Your mouth and heart disease
Treating gum disease lowers blood pressure
A study presented at the American Heart Association’s Scientific Sessions this past November showed a connection between treatment of gum disease and lowered blood pressure. High blood pressure is a major risk factor for heart disease, and new guidelines released by the AHA and the American College of Cardiology in the fall mean that anyone with blood pressure higher than 120/70 (either number) needs to take steps to lower it.
A study in China followed 107 Chinese women and men age 18 years and over with prehypertension and moderate to severe gum disease.
• One month after treatment, systolic blood pressure was nearly 3 points lower in participants receiving intensive treatment, but no significant difference was observed in diastolic blood pressure.
• Three months after treatment, systolic blood pressure was nearly 8 points lower and diastolic pressure was nearly 4 points lower in patients receiving intensive treatment.
• Six months after treatment, systolic blood pressure was nearly 13 points and diastolic blood pressure was almost 10 points lower in patients receiving intensive treatment.
“The present study demonstrates for the first time that intensive periodontal intervention alone can reduce blood pressure levels, inhibit inflammation and improve endothelial (relating to the inner lining of blood vessels) function,” said study lead author Jun Tao, MD, PhD, chief of the department of Hypertension and Vascular Disease and director of the Institute of Geriatrics Research at The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China.
Infective endocarditis, congenital heart defects and dental procedures
Two groups of people should take extra precautions when visiting the dentist: those born with certain types of congenital heart defects, and those with artificial heart valves. One in 100 babies is born with a congenital heart defect, the most common birth defect. Those who need to take an antibiotic one hour before a dental procedure have:
• Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), that has not been fully repaired, including children who have had a surgical shunts and conduits. • A congenital heart defect that’s been completely repaired with prosthetic material or a device for the first six months after the repair procedure.
• Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at or adjacent to a prosthetic patch or prosthetic device.
People at risk of infective endocarditis should also take antibiotics before a dental procedure. Infective endocarditis, or bacterial endocarditis, is an infection caused by bacteria that enters the bloodstream and settle in the heart lining, a heart valve or a blood vessel. Those at highest risk of infective endocarditis have:
• A prosthetic heart valve or have had a heart valve repaired with prosthetic material; • A history of endocarditis;
• A heart transplant with abnormal heart valve function.
—By American Heart Association/American Stroke Association
Make the connection
Oral health and overall health
Did you know that there can be significant connections between your oral health and overall health and that the mouth can signal health problems elsewhere? That relationship to total health emphasizes the need for patients to be educated about the importance of preventive oral health care. Research suggests periodontal (gum) disease as a risk factor for heart and lung disease, diabetes, premature, low birth weight babies and a number of other conditions. The Surgeon General’s report, Oral Health in America, called attention to this connection and stated that, if left untreated, poor oral health is a “silent X-factor promoting the onset of life-threatening diseases which are responsible for the deaths of millions of Americans each year.”
Periodontal disease and general health
The signs and symptoms of many potentially life-threatening diseases appear in the mouth first. Dentists and dental hygienists routinely look for these signs and symptoms during regular oral health examinations and explain their observations to patients, urging them to follow up with a medical visit for a definitive diagnosis. When necessary, dental professionals also provide therapy for the oral manifestations of systemic diseases.
A major disease with an oral health connection is heart disease—the number one killer of men and women—claiming more victims than all forms of cancer and chronic lower respiratory disease combined. About 92.1 million people are living with some form of cardiovascular disease or the after-effects of stroke, and cardiovascular disease is the underlying cause of death in about one in three deaths or 2,300 deaths each day. Some studies have suggested a connection between heart disease and key bacteria in periodontal disease and that inflammation caused by periodontal disease may be responsible for the association. Research has indicated that periodontal disease increases the risk of heart disease. While research continues to explore this link, dentists and dental hygienists are instrumental in identifying the presence and extent of the periodontal infection and work with patients, both to treat existing periodontal problems and to prevent future complications.
Another disease that has an important relationship to periodontal disease is diabetes—a serious, costly, and increasingly common chronic disease that, as of 2015, affected 30.3 million children and adults, or 9.4% of the population in the United States. Diabetes is the 7th leading cause of death with diabetes listed in almost 80,000 deaths as the underlying cause and as an underlying or contributing cause of death in almost 253,000 deaths.
Research shows that people with diabetes are more susceptible to serious gum disease and also that serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes.
Approximately 95 percent of Americans who have diabetes also have periodontal disease and research shows that people with periodontal disease have more difficulty controlling their blood sugar level. Severe periodontal disease also can increase the risk of developing diabetes. Almost one-third of people with diabetes have severe periodontal disease with loss of attachment of the gums to the teeth measuring 5 mm or more. After a physician has made a conclusive diagnosis of diabetes, it is critical that patient receive professional oral health care regularly and follow a customized home-care routine to help keep blood sugar levels in check.
Oral infection also has been implicated in respiratory ailments. Bacteria in periodontal disease can travel from the mouth to the lungs and lower respiratory system, where it can aggravate respiratory conditions, particularly in patients who already have other diseases. A routine oral health exam also can uncover signs and symptoms of osteoporosis and low bone mass, conditions that affect about 54 million Americans; eating disorders, such as anorexia nervosa and bulimia, which can be detected by thin tooth enamel and a red mouth; and HIV, which often shows signs in the mouth first. Periodontal disease also has been linked to premature, low birth weight babies. Studies have indicated that expectant mothers with periodontal disease are up to seven times more likely to deliver premature, low birth weight babies.
One of the most serious diseases found in the mouth is oral cancer. Often curable in its early stages, oral cancers are a major cause of death and disfigurement in the United States, according to the National Cancer Institute. Oral cancer is more common than leukemia, skin melanoma, Hodgkin’s disease and cancers of the brain, liver, thyroid gland, stomach, ovaries, and cervix. If caught early, it can be treated successfully; however, if not, it can spread into other parts of the body and become difficult, if not impossible, to treat. The oral cancer screening is one of the most important components of a routine dental exam.
The Centers for Disease Control report that about one of two U.S. adults age 30 and older have periodontitis, the more advanced form of periodontal disease. In adults 65 and older, this prevalence rate increases to 70 percent. In view of the critical relationship of periodontal disease to overall health, and the staggering number of Americans who develop it, it is essential that the disease be prevented or detected early and treated aggressively.
Resources: American Dental Hygienists’ Association – adha.org American Dental Association – mouthhealthy.org American Academy of Periodontology – perio.org American Diabetes Association – diabetes.org American Heart Association – heart.org Centers for Disease Control – cdc.org
—By Lucy Greene