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GUM DISEASE LINKED TO HEART DISEASE

Gum disease will affect the condition of your heart.*

The most common strain of bacteria in dental plaque can cause blood clots that induce heart attacks when they escape into the bloodstream, researchers have reported.

Gum disease may weaken heart meds

Finnish researchers are linking periodontitis, or gum disease, with the long-term effectiveness of antibiotics that prevent heart attacks. Scientists in Helsinki gave 141 patients with and without periodontitis a three-month course of treatment with antibiotics made to decrease the recurrence of cardiovascular events. The double-blind trial then registered the recurrence of new cardiovascular eventsover the course of one year. According to the article, which is in the journal Atherosclerosis, 79 percent of patients without gum disease went a year without new heart problems. That number dropped to 74 percent in the patients without teeth and 66 percent in those with periodontitis. Periodontitis destroys the soft tissue and bone that support your teeth and can cause tooth loss.

The researchers said this is the first time dental infections have been linked to the effectiveness of long-term treatment with these antibiotics. But other research has recently linked gum disease with
an increase risk for heart disease, stroke and premature births.
Sat 07 Jan 2006 01:13 PM CST WASHINGTON DC (myDNA News)
RESEARCH REPORT
     

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Full-mouth Tooth Extraction Lowers Systemic Inflammatory and Thrombotic Markers of Cardiovascular Risk

Prior studies of a link between periodontal and cardiovascular disease have been limited by being predominantly observational. We used a treatment intervention model to study the relationship between periodontitis and systemic inflammatory and thrombotic cardiovascular indicators of risk. We studied 67 adults with advanced periodontitis requiring full-mouth tooth extraction. Blood samples were obtained: (1) at initial presentation, immediately prior to treatment of presenting symptoms; (2) one to two weeks later, before all teeth were removed; and (3) 12 weeks after full-mouth tooth extraction. After full-mouth tooth extraction, there was a significant decrease in C-reactive protein, plasminogen activator inhibitor-1 and fibrinogen, and white cell and platelet counts. This study shows that
elimination of advanced periodontitis by full-mouth tooth extraction reduces systemic inflammatory and thrombotic markers of cardiovascular risk. Analysis of the data supports the hypothesis that  treatment of periodontal disease may lower cardiovascular risk.

B.A. Taylor1,*, G.H. Tofler2, H.M.R. Carey1, M.-C. Morel-Kopp2, S. Philcox2, T.R. Carter1, M.J. Elliott1, A.D. Kull2, C. Ward2, and K. Schenck3 1 Sydney Dental Hospital, 2 Chalmers Street, Surry Hills NSW 2010, Australia; 2 Royal North Shore Hospital, New South Wales, Australia; and3 Department of Oral Biology, University of Oslo, Norway* corresponding author, barbara.taylor@email.cs.nsw.gov.au

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New Evidence:

Periodontal therapy lowers levels of heart disease inflammation markers

UC Davis study identifies C-reactive protein as cause of blood clot formation

New research finds link between gum disease, acute heart attacks

Assay Characteristics of HSCRP Tests

Periodontal Disease, C-Reactive Protein and Overall Health

Periodontitis and cardiovascular disease: A review of shared risk factors and new findings supporting a causality hypothesis

Periodontitis is a common chronic disease worldwide. It is a major cause of tooth loss among adults and recently has been suggested to increase the risk for developing several systemic diseases, including cardiovascular disease. Populations are not equally affected by periodontal disease because there are several environmental and host factors modulating susceptibility. Cardiovascular disease shares many of the same susceptibility factors. The purpose of this report is to identify risk factors and indicators common to periodontitis and cardiovascular disease, and also to discuss their possible interrelationship in this association. Recent findings to support a causal association between the 2 conditions are also presented. Mohammad S. Al-Zahrani, BDS, MSD, PhD / Rayyan A. Kayal, BDS / Nabil F. Bissada, DDS, MSD

 (Reuters Health) - Treating Severe Periodontal Disease can Improve Indothelial Function

Epidemiological studies have linked periodontal infections to cardiovascular disease, Dr. Gerald Seinost of University Hospital in Graz, Austria and colleagues write in the June issue of the American Heart Journal.

They conducted the current study to determine whether endothelial dysfunction, a crucial step in atherosclerosis progression, would be worsein patients with severe periodontal disease and whether treating the disease
would improve endothelial dysfunction.

Average flow-mediated dilation in the patients was 6.1% before treatment compared to 8.5% for the controls. After successful treatment, flow mediated dilation increased by 9.8% over baseline, and was similar to that of healthy
controls. Treatment also resulted in a significant drop in C-reactive protein levels.

All patients underwent scaling and root planing, and also received instruction in oral hygiene and several cleanings. Chlorhexidine gluconate mouthwashes were prescribed for 14 days, and systemic antimicrobial treatment for seven days.

"These results indicate that treatment of severe periodontitis reverses endothelial dysfunction. Whether improved endothelial function will translate into a beneficial effect on atherogenesis and cardiovascular
events needs further investigation," the researchers conclude.

Considering that at the very least, periodontal therapy would improve oral health, we suggest that periodontal therapy as an integral component of preventive cardiology treatment.


Am Heart J 2005;149:950-954,1050-1054.

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Radiographic Measures of Chronic Periodontitis and Carotid Artery Plaque

 Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study wasto determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure ofsubclinical atherosclerosis. Panoramic oral radiographs were obtained from 203 stroke- free subjects ages 54 to 94 during the baseline examination

Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.


Steven P. Engebretson, et al.,Radiographic Measures of ChronicPeriodontitis and Carotid Artery Plaque Stroke. 2005;36:561

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Associations Between Periodontal Disease and Risk for Atherosclerosis, Cardiovascular Disease, and Stroke.

     Recent studies implicate exposure to systemic conditions involving chronic inflammation, including chronic periodontitis,in the etiology of atherosclerosis. MEDLINE, pre-MEDLINE, MEDLINE Daily Update,
and the Cochrane Controlled Trials Register were searched to identify human studies that related variables associated with atherosclerosis to periodontal disease. Searches were made for papers published from 1966
through March 2002.
     Results: Of the initial 1,526 studies identified, 31 (including 8 case-control and 18 cross-sectional reports) were included in the analysis. Taken together, most of the literature supports a modest association between
periodontal disease and atherosclerosis.

                Reviewers' Conclusions: Periodontal disease may be modestly associated with atherosclerosis, MI, and CVD. Additional large-scale longitudinal epidemiologic and intervention studies are necessary to validate this association and to determine causality.

A Systematic Review Frank A. Scannapieco, Renee B. Bush, and Susanna PajuAnn Periodontol 2003;8:38-53.

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The Role of Inflammatory and Immunological Mediators in Periodontitis and Cardiovascular Disease
      

             Epidemiological studies have implicated periodontitis (PD) as a risk factor for development of cardiovascular disease (CVD). Persistent infections such as periodontitis induce inflammatory and immune responses which may contribute to coronary atherogenesis, and, in conjunction with other risk factors, may lead to coronary heart disease (CHD). Periodontal diseases are bacterial infections associated with bacteremia, inflammation, and a strong immune response, all of which may represent significant risk factors for the
development of atherogenesis, CHD, and myocardial infarction (MI). Several mechanisms may participate in this association, including those induced by oral organisms, and those associated with host response factors.
Ann
Periodontol Ernesto De Nardin 2001;6:30-40.

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The Relationship Between Infection, Inflammation, and Cardiovascular Disease: An Overview
      


             While control of chronic infection in the mouth, stomach or lungs is appropriate for its local effects, proving its efficacy in prevention of CVD presents a continuing challenge to medical science.
Ann PeriodontolGordon D.O. Lowe 2001;6:1-8.

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Perio as a risk factor for atherosclerosis

The current literature regarding periodontal diseases and atherosclerosis and coronary vascular disease was searched using theMedline and PubMed databases.An emerging concept suggests that a pathogenic burden from different sources might overcome an individual threshold culminating in clinical sequela. P. gingivalis contributes directly and indirectly to atherosclerosis.


[Chun YHP, Chun KRJ, Olguin DA, H Wang HL  Biological foundation forPeriodontitis as a potential risk factor for atherosclerosis Journal of Periodontal Research 205;40(1):87.]

Listen to a program on how gum disease affects our heart health.

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Periodontitis as risk factor for acute myocardial infarction. A case control study of Spanish adults

A study was conducted of 149 Spanish patients aged between 40 and 75 years. Males, older patients, smokers, and those with hypertension, diabetes or hypercholesterolemia, showed an increased risk of acute myocardial infarction.  The association between periodontitis and acute myocardial infarction was high There is evidence of an association between periodontitis and acute myocardial infarction after adjusting for well-known risk factors for acute myocardial infarction.

Journal of Periodontal Research  Volume 40 Issue 1 Page 36  -February 2005 A. Cueto, F. Mesa, M. Bravo, R. Ocaña-Riola

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

October  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.

The study proposes two hypotheses for this occurrence.

bullet

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.)

bullet

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.                         Back >>>>>

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November 2002

 
Harvard Medical School researchers studied longevity and found one of the most important contributing factors was daily flossing. Because it removes bacteria from the teeth and gums, flossing helps to prevent periodontal disease and gingivitis. Another study found that men with periodontitis had a whopping 72% greater risk of developing coronary disease. Gingivitis was associated with a 42% increased risk for men. Nov 02

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Inflammatory Response to Acute Coronary Syndrome in Patients With  Coexistent Periodontal Disease

Conclusions: The periodontal health of patients admitted to the Coronary Care Unit due to acute coronary syndrome is unacceptable. The mean values for CAL and probing depth, as well as extensive bleeding on probing sites indicate the presence of active periodontal disease, which may affect the incidence of cardiovascular disease.  We observed that patients with acute coronary syndrome had more advanced periodontal disease. Patients with less advanced periodontal disease were characterized by a faster diminution of the inflammatoryresponse in comparison to the groups with more advanced periodontal disease.

[J Periodontol 2004;75:1020-1026.]
July 2004 (Vol. 75, No. 7) Inflammatory Response to Acute Coronary Syndrome in Patients With 
Coexistent Periodontal Disease Maciej R. Czerniuk, Renata Górska, Krzysztof J. Filipiak, andGrzegorz Opolski
 

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August 2002

   There is some evidence now that anti-collagenase found in Periostat a medication used for gum disease, may also help cut down dissemination of metastatic cancer and invasion of the artery wall in arteriosclerosis.

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Heart-Gum Disease News Updates:

Periodontal Pockets and Elevated Cholesterol and Low Density Lipoprotein Cholesterol : Periodontitis is associated with increased prevalence of cardiovascular morbidity and mortality. 
The presence of periodontal pockets was positively associated with higher cholesterol and low density lipoprotein (LDL) cholesterol blood levels in men
. No significant association was found in women. The findings of the study support the reports linking increased prevalence of cardiovascular mortality among patients with periodontal disease.
May 2002 (Vol. 73, No. 5) Association Between Periodontal Pockets and Elevated Cholesterol and Low Density Lipoprotein Cholesterol Levels J Periodontol 2002;73:494- 500. Joseph Katz, Moshe Y. Flugelman, Avishai Goldberg, and Marc Heft 

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March 2002

Periodontal antibiotic gel lowers inflammatory activity throughout body

Treating periodontal infections with an antibiotic gel decreased the presence of two chemical markers of inflammation throughout the body, pointing to further evidence of the connection between oral health and overall health.

Following treatment, the groups that received the gel showed:
bulletlower levels of oral bacteria 
bulletdecrease in the amounts of C-reactive protein 
bulletdecrease fibrinogen in the blood stream

 The "two markers" of inflammatory activity (c-reacitve protein and fibrinogen) are associated with the development of atherosclerosis and other chronic diseases. This reduction in C-reactive protein remained for six months.

Several studies conducted have found oral bacteria from gum infections in arterial plaque. 

Now we have shown that therapy for periodontal disease lessens the inflammatory burden throughout the body.

Source: The University at Buffalo and National Institute of Dental and Craniofacial Research.

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February 2002
New Study Confirms Periodontal Disease Linked To Heart Disease
     A newly published study in the Journal of Periodontology confirms recent findings that people with periodontal disease are at a greater risk of systemic diseases such as cardiovascular disease.

     Researchers found diseased gums released significantly higher levels of bacterial pro-inflammatory components, such as endotoxins, into the bloodstream in patients with moderate to severe periodontal disease compared to healthy patients. Additionally, those with severe periodontal disease had approximately four times more harmful bacterial products in their blood than those with moderate or no periodontal disease

     "We found the mouth can be a major source of chronic or permanent release of toxic bacterial components in the bloodstream during normal oral functions," said Dr. E.H. Rompen, director of the study. "This could be the missing link explaining the abnormally high blood levels of some inflammatory markers or endotoxemia observed in patients with periodontal disease."

      "This data clearly stresses the importance of regular dental checkups to ensure a healthy, diseased-free mouth."

     Periodontal diseases are serious bacterial infections that destroy the attachment fibers and supporting bone that hold your teeth in your mouth. When this happens, gums separate from the teeth, forming pockets that fill with plaque and even more infection. As the disease progresses, these pockets deepen even further, more gum tissue and bone are destroyed and the teeth eventually become lose. Approximately 15 percent of adults between 21 and 50 years old and 30 percent of adults over 50 have the disease.

American Academy of Periodontology, 02/02

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Periodontal Diseases relationship to Heart Disease

Mark Herzberg of the University of Minnesota said the findings are the first to link bacteria to the formation of potentially fatal blood clots.

Previous studies had found the incidence of heart disease is about twice as high in people with periodontal disease, but scientists didn't know why.

"Now we show a potential biological reason." Herzberg told the 150th annual meeting of the American Association for the Advancement of Science.

In lab tests, Herzberg and colleagues injected bacteria from dental plaque into the bloodstream of rabbits. The bacteria caused blood clots to form within minutes. Rabbits are a proven model for testing hypotheses about human heart disease and heart attacks.

Chronic inflammation of the gums due to plaque also could be involved in the inflammation of the lining of the blood vessels that is known to lead to the build-up of plaque in the arteries, Herzberg said.

Additional studies presented at the meeting show that bacteria in plaque also are linked to:
bulletA potentially fatal disease called infective endocarditis in which the sac around the heart becomes inflamed.
bulletLung infections in people with chronic lung diseases such as chronic obstructive pulmonary disease.
bulletA weakened immune system that can slow wound healing and diminish a person's response to vaccines against hepatitis B and influenza.
bulletA higher risk of giving birth to premature, low birth-weight infants.

Reducing risk of diseases linked to dental bacteria is a common lesson preached by dentists: 

bullet Have the teeth cleaned regularly
bulletFloss daily. 

If necessary, have bone implants to replace dental bone lost from periodontal disease, says researcher, Frank Scannapieco, State University of New York, Buffalo. Bacteria reside in pockets caused by bone loss where the teeth are attached.

By Tim Friend, USA Today. Reprinted with permission.

(Article from Pro-Dentec)              

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Scaling and Root Planing are the procedures to help restore gum tissue to health.

Scaling removes the plaque and tartar from the crown of your tooth  *                                           Root planing removes the calculus from the root of your tooth*

*By Ms Flossy

February 06, 2008

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          If you have any questions please e-mail me at: drdpeterson@scottsbluff.net
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