Heart Health

Much has been written – and will continue to be written – about the connection between heart health and oral health.

A large literature review was recently completed looking at a summary of evidence supporting “causal criteria” relating gum disease with atherosclerotic disease, which includes heart disease and peripheral artery disease.

On a scale of “- – -” to “+ + +”, the following criteria had a “+” or a “+ +” rating. These criteria were:

  • Strength of Association
  • Dose – Response
  • Time Sequence
  • Biologic Plausibility
  • Independence from Confounding

OK, are you confused? I’ll explain.

The only criterion that did not have a high supportive evidence was “Consistency”, owing to the large variety of studies and variables, and sometimes consistent results, sometimes not.

Let me go back and define each of these criterion so you’ll have a better grasp of what this very large study looked at.

Strength of Association

A strong statistical association is more likely to have a causal component. In other words, there is a strong association between heart disease and gum disease.


For this to be true, the outcome should increase with an increasing dose of exposure. Very few studies have evaluated this element, but the few that have found a significant dose-response relationship.

Time Sequence

Simply put, the exposure must precede the outcome. In other words, gum disease precedes heart disease.

Biologic Plausibility

Ideally, the observed association should be biologically explainable and should not contradict present overall scientific knowledge.

Independence from Confounding

Oh, this one’s my favorite! A “confounder” is a extraneous factor that leads to an apparent association between the exposure and the outcome than is different from the true association. Got it? Good! Bottom line: among health professionals, positive associations were found between gum disease ad heart disease. (Wasn’t that easier?)

Today, depending on which study you read or hear about, no one is willing to go out all the way on a limb to say that there is an INDEPENDENT causal relationship between gum disease and heart disease.

In my opinion, there’s no real need for anybody to “go out on a limb”. Lack of gum disease is just good health – and an important one at that! The threat of heart disease might scare some into being healthy, but just being informed and doing the right thing is the preferred approach.