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Gum Disease and Heart Disease – A Strong Connection

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Benjamin Franklin once quoted “She laughs at everything you say. Why? Because she has fine teeth.” We can now probably add “and a healthy heart.” Recent research studies have shown a striking association between poor dental hygiene and coronary heart disease. Coronary heart disease may be responsible for 20% of deaths across the world and almost 50% of deaths in developed countries. A study from Boston University School of Dental Medicine in Massachusetts, published in the March 9, 2004 issue of Circulation reported that patients with five poor oral health pathologies have a 70% probability of having coronary heart disease. Findings from the Behavioral Risk Factors Surveillance System, reported in the December 2005 issue of the American Journal of Preventive Medicine also demonstrated a significant association between tooth loss and the prevalence of coronary heart disease. This large study involved 41,891 adults aged 40 to 79 years living in 22 states and in the District of Columbia. Periodontal disease in heart attack survivors was also found to cause a rise in inflammatory markers, putting them at a greater risk of future heart attacks, according to research conducted at the University of North Carolina at Chapel Hill.

The underlying cause of coronary artery disease is atherosclerosis, commonly known as hardening of the arteries. This is usually associated with several modifiable risk factors (e.g., smoking, systemic hypertension, diabetes mellitus, high cholesterol levels) and some non-modifiable risk factors (e.g., age, gender and family history). However, atherosclerosis is also known to follow bacterial (Chlamydia Pneumoniae and Helicobacter pylori) or viral (Cytomegalovirus and Coxsackie B) infections. Recent data has confirmed that persistent dental infections also contribute to the pathogenesis of atherosclerosis. Such infections release several toxins which insult the delicate inner lining of the blood vessels, called the endothelium. There is also an associated immuno-inflammatory response, which causes further injury. C-reactive protein, a sensitive marker of inflammation and a predictor for future cardiovascular events, is consistently elevated in patients with chronic dental disease.

The earliest phase in gum disease, gingivitis, is an inflammation caused by the accumulation of plaque. Plaque is a soft, sticky, colorless film above the gum line. It results from the interaction of sugars and starches with bacteria normally found in the mouth. Plaque can provide shelter for over 400 species of bacteria and other microorganisms. In the early stages gingivitis may not produce any symptoms. However, as the bacteria grow and proliferate, it can cause red, puffy, swollen or tender gums that bleed during routine brushing or flossing. There may be a constant bad breath or a bad taste in the mouth. Gingivitis may be aggravated by an underlying illness or by hormonal changes associated with pregnancy or puberty. Medications such as steroids and those used for seizures, high blood pressure, and organ transplants can suppress the immune system and encourage bacterial infection in the gums.
Unchecked, the plaque of gingivitis will gradually build up between the teeth and gums, in damaged or faulty fillings, and around partial dentures, bridges, and braces. The gums may also begin to form pockets below the gumline, trapping food and more plaque, resulting in an infection or even an abscess
formation. This is called periodontitis and can only be treated by a dental professional. At this stage, pus may start oozing from between your teeth and gums. As the disease progresses, bacterial toxins eventually break down the underlying bone and connective tissue that holds the teeth in place. The ultimate outcome is tooth loss.

An unknown author once said, “You don’t have to brush your teeth—just the ones you want to keep.” Regular brushing and flossing will help prevent gingivitis and its later complications. And as the scientific data suggests, it will also protect your heart. The famous US writer, Fannie Fern said “The way to a man’s heart is through his stomach.” Perhaps we should also keep in mind that “The way to heart disease may be through a man’s mouth.”

Shashi K. Agarwal, MD is Board Certified in Internal Medicine and Cardiovascular Diseases. He has in private practice in New York City and New Jersey. He is also a Diplomate of the American Board of Holistic Medicine and the American Academy of Anti-Aging Medicine.

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