Connection+Between+Periodontal+Disease+and+Coronary+Heart+Disease

= =   Reina: One of the first researchers to indicate a relationship between orofacial infections and atherosclerosis, the most common cause of myocardial infarction and ischemic stroke, were Mattila et al. in 1989. Having evaluated the number of teeth, caries of foci, gingival and bony pockets, and panos of 100 Finnish men and women who had had a myocardial infarction, they concluded that their dental was significantly worse than that of 102 control subjects. The first prospective cohort studies were carried out by DeStefano et al. in 1993. Based on a 14-year observation of 1,000 subjects, they found a 25% increase in coronary heart disease in those with clinically diagnosed periodontal pockets. The authors noted this association might have been only accidental and resulting from the poor hygiene and lack of pro-health behavior often seen in p patients with cardiovascular disease. Three hypotheses for mechanisms that associate chronic periodontitis with atherosclerotic and thrombotic components of cardiovascular disease have emerged, and they seem to complement one another: 1. Bacterial invasion assumes direct action of bacteria and their toxins on the endothelium. 2. Inflammatory mediators released by the cells of the immune system play the key role in the damage to the vascular wall endothelium (cytokine theory). 3. Heat shock proteins (HSP65) expressed on oral pathogens, e.g. //Porphyromonas// //gingivalis//, //Prevotella intermedia//, and //Actinobacillus actinomycetecomitans// are significant. Anti-hsp65/60 antibodies in the saliva of subjects with chronic periodontitis were not seen in health periodontium. Antibacterial antibodies reacting with endothelial HSP-60 led to endothelial cell damage and exposure to inflammatory factors. Niedzielska, I., Janic, T., Cierpka, S., & Swietochowska, E. (2008, July). The effect of chronic periodontitis on the development of atherosclerosis: Review of the literature. //Medical Science Monitor: International Medical Journal of Experimental and Clinical Research//, //14//(7), RA103-106. Chun, Y. H., Chun, K. R., Olquin, D., & Wang, H. L. (2005, February). Biological foundation for periodontitis as a potential risk factor for atherosclerosis. //Journal of Periodontal Research//, //40//(1), 87-95.
 * Connection Between Periodontal Disease and Coronary Heart Disease **

Coronary heart disease (CHD) has been associated with periodontal disease for some time. The exact correlation and the extent of the association are still being researched. The oral cavity is a part of the body, so when people have periodontal disease it does affect their body in many ways. An article from JADA, stated that the connection between CHD and periodontitis is weak and not significant. They said that treating chronic periodontitis does not lower the risk for CHD or c-reactive serum protein levels, which has been found to mediate CHD. This study was done in 2002, so more research had been done since then. I found a later study of 250 individuals that was done in 2006, a little less than half of the sample had CHD and the other 140 did not. The evaluators obtained their probing depths, BOP, attachment level, and alveolar bone level. There was a significant difference between the two groups. There was also a direct correlation between participants over 60 with CHD and alveolar bone loss >4mm. So this study did show that CHD is associated with periodontal disease, however many of the participants smoked or had diabetes, so we need to take that into consideration as well. Both of those conditions would defiantly alter a patient’s periodontal status, which would make them significant risk factors. In addition, age does not directly cause periodontal disease, but factors such as, decreased healing time, medications, and decrease vitality would be contributing factors. Other articles on CHD and periodontitis have stated a correlation between the disease and poor oral health, which can lead to periodontitis. This is a huge factor; people who do not take care of the oral cavity are more likely to not take care of their body. Exercising, diet, tobacco use, cholesterol, etc are more likely to be a problem within these patients. Those factors put together can lead to periodontitis and coronary heart disease. In conclusion, we can use this information with our patients who may or may not have CHD and educate them on the possibilities and the complications that could and may arise from not taking care of their oral cavities. Periodontal disease is multi-factorial, so CHD could definitely be a factor within the disease and vice versa.

Friedlander, A. H., Sung, E. C., and Child, J. S. (2004). Poor oral health linked with coronary heart disease. //The Journal of the American Dental Association, 135//(4), 416. Geismar, K., Stoltz, K., Sigurd, B., Gyntelberg, F., and Holmstrup, P. (2006). Periodontal disease and coronary heart disease. //Journal of Periodontology, 77//(9), 1547-1554. Hujoel, P. P. (2002). Does chronic periodontitis cause coronary heart disease? The //Journal of the American Dental Association, 133//(1), 31-36. Hujoel, P. P., Drangsholt, M., Spiekerman, C., and Derouen, T. A. (2001). Examining the link between coronary heart disease and the elimination of chronic dental infections. //The Journal of the American Dental Association, 132(//7), 883-889. Newman, M. G., Takei, H. H., Klokkevold, P. R., and Carranza, F. A. (2006). //Carranza’s Clinical Periodontology,// 10th ed. Missouri: Saunders Elsevier.

Periodontal disease is caused by multifactor such as age, sex, ethnicity, smoking status, and socioeconomic status. The researchers stated that periodontal disease is associated with cardiovascular disease, but not caries. People with periodontal disease have 50 to 80 percent risk of developing coronary heart disease, especially if they are younger in age. On the other hand, two other cohort studies reported that there are no relationship between periodontal disease and coronary heart disease, but periodontal disease has strong related to cerebrovascular disease (CVD). Two other reports from United State and Germany stated that periodontal disease associate with CVD in men more than in women. However, these controversy need to have more studies to confirm (Demmer & Desvareix, 2006). Meumen stated that periodontal disease associated with Coronary heart disease cause 33 percent death in the U. S. following by CVD. This article also stated that periodontal disease has stronger relationship to CVD than coronary heart disease (Meuman, Sanz, & Janket, 2004). It is interesting that the bacteria that cause cavities do not associated with coronary heart disease or CVD. For instance, if a patient who is smoker, he or she is less likely to have cavities, but has higher risk of developing heart attack. The second interesting point is that the bacteria causing periodontal disease have strong correlation to coronary and CVD. Many patients don’t believe that teeth are related to their hearts, so some patients don’t want to disclose their systemic information to dental professionals. I think dental hygienists have important role in educating patients and helping them understand the connection from their oral cavities to their bodies. Demmer, R., Desvareux, M., (2006). Periodontal infection and cardiovascular disease. //The Journal of American Dental Association, 137//, 14S-20S. Meuman, J., Sanz, M., and Janket, S. (2004). Oral health, atherosclerosis, and cardiovascular disease. //Critical Reviews in Oral Biology and Medicine, 15//(6), 403-413.
 * Periodontal Disease Heart Diseases- Diem**

Brein A recent study published in the Journal of Periodontology discussed the connection between cardiovascular disease and periodontal disease. The study compared 108 patients with CAD and those without CAD and the prevalence of periodontal disease in each case. The study showed that patients with coronary heart disease had a significantly higher rate of having periodontal disease then those without coronary heart disease. 91% of the patients who had coronary heart disease suffered from moderate to severe periodontitis. This study also showed that periodontitis had an influence on the occurrence as well as the severity of coronary heart disease and can also increase the risk of heart attack or stroke. This is thought to occur by periodontal pathogens entering into the bloodstream and then invading the blood vessel walls in turn causing atherosclerosis. Another thought is that periodontal infections can be correlated with an increase in plasma levels of inflammation such as fibrinogen causing blood clots.

Rethmun, M. (2004). Further Evidence Reveals the Association Between Periodontal Disease and Coronary Artery Disease. American Academy of Periodontology. American Academy of Periodontology. (2008). Gum Disease Links to Heart Disease Stroke.

Jackie Rocamora DEH 43 Research show that dental bacteria and viruses are a risk factor for atherosclerosis. There is not proven direct relationship between dental infections and systemic health. Other disease that have been related to oral pathogens are glomerulonephritis, rheumatoid arthritis, keratitis, and retinitis, miscarriage or low birth weight newborns, and COPD. Cardiovascular diseases is the number one cause of death in the world and for that reason many studies have been done to find out the damage extend periodontitis has on these diseases. Niedzielska, I., Janic, T., Cierpka, S., & Swietochowska, E. (2008). The effect of chronic periodontitis on the development of atherosclerosis: review of the literature. Medicine Science Monitoring, 14 (7), 103-106.

Dental pathogens affect cardiovascular diseases by releasing cytokines and other pro-inflammatory mediators which may start a cascade of biochemical reactions and cause endothelial damage and facilitate cholesterol plaque attachment. Periodontal disease presents a risk to worsen atherothrombosis (heart infection, stroke, and peripheral vascular disease. Stroke and oral health has been statistically associated with patients all around the globe. Many studies have been done to study the association between periodontal disease and cardiovascular diseases; however, more studies need to be done to concretely prove what these studies show which is a small but significant association between oral infections, mostly periodontitis and all the cardiovascular diseases.

Meurman, J., Sanz, M,. & Janket, S. (2004). Oral health, atherosclerosis, and cardiovascular disease. International and American Associations for Dental Research, 15 (6), 403-413.

Shari Stuart DEH 43 Oral health conditions play a role in systemic health. There are several studies to suggest that there is a link between periodontal disease and coronary heart disease. Factors of particular importance to focus on regarding periodontal disease and coronary heart disease are dental infections, genetic factors and inflammatory mediators. The bacteria associated with periodontal bacteria can increase in numbers over whelming the oral cavity releasing an inflammatory response. The result of an inflammatory response in the oral tissue weakens the oral tissue environment and gives strength for pathogen to travel in the blood stream to infect our systemic health. Bacteria from the oral cavity can be found in other tissues in the body suggesting a link of periodontal disease and heart disease. Periodontitis, atherosclerosis and cardiovascular all have multifactorial etiology. Bacteria from the cavity inters the aortic wall of the heart is from dental procedures. The bacteria in the oral cavity can inter the blood vessels from the oral mucosa when inflamed or manipulated; such as, extractions, surgery, scaling/root planning and brushing the teeth. Subgingival gram-negative bacteria found in plaque such as Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Streptococcus sanguis cause periodontal disease. These gram-negative bacteria have an outer membrane that release a lipopolysacharite that produce endotoxins that breaks down oral tissue and osseous. When the oral mucosa is disrupted during dental procedures the inflamed tissue breaks which gives plaque the opportunity to inter the bloodstream and travel to the aortic wall of the heart. The plaque then adhere to the vessel walls and the bacterial plaque such as A.a. and P. gingivalis grow in the wall which in fact increases the plaque build and amplify the risk for coronary heart disease. Coronary heart disease affects 7 million American people which, contributes to 500,000 deaths a year. People under age fifty years have a 70% chance of the developing coronary heart disease. Younger men and middle aged adults are at a major risk for the development of coronary heart disease when periodontitis is present. Genetic and environmental factors include dietary habits, personal hygiene, tobacco use, males, stress, hypertension, obesity, and endothelial cell injury.

Reference:

Karnoutsos, K., Papastergiou, P., Stefanidis, S., Vakaloudi, A. (2008). Periodontitis as a risk factor for cardiovascular disease: The role of antiphosphorylcholine and anti-cardiolipin antibodies. Heppokratia Quarterly Medical Journal. 12(3): 144-149. Retrieved November 15, 2008 from http://www.pubmedcentral.nih.gov/articlerender.fegi?tool=pubmed&pubmedid=18923669

Meurman, J., Sanz, M., Janket, S. (2004). Oral health, atherosclerosis, and cardiovascular disease. Critical Review Oral Biology medicine. 15(6): 403-413. Retrieved November 15, 2008 from http://www.cytok.com/showabstract.php?pmid=15574681

Natalie: Coronary heart disease and periodontal disease are both multifactorial diseases with a variety of contributing factors. Over time, several studies have been performed to determine if a link between these two diseases actually exists. Can periodontal disease predispose a person to coronary heart disease? If so, what are the factors involved? And can treating the periodontal disease reduce or inhibit coronary heart disease from progressing? One philosophy states that periodontal pathogens such as A. a. or P. gingivalis could enter the bloodstream from the subgingival plaque and invade and damage the blood vessel endothelial leading to atherosclerosis and acute coronary heart disease. Other studies demonstrate how during chronic periodontitis or an acute infection there is an increase in inflammatory mediators such as fibrinogen, C-reactive protein, or several cytokines. These inflammatory mediators work together and create atherosclerotic clots and an increase in plaque build-ups which can lead to other dangerous heart conditions such as angina or an MI.

One longitudinal study evaluated 1203 men and found a “dose-dependent association” between periodontitis and CHD among men younger than 60 years old. They looked at radiographic bone loss, pocket depths and ruled out risk factors for CHD such as age, BMI, smoking, alcohol intake, diabetes, fasting glucose, total cholesterol, HDL cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure. Those men with the lowest bone loss and pocket depths had a statistically significant decrease in cardiovascular disease and the opposite was also true. Those over the age of 60 did not seem to have an association between CHD and periodontitis. Another study evaluated 20 individuals with chronic periodontitis who had pocket depth over 5mm. Subgingival plaque was collected and DNA testing was used to “identify eight pathogens responsible for periodontal tissue destruction” (Zaremba, 2007). “In 13 of 20 patients, the pathogens most frequently found in severe chronic periodontitis were also found in coronary vessels.” In 50% of the case, the same species of bacteria in chronic periodontitis also existed in atherosclerotic plaque but these individuals also had a high BOP which indicated an acute inflammatory infection. (Zaremba, 2007). Other studies performed have not necessarily found a correlation because of so many other contributing factors to both diseases. Although many studies have been done, the results are inconclusive. As dental professionals, we should encourage our patients maintain a healthy mouth and reduce any possible risks for heart disease.

Dietrich, T., Jimenez, M., Kaye, E., Vokonas, P., & Garcia, R. (2008). Age-dependent associations between chronic periodontitis/edentulism and risk of coronary heart disease: Dietrich, Periodontitis and CHD Circulation.117(13): 1668–1674.

Zaremba, M., Górska, R., Suwalski, P., & Kowalski, J. (2007). Evaluation of the Incidence of Periodontitis-Associated Bacteria in the Atherosclerotic Plaque of Coronary Blood Vessels. Journal of Periodontology (78)2: 322-327

Maria:

Coronary heart disease (CHD) is a narrowing of the small blood vessels that supply blood and oxygen to the heart, usually caused by atherosclerosis. Risk factors such as diabetes, hypertension, obesity and smoking increase the risk of CHD. Aside from these factors, many studies have suggested the link between periodontal disease and coronary heart disease. According to the American Academy of Periodontology, people with periodontal disease are nearly twice as likely to suffer from CHD. In a study conducted by Spahr et al. (2006), researchers found that A. actinomycetemcomytans, P. gingivalis, and P. intermedia can enter the bloodstream and attach in coronary arteries and contribute to plaque formation in patients with periodontal disease. In another study conducted by Pussinen et al. (2003) found that edentulousness, seropositivity for P. gingivalis, and high antibody response against major periodontal pathogens are associated with CHD. Furthermore, a study conducted by Angeli et al. (2003) found that infections in periodontal patients can accelerate atherosclerosis due to the release of inflammatory endotoxins. Because these studies confirm the link between CHD and periodontal disease, it is important that we as clinicians explain this association. There is unawareness among patients with periodontal disease and dental professionals need to inform patients that the oral cavity is connected to the entire body. It is also important that patients receive proper treatment to control periodontal disease to decrease the risk of CHD development.

American Academy of Periodontology. Gum disease and heart disease links to heart disease and stroke. Retrieved April 3, 2009, from http://www.perio.org/ consumer/mbc.heart.htm

Angeli, F., Verdecchia, P., Pellegrino, C., Pellegrino, R. G., Pellegrino, G., et al. (2003). Association between periodontal disease and left ventricle mass in essential hypertension. Hypertension. 41(3), 488-492.

Pussinen, P. J., Jousilahti, P., Alfthan, G., Palosuo, T., Asikainen, S., et al. (2003). Periodontal pathogens are associated with coronary heart disease. Atherosclerosis, Thrombosis, and Vascular Biology. 23(6), 1250-1254.

Spahr, A., Klein, E., Khuseyinova, N., Boeckh, C., Muche, R., et al. Periodontal infections and coronary artery disease. Archives of Internal Medicine. 166(3), 554-560.

Weinrach, L. A. (2008). Coronary heart disease. Retrieved April 3, 2009, from http://www. nlm.nih.gov/medlineplus/ency/article/007115.htm

When there is inflammation in the body there is an increase of protein called C-reactive protein (CRP). Periodontal disease cases increased inflammatory effects of the periodontium which C-reactive proteins are created and then are found in increase levels in system. There have numerous of studies to show that the increase numbers of CRP in the blood is associated with coronary heart disease. Slade et al. (2003) found that people with periodontal disease of pocket depths greater than <4mm were approximately one-third had greater CRP levels than those with less pocket depths. People may get tested for CRP levels which may indicate risk of heart attack or stroke. The following were taken from ADA website: If hs-CRP level is lower than 1.0 mg/L, a person has a low risk of developing cardiovascular disease. If hs-CRP is between 1.0 and 3.0 mg/L, a person has an average risk. If hs-CRP is higher than 3.0 mg/L, a person is at high risk. -Marcia

American Heart Association. Inflammation, heart disease and stroke: the role C- reactive protein. Retrieved April 4, 2008 from http://www.americanheart.org/presenter.jhtml?identifier=4648

Slade, G. D., Ghezzi, E. M., Heiss, G., Beck, J.D., Riche E., & Offenbacher. (2003). Relationship between periodontal disease and c-reactive protein among adults in the atherosclerosis risk in communities study. Archives of Internal Medicine 163(10), 1172-1179. Retrieve April 4, 20008 from http://archinte.ama-assn.org/cgi/content/full/163/10/1172

Jennifer Upon research of this topic I realized periodontal disease is a major risk factor to heart disease. I read that some of the bacteria found in the mouth of someone with periodontal disease does aggregate and can aggregate in the tissue of the heart, especially of already compromised heart tissue. This is the reason we would consider antibiotic pre med. But that periodontal disease is a risk factor for heart disease was a eye opening fact. I read an article that says it is a larger risk factor for heart disease then being overweight, or smoking. I think this is very important information which the patient's with periodontal disease need to know. As discussed in early topics just simple brushing can release these varlent bacteria into the blood stream, but the use of premed is not advised in one who is not of high risk, so these bacteria can cont. to aggregate and increase the vessels in the vessels.

Zibereenezhad,M.(2008).Association between periodontal disease and coronary artery disease. Central European Journal of Medicine.3(308-314).

Dental disease as a risk factor for cardiovascular disease(1999) http://www.bracesinto.com/cardiovascular.htm.

Noo: Researchers found periodontal diseases released significantly higher levels of bacterial pro-inflammatory components, such endotoxin into the blood stream in patients with severe periodontal disease compared to healthy patients ( Soejima et al.) As a result, these harmful bacterial products in the blood can be collected in vessels and cause Atherosclerosis. One study showed periodontal disease many cause oral bacterial components that enter blood stream and trigger the liver to make fibrinogen, several cytokines and C-reactive proteins, which are a predictor for increased of cardiovascular diseases( Goteiner et al.). The study also showed that periodontitis in cardiac patients was significantly more frequent than in no cardiac ones. The study found 91% of patients with cardiovascular disease suffered from moderate to severe periodontitis, while this proportion was 66% in the non-cardiac patients. Soejima H., nakayama, H., Sugamura, K., Kawano, H., Sugiyama S., Matsuo, K., Sinohara,M., and Ogawa, H. (2009) Significant association between score of periodontal disease and coronary heart disease. //Heart Vessels//. //24(2):// 103-107 Goteiner,D., Craig, R., Ashmen R., janal M., Eskin ,B., and Lehrman, N. (2008). Endotoxin levels are associated with high-density lipoprotein, triglycerides, and troponin in patients with acute coronary syndrome and angina: possible contributions from periodontal sources. //Journal of// //Periodontology 79(12//): 2331- 2339.

__Tawnya__ With heart conditions being more understood and diagnosed, it is important that us as dental professionals understand and educate our patients on the correlation between whole body wellness (including heart health) and a healthy oral cavity. I was interested in reading the correlation between coronary heart disease and the severity of periodontal disease. Patients with a history of heart disease were more likely to have the presence of periodontal disease with increased severity. Further, patients with periodontal disease have an increased risk of stroke and other heart conditions. Education of good oral hygiene as well as maintaining regular recall intervals is critical for all of our patients but especially those with periodontal disease, history of heart disease, high blood pressure or a family history of heart disease. This makes me realize even more the importance of our thorough health history including family history, and we should pay close attention to this. Genco, R., Offenbacher, S., & Beck, J. (2002). Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms. The Journal of the American Dental Association. 133, 14S-22S. Meuman, J., Sanz, M., and Janket, S. (2004). Oral health, atherosclerosis, and cardiovascular disease. Critical Reviews in Oral Biology and Medicine, 15(6), 403-413. Rethmun, M. (2004). Further Evidence Reveals the Association Between Periodontal Disease and Coronary Artery Disease. American Academy of Periodontology. Zibereenezhad,M.(2008).Association between periodontal disease and coronary artery disease. Central European Journal of Medicine.3(308-314).

Dorinda Epidemiological studies have provided information that periodontist is a risk factor to coronary heart disease. Periodontitis induces the inflammatory and immune response which has been found to contribute to coronary atherogenesis and with other contributing factors can lead to CHD. In addition other studies that have been conducted regarding the association between periodontal disease and coronary heart disease analyzed and compared that the two are associated and there is a high rate of coronary heart disease associated with CHD. It is so important that we educate our patient on the association and correlations between the two so that our patients are more aware of why they need to eat healthy and exercise and also if they are at higher risk for heart disease - high blood pressure, then we really need to provide them with our knowledge and educate them. Gum disease linked to heart disease. (2008, February). Retrieved April 1, 2009 from http://www.dentalgentlecare.com/new_page_20.htm Periodontal disease is associated with coronary heart disease, preterm birth and low birth weight. (2009) British Journal Association. Retrieved April 1, 2009 from [].

Britney

In the research that I did on the efficacy of systemic antibiotics on the treatment of periodontal disease I found that along with SRP systemic antibiotics can play a role in helping to reduce periodontal pockets. There is always the risk however, that the systemic antibiotics can be used too much or in the wrong instance. If this happens then resistant strains of bacteria can develop. I think that to make sure that the antibiotics are used properly; they need to be used on a case by case basis and used with caution. The research talks about making sure that you are only using the antibiotics when necessary such as when there are instances of NUP or when a patient is not responding to treatment for whatever reason. I also think that culturing of bacteria in these patients can also help to make sure that the right antibiotics are used and that they are only used when absolutely needed. Hopefully with the advances in technology, soon enough it will be easier/less expensive to test/culture bacteria from periodontal pockets to find out what is causing periodontal disease in specific patients so that more personalized and effective therapy can be developed for that patient. Overall I think that systemic antibiotics can be a big help in the fight against periodontal disease as long as they are used with caution and are utilized only when necessary.

References:

Greenstein, G. (2000). Nonsurgical periodontal therapy in 2000: a literature review. Journal of the American Dental Association. 131(11), 1580-1592.

Moeintaghavi, A., Talebi-ardakani, M.R., Haerian-ardakani, A., Zandi, H., Taghipour, S., Fallahzadeh, H., et al. (2007). Adjunctive effects of systemic amoxicillin and metronidazole with scaling and root planning: a randomized, placebo controlled clinical trial. Journal of Contemporary Dental Practice. 8(5), 51-59.

Ceri: One study found that many different pathogens are found in carotid atheromas. Those involved are A.a, P. gingivalis, B. forsythus, P. intermedia and C. pneumoniae. Other bacteria like S. sanguis and P. gingivalis can induce platelet aggregation. This aids in forming clots or thromboses. Blood vessels damaged by periodontal bacteria or their products. One possibility is that bacteria from the mouth—or products released by these bacteria—travel through the bloodstream to other parts of the body, where they damage the linings of blood vessels. Cytokines are released by dental pathogens in patients with cardiovascular disease. Endothelial damage may occur due to the biochemical reactions caused by the release of inflammatory mediators. Some studies state that there is a strong correlation with regards to patients who have heart disease also having periodontal disease. But other studies state that the information received is inconsistent. One study done by Loesche found that certain patients with coronary artery disease may have elevated levels of different types of periodontal bacteria. These periodontal bacteria contain lipopolysaccharides. These are considered toxins that can cause illness when released into the body. Although there is evidence that there is correlation with periodontal disease and cardiovascular disease more research needs to be done to truly correlate findings.

Genco, R., Offenbacher, S., & Beck, J. (2002). Periodontal disease and cardiovascular disease: Epidemiology and possible mechanisms. The Journal of the American Dental Association. 133, 14S-22S.

Real connection between oral health and heart disease. (1999). Retrieved April 2, 2009 from: http://www.ns.umich.edu/htdocs/releases/story.php?id=2566

Meurman, J., Sanz, M,. & Janket, S. (2004). Oral health, atherosclerosis, and cardiovascular disease. International and American Associations for Dental Research, 15 (6), 403-413.


 * Priscilla** **Garcia**

Heart disease is a major concern and it affects thousands of people every year. Research has shown that there may be some relationship between perio disease and heart disease. Some common risk factors that contribute to heart disease include age, smoking, cholesterol, diabetes and low socioeconomic status. Research has also shown that pregnant women with oral infections have a higher risk of premature or low birth weight babies. Pulmonary pathogens such as C. pnuemoniae and LPS-producing oral pathogens in dental plaque can move through the circulation to infect the cardiovascular tissues and contribute to arthrosclerosis and the risk of myocardial infarction. Other bacteria such as S.sanguis and P. gingivalis induce platelet aggregation (Slavkin, 1999). Possible respiratory pathogens may also become established in the oral flora with perio disease. Patients who are taking antibiotics may have greater numbers of potential respiratory pathogens adherent to bacteria in subgingival plaque. Patients who have compromised swallowing reflexes can lead to aspiration of these pathogens. Aspiration of oral bacteria can possibly contribute to the exacerbation of COPD (Corgel & Merin, 2002). Research has shown that there is a great possibility of some relationship between perio disease and heart disease, but there has not been enough research to prove beyond a doubt that there is a connection.

Corgel, J., Merin, R. (2002). Periodontal disease and systemic health—What you and your patients need to know. Journal of the California Dental Association.

Slavkin. H. (1999). Does the mouth put the heart at risk?. Journal of American Dental Association (130) 109-113.

Melody: A study conducted at the University of Buffalo where gum disease and heart disease connection was uncovered found that two pathogens in the mouth were associated with an increased risk of having a heart attack but that the total number of germs regardless of type, was more important to heart health. T. Forsynthesis and P. Intermedia had a statistically significant association w/ an increased risk of heart disease. Even though these type were significant remember the main factor is the total number of bacteria not the type. So we need to let our patients know how important it is to take care of their teeth not only to save their teeth for life but to save their life. http://www.huliq.com http://www.sciencedaily.com

Drina: Periodontal disease is associated with factors that increase cardiovascular disease but does not cause cardiovascular disease. One study showed that people who had complete removal of dental infections (from tooth removal) do not have a lower risk of developing coronary heart disease than people with periodontitis. By reducing dental infections, the risk of cardiovascular disease is not decreased.

Reference: Hujoel, P., Drangsholt, M., Spiekerman, C., & Derouen, T. (2001, July). Examining the link between coronary heart disease and the elimination of chronic dental infections. The Journal of the American Dental Association, 132: 883-889.

Karnoutsos, K., Papastergiou, P., Stefanidis, S., & Vakaloudi, A. (2008). Periodontitis as a risk factor for cardiovascular disease: The role of anti-phosphorylcholine and anti-cardiolipin antibodies. Hippokratia, 12(3):144-149.

Coronary artery disease is characterized by thickening of the walls of the coronary arteries due to the buildup of fatty proteins, cholesterol. These blood clots can obstruct normal blood flow, which can restrict the ability of nutrients and oxygen to reach the heart for proper function. Periodontal disease is caused by plaque and is characterized by inflammation that destroys the periodontium of the teeth. Several schools of thought exist as to the connection between periodontal disease and coronary heart disease. Some speculate that the bacteria present in perio are the same bacteria found in the bloodstream of patients with coronary heart disease. Other thoughts are that patients that don’t take care of their overall health are more likely to neglect their oral health, therefore, coincidentally leading to a correlation between CHD and Perio disease. 657 people participated in a study. They had no history of MI or stroke. The aim of the study was to analyze the relationship between perio and CVD. CVD risk factor measurements were taken which included white blood cell count, C- reactive protein values and a carotid. The relationship between perio microbiology and subclinical atherosclerosis was direct and exists independent of C-reactive protein. This particular study leads me to believe that perio pathogens are the same pathogens that contribute to atherosclerosis. I also read a study, aimed to look at the release of endotoxins into the bloodstream upon gentle mastication. The study did confirm that gentle mastication is able to induce the release of bacterial endotoxins from oral origin into the bloodstream; the study also concluded that this occurred more so in patients with severe perio. Therefore, patients with CHD would be at a higher risk of CHD due to the release of bacteria, related to perio, into the bloodstream. I have a study that I would like some of you to take a look at. I had a difficult time interpreting their findings. What I think the study found was that our systems ability to fight infection, bacteria from the oral cavity, is more of a correlation between CHD and perio than clinical findings. http://www.ncbi.nlm.nih.gov/pubmed/15983248?dopt=Citation It seems that smoking is a reason that it is difficult to find solid evidence correlating CHD and perio disease. Certain bacteria are associated with CHD among smokers while other oral bacteria are associated with CHD among nonsmokers. Why is this?
 * Connection between Periodontal Disease and Coronary Heart / Disease/Atherosclerosis - Stacy**

Reference:

Beck, J.D., Eke, P., Heiss, G., Madianos, P., Couoper, D., Lin, D., Moss, K., Elter, J., and Offenbacher, S. (2005). Periodontal disease and coronary heart disease: a reappraisal of the exposure. //Circulation, 112//(1): 19-24.

Desvarieus, M., Demmer, R.T., Rundek, T., Boden-Albala, B., Jacobs, D.R., Sacco, R.L., and Papapanou, P.N. (2005). Periodontal microbiota and carotid intima-media thickness. //Circulation, 111//: 576-582. Geerts, S., Nys, M., De Mol, P., Cahrpentier, J., Albert, A., Legrand, V., and Rompen, E. (2002). Systemic release of endotoxins induced by gentle mastication: Association with periodontitis severity. //Journal of Periodontology, 73//(1): 73-78.