Brush your way to better cardiovascular health

By Liz Meszaros, MDLinx
Published October 20, 2016

Key Takeaways

A new toothpaste designed specifically to identify plaque, may help significantly reduce plaque and inflammation throughout the body as measured by high sensitivity C-reactive progein (hs-CRP), according to results from a recent, randomized trial, published in the American Journal of Medicine.

The link between oral health and inflammatory diseases throughout the body has been on the radar for many years.

“While the findings on reducing dental plaque extend a previous observation, the findings on decreasing inflammation are new and novel,” said Charles H. Hennekens, MD, DrPH, senior author and first Sir Richard Doll Professor, and senior academic advisor to the dean in the Charles E. Schmidt College of Medicine at Florida Atlantic University in Boca Raton, Florida.

Dr. Hennekens and colleagues studied a new toothpaste, Plaque HD (TJA Health LLC, Joliet, IL), designed to identify plaque, to determine whether its use could significantly reduce dental plaque as well as hs-CRP. This new product is the first toothpaste that reveals plaque so that it can be removed with directed brushing, and contains unique combinations and concentrations of cleaning agents that weaken the core of the plaque structure to help the subject visualize and more effectively remove the plaque.

They randomly assigned 61 apparently healthy subjects who were aged 19 to 44 years to this Plaque HD (n=31) or placebo toothpaste (n=30) for 60 days, and assessed changes from baseline to follow up in dental plaque and hs-CRP. Dental plaque was identified after subjects used a fluorescein mouth rinse, and using black light imaging, researchers obtained intraoral photographs. They also measured hs-CRP levels via enzyme linked immunosorbent assess at an independent laboratory.

In their intention-to-treat analysis, Dr. Hennekens and fellow researchers found that the plaque identifying toothpaste significantly reduced the mean plaque score by 49% compared with a 24% reduction in placebo (P=0.001). Furthermore, they found that in a pre-specified subgroup analysis of 38 subjects with baseline levels > 0.5 milligrams per liter, the plaque identifying toothpaste reduced hs-CRP by 29% compared with a 25% increase in placebo toothpaste (P=0.041).

In an accompanying editorial, Joseph S. Alpert, MD, professor of medicine, University of Arizona College of Medicine, Tucson, AZ, and an internationally renowned cardiologist, stressed the importance of these new findings, and commented on how his father, a dentist, had told him even before he went to medical school, that dental health may affect heart attacks and strokes.

"My father was a busy and successful dentist in New Haven, Connecticut. One of my earliest memories is of sitting in one of his dental chairs and having my teeth inspected and cleaned. Many years later when I was about to start medical school, my father told me that in his practice, patients with poor dental condition and poor mouth hygiene frequently had other serious medical conditions. Clearly, it appears that my father’s comment was prescient.1-7 A recent review revealed 468 articles published since 1991 involving the relationship between poor dental hygiene, such as periodontitis and/or missing teeth, and the presence of atherosclerosis often in the form of ischemic heart disease," he wrote.

"The relationship between inflammation and atherosclerosis is now well established, and poor oral hygiene is certainly an important potential site in the body for continuous inflammatory stimulation. If the use of a plaque identifying toothpaste were shown to reduce coronary events, this would represent a simple, easily performed method for reducing the impact of coronary arterial atherosclerosis. I would like to urge the NIH to consider seriously such a trial. The study design would be straightforward as would be the determination of the cardiovascular outcomes. I for one, hope that such a trial would confirm my father’s clinical observations made many decades ago!!" concluded Dr. Alpert.

Dr. Hennekens, co-author Patrick E. McBride, MD, MPH, professor of medicine and interim associate dean for faculty affairs at the University of Wisconsin School of Medicine and Public Health, and fellow researchers are working on conducting a large scale, randomized study to assess whether Plaque HD can reduce the risks of heart attacks and strokes in the Wisconsin Network for Health Research (WiNHR) and the Wisconsin Research and Education Network (WREN).

The trial was funded as an investigator initiated research grant by TJA Health, LLC, in Joliet, Illinois to the University of Illinois, College of Dentistry with Ms. Kimberly Fasula as Principal Investigator and Professor Carla Evans as Co-Principal Investigator. The funding source had no role in the design, conduct, analysis, interpretation, preparation of the manuscript, or in the decision where to submit.


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