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 ORAL HEALTH AND YOUR HEART

One study  found that 85 percent of Heart-attack patients  had periodontal disease.

Current Research on Gum Disease Link to Heart Disease

Periodontal or gum tissue care interacts with three areas relating to cardiovascular disease: effects of medications, infective endocarditis, and the potential for periodontal disease to contribute to heart disease.+

Did you know that the connection between gum disease and heart attacks is higher than the connection between high cholesterol and heart attacks?

What Should I be Concerned About?

      Researchers are finding possible links between periodontal infections and other diseases throughout the body.  Current studies suggest that there may be a link between periodontal (gum) disease, heart disease and other health conditions.  In fact, research suggests that gum disease may be a more serious risk factor for heart disease than hypertension, smoking, cholesterol, gender and ages.

     New studies suggest that people who have gum disease seem to be at a higher risk for heart attacks, although no one is certain how this relationship works.  Your oral health affects your overall health, but the studies that will find exactly why these problems are linked are still underway.

Flossing matters!:  People who have both gum disease and a high body mass index, were more likely to have increased C-reactive protein-a serum in blood that is a marker for heart disease.  Archives of Internal Medicine 12/03

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How Can Gum Disease Affect My Overall Health?

     The current theory is that bacteria present in infected gums can come loose and move throughout the body.  The same bacteria that cause gum disease and irritate our gums might travel to your arteries.  

     Researchers are unsure what causes the bacteria to become mobile, but it has been suggested that bacteria can be dislodged and enter the bloodstream during tasks as simple as brushing, flossing or even chewing.

    Research shows that risk varies according to the level of gum infection.  The worse the infection, the more likely the bacterial are to become blood-borne.  Infected gums bleed, making it easier for bacteria to enter your bloodstream.  If bacteria become dislodged, the bacteria enter through cuts or sores in your mouth and travel to other parts of the body through your bloodstream.

    Once bacteria reaches the arteries, they can irritate them in the same way that they irritate gum tissue.  This could cause arterial plaque to accumulate in the arteries; which can cause hardening and affect blood-flow.  

     Compromised blood-flow to your heart can cause a heart attack.  Also, arterial plaque can come loose and travel to other parts of the body.  If blockage occurs in the brain, it can cause a stroke.

    Your dentist may use a special rinse before a dental procedure to neutralize these bacteria, but your best protection is to maintain a healthy mouth.

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What Should I Do?

     Keep your mouth healthy!  See your dentist at least twice a year for periodic maintenance.  Gum disease is a serious gum infection that should always be taken seriously.  

     Although gum disease can often show few or no symptoms at all, watch for gums that are red and irritated, or gums that bleed easily.  There are many new treatments available to control and help reverse gum disease.

    Always remember that gum disease is caused by plaque buildup.  Brush and floss regularly to remove plaque that you can’t see below the gum line and remember to schedule regular check-ups.  If you remove the plaque, you minimize the chance for getting gum disease.

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(picture courtesy of American Academy of Periodontology)

"Every $1 spent on dental care can save $20 in medical care"*

1.5 men have heart attacks every minute.

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When to Have Dental Treatment After a Heart Attack

The percentage of reinfarction is unusually high for the first 6  months after an MI.  During this time avoid anything but absolutely necessary emergency dental treatment and with close consultation with the cardiologist. While the six month rule is a good starting point checking with the cardiologist is a good rule to follow. If treatment is really absolutely needed before the 6 month time period,  hospital dentistry then becomes the location to have the emergency procedures done.

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New Study

Further Evidence Reveals the Association Between Periodontal Disease and Coronary Artery Disease

CHICAGO – October 26, 2004 –A study published in a recent issue of the Journal of Periodontology explains another reason why people with periodontal diseases are at a significant risk for coronary artery disease (CAD).

The study looked at 108 patients with CAD  and a group of 62 people without CAD.

The results of this study showed that periodontitis in cardiac patients was significantly more frequent than in non-cardiac patients.” said Professor E.H. Rompen, Department of Periodontology - Dental Surgery, C.H.U. Liège, Belgium. “We found that 91% of patients with cardiovascular disease suffered from moderate to severe periodontitis, while this proportion was 66% in the non-cardiac patients.”

Periodontitis seems to influence the occurrence and the severity of coronary artery disease and increases the risk of heart attack or stroke, and the study proposes two hypotheses for this occurrence. One hypothesis is that periodontal pathogens could enter the bloodstream, invade the blood vessel walls and ultimately cause atherosclerosis. (Atherosclerosis is a multistage process set in motion when cells lining the arteries are damaged as a result of high blood pressure, smoking, toxic substances, and other agents.)

Another hypothesis is based on several studies that have shown that periodontal infections can be correlated with increased plasma levels of inflammation such as fibrinogen (this creates blood clots), C-reactive protein, or several cytokines (hormone proteins).

"This study supports earlier findings, and even showed a significantly higher prevalence of periodontal diseases in cardiac patients. The data in this study shows the importance of regular dental checkups to ensure a healthy, diseased-free mouth.”

From: http://www.perio.org/consumer/coronary-disease.htm

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Loss of Teeth and Coronary Heart Disease

This study found there was a significant hazard ratio for total mortality, but only for edentulousness. When examined by stepwise regression of the coronary heart disease risk factors,all significance of risk from the three oral parameters was lost, smoking having the largest effect of all risk factors.

Number of remaining teeth, edentulousness, and number of years of edentulism were not independent risk factors for total or coronary heart disease mortality, but they were surrogate markers for the risk from smoking. 

[Ragnarsson E, Eliasson ST, / Gudnason V Loss of Teeth and Coronary Heart Disease International Journal of Prosthodontics  2004;17(4): 441-446.]

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Periodontitis and atherogenesis

 The aim of this study was to assess the systemic effects of treating severe widespread periodontitis in a population of otherwise healthy individuals by examining treatment associated changes in markers of inflammation that are also implicated in cardiovascular atherosclerotic diseases. Control of periodontitis, achieved with non-surgical periodontal therapy, significantly decreased serum mediators and markers of acute phase response. The significance of the serum response was associated with the half of the population that responded better to non-surgical periodontal therapy. The results of this pilot study indicate that severe generalised periodontitis causes systemic inflammation. This is consistent with a causative role of periodontitis in atherogenesis.
 [D'Aiuto F, Parkar M, Andreaou G, Brett PM, Ready D, Tonetti MS Periodontitis and atherogenesis: causal association or simple coincidence? J Clin Periodontol 2004;31(5):402 - 411.]

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Diet Changes Because of Tooth Loss Could Lead to Heart Risk 

Changes in diet because of tooth loss could increase the risk of developing chronic ailments, including cardiovascular disease, according to a study in this month's Journal of the American Dental Association (JADA). In the study, researchers assessed the relationship between tooth loss and changes in diet over an eight-year period among 31,813 male health professionals. They focused on consumption of specific foods and nutrients associated with cardiovascular and other systemic diseases.  The results of this study support the detrimental impact of tooth loss on dietary intake. Results suggest that changes in diet owing to tooth loss could contribute to an increased risk of chronic disease that has been associated with poor dentition.  According to the study, the dietary change of men who lost five or more teeth was unhealthier than that of men who lost no teeth.  www.rdh.net 10/03

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Dentist detects heart problems

A dentist may be the first one to suspect health problems, including heart disease. A sore or painful jaw is one indicator of heart disease. There's also a connection between gum disease and heart problems. By eliminating a local infection involving a tooth or the gums, patients have been able to decrease blood pressure medications and improve overall health. New research is suggesting that people with gum disease are at higher risk for heart attacks. If bacteria in the infected gums dislodge, they can enter the bloodstream, attach to blood vessels and increase clot formation. That in turn decreases the blood flow to the heart, increasing chances of a heart attack and aggravating high blood pressure.

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Medications a Risk Factor For Periodontal Disease

Calcium channel blockers, nitroglycerin that contains a sugar base, aniotensin converting enzyme (ACE) inhibitors and chewable medications containing sugar as a major ingredient are medications recognized as risk factors for oral disease.

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New Study Confirms Periodontal Disease Linked to Heart Disease

     Data reveals diseased gums pump high levels of harmful bacterial components into bloodstream!

    A study from Journal of Periodontology has confirmed findings that people with periodontal disease are at greater risk of contracting systemic disease such as as cardiovascular disease.

     Patients with diseased gums release significantly higher levels of bacterial components such as endotoxins into the bloodstream where they can travel to other organs in the body.  The mouth can be a major source of chronic or permanent release of toxic bacterial components in the bloodstream during chewing.  Individuals with severe periodontal disease had approximately 4 times more harmful bacterial products in their blood.  

     The study concludes that this data clearly "stresses the importance of regular dental checkups to ensure a healthy disease free mouth.
Dentistry Today, Vol. 21, No 3; March 2002 pg 30.

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Heart/Dental Connection Updates

Further Evidence of the Association Between Periodontal Conditions and Coronary

There is increasing evidence that chronic infections, such as periodontal diseases, could play a role in the initiation and development of coronary artery disease (CAD). population.

Periodontitis was significantly more frequent in CAD patients than in controls (CAD patients: 91%; controls: 66%). Furthermore, proportions of mobile teeth, bleeding sites, periodontal pockets, and involved furcations were
significantly higher in CAD patients than in controls. In addition, the extent of the periodontal disease present was also greater in cases than in controls.
In the present study, periodontitis was revealed to be a significantrisk factor for CAD after adjusting for other confounding factors, with the level of association increasing with the individual extent of
the periodontal lesions.


[Sabine O, et al., Further evidence of the association between periodontal conditions and coronary artery disease  Sabine O. Geerts, Victor Legrand, Joseph Charpentier, Adelin Albert,and Eric H. Rompen J Periodontol 2004;75(9):1274-1280.]

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Study links periodontal bacteria, edentulism with heart disease Two types of bacteria that cause gum disease may also create problems for the heart. And having no teeth doesn't help matters either. In a new study, Dr. Pirkko J. Pussinen, from the University of Helsinki, and colleagues looked for antibodies to these dental bugs in the blood of 1163 men. Antibodies are chemicals produced by the body to fight infection and are an indirect way of determining whether a particular bug is present. Men with antibodies to the dental bacteria (because they have gum disease) were 50 percent more likely to have heart disease than men without these antibodies. Interestingly, men with antibodies also had lower blood levels of HDL cholesterol--the good type of cholesterol. Another big risk factor for heart disease was not having teeth. Nearly 20 percent of men without teeth had heart disease compared with only about 12 percent of men with teeth.   SOURCE: Arteriosclerosis, Thrombosis, and Vascular Biology July 2003

Atridox Helps Fight Heart Disease

     Atridox a localized antibiotic treatment for gum disease.  Atridox lowers inflammatory factors in the blood and bactermia when used as a part of periodontal therapy to decrease the risk of a heart attack.
Dentistry Today pg 32, September 2002

More Evidence That Periodontitis May Be a Risk Factor for Heart Disease 

Cardiac transplant patients had a significantly higher incidence of periodontal disease than patients with no history of heart disease. The study adds further evidence that periodontal disease - an infection of the gums - may be linked to more serious systemic illnesses.  The study concluded that 77% of the transplant patients had periodontitis, compared with only 13% of the healthy patients. 

"This study adds one more piece of significant evidence that, along with high cholesterol and blood pressure, periodontal disease should be seen as a risk factor for cardiovascular disease," Lessem said. "In recent decades, large epidemiological studies have demonstrated the potential link between periodontitis and ischemic heart disease in particular.  Among the most recent studies was one published in the The Journal of Periodontology (February 2002) showing that diseased gums released significantly higher levels of bacterial proinflammatory components, such as endotoxins, into the bloodstream in patients with severe periodontal disease compared with healthy patients. As a result, these harmful bacterial components in the blood could travel to other organs in the body, such as the heart, and cause harm. That study was in line with recent findings at the University of Buffalo, where researchers suggested periodontal disease may cause oral bacterial components to enter the bloodstream and trigger the liver to make C-reactive proteins, which are predictors for increased risk of cardiovascular disease. 

It is now common practice for dentists to prescribe antibiotics prior to oral surgery or even advanced cleaning techniques for patients with particular heart health profiles. 
This article was prepared by Heart Disease Weekly editors from staff and other reports. Heart Disease Weekly via NewsRx.com & NewsRx.net; "Periodontitis: A New Cardiovascular Risk Factor," researcher Jan Lessem, MD, PhD, the chief medical officer and executive vice president clinical research of OraPharma, Inc.

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Candidates for the heart transplant are more likely to suffer from serious gum disease then patients with no history of heart trouble. This according to research presented at the World's 24th Congress of Cardiology meeting held in May in Sydney, Australia. In the study, "Periodontitis: A New Cardiovascular Risk Factor," researchers found 77% of heart transplant patients had gum disease, while only 13% of healthy patients suffered from the gum infection. Results were based on comparisons of 962 patients with no history of heart disease with 82 cardiac transplant patients.

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 People who are ill with respiratory or urinary tract infections face a higher risk of heart attack or stroke while they are sick.

But the researchers -- who examined more than 5 million patientrecords in England and Wales to test a theory that the risk of heart attack and stroke rises when the lining of blood vessels becomes inflamed -- found that vaccination against the flu, tetanus or pneumonia, which also causes inflammation, does not increase the risk.

In fact, flu shots seemed to reduce the danger, but only in the short term. It was discovered that the real risk came when the inflammation was caused by illness.

“This study provides support for the concept that inflammation is an important factor is atherosclerotic disease and also provides reassurance that vaccination does not increase the risk of vascular events,”

During the first three days of a respiratory tract infection, the risk of a heart attack increased by 395 percent and the likelihood of a stroke was 219 percent higher than normal.

It wasn’t just the strain on the lungs and throat that increased therisk. People with urinary tract infections had a higher risk as well -- 66 percent higher for a heart attack and 172 percent higher for astroke during the first three days of the infection.

The risk declined gradually over time, but it was still elevated forup to 28 days.

Source: Prevention Update, Dentistry Today.
* Dr. David Page ADA News 2000
Fact Sheet by Academy of General Dentistry. Visit: The Mouth-Body Connection by The American Academy of Periodontology  
+ Perio and heart disease by Trisha E. O'Hehir RDH Sept. 2003   

September 14, 2007

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