In reply
We appreciate the interest of Kowolik and Dowsett and Janket and Meurman in our research. Both letters point out the relation of poor periodontal health with CVD that has been observed in epidemiologic studies,1 and the possibility that inflammation induced by periodontitis may be involved in the pathogenesis of CVD. Studies cited by Janket and Meurman have shown that periodontitis is associated with elevations in the levels of systemic markers of inflammation, such as C-reactive protein, interleukin 6, and WBC count. Furthermore, treatment of periodontitis has been shown to decrease levels of inflammatory markers compared with untreated controls.2 Kowolik et al3 have shown that healthy adults who are not permitted to brush or floss their teeth for 3 weeks (an experimental model of gingivitis) develop increased WBC and neutrophil counts that regress on resumption of good oral hygiene. We agree that further studies are required to investigate whether interventions to lower the WBC count and other inflammatory markers will lower the risk of atherosclerotic CVD.