health, at the faculty of dentistry, University of Manitoba, Winnipeg, Manitoba. Email: iacopino@cc.umanitoba.ca.

The views expressed are those of the author and do not necessarily reflect the opinions or official policies of the Canadian Dental Association.


  1. Persson GR, Persson RE. Cardiovascular disease and periodontitis: an update on the associations and risk. J Clin Periodontol. 2008;35:362-79.
  2. Iacopino AM. Relationship between periodontal disease and general health: role of inflammation. J Can Dent Assoc. 2008;74(8):695-6.
  3. Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, et al. The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol. 2009;104(1):59-68.
  4. Hein C, Small D. Combating diabetes, obesity, periodontal disease and interrelated inflammatory conditions with a syndemic approach. Grand Rounds Oral-Sys Med. 2006;2:36-47.
  5. de Olivera C, Watt R, Hamer M. Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ. 2010;340:c2451.
  6. Eke PI, Genco RJ. CDC Periodontal Disease Surveillance Project: background, objectives, and progress report. J Periodontol. 2007;78(7 Suppl):1366-71.