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James S. Minutello, DDS &
Regina D. Minutello, DMD, MS, Inc.
Periodontics & Implant Dentistry

Heart Disease

  The heart is one of the most susceptible organs affected by periodontal disease. 

There are a few theories to explain the link between periodontal disease and heart disease.  One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation.

In addition without symptoms and therefore, likely without treatment, oral inflammation and periodontal disease can persist for several years.  This persistent inflammation may induce and enhance the already existing atherosclerosis which is also an inflammatory disease. 

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease. 

 

The mechanisms that link periodontal disease to cardiovascular disease are further explained.  Dental plaque is a bio-film that initiates a cascade of events that not only leads to periodontal disease but can affect a patient’s general well-being.

                         THE SEQUENCE OF EVENTS LEADING TO CORONARY ARTERY DISEASE:
       BIOFILM  ---> BACTEREMIA  ---> INFLAMMATORY RESPONSE ---> ELEVATED C-REACTIVE PROTEIN ----------                                                 ----------> VASCULAR EFFECTS

BIOFILM: Is found floating on lakes, in plumbing lines, on the edges of vases, and on top of rivers and ponds.  Bio-films grow in stacks with different types of bacteria.  There is an order to the stacking of the bacteria as well as communication between the different layers.  A slimy matrix forms on top of the bacteria shielding them.  The biofilm in the gingival crevice is massive.  There are between 10 million and 1 billion bacteria in the gingival crevice depending on the depth of the pocket.

BACTEREMIA: It means bacteria in the blood.  Direct opening through the inflamed sulcular/ gum tissue allows bacteria to enter the general circulation.

INFLAMMATORY RESPONSE:  Cytokines, PMNs, B-cells and T-cells are produced as a result of the bacteremia.  Enzymes are also produced such as:  COLLAGENASE (destroys collagen); GELATINASE (hydrolyses gelatin);   ELASTASE (breaks down proteins) and PROTEASE (breaks down proteins)

C-REACTIVE PROTEIN (CRP):  Produced by the liver as part of the normal immune system response to injury, inflammation and infection.  CRP participates in the development of clots and plaques that lead to an increased risk of heart attacks and strokes.  Women with elevated CRP have a seven times increased chance of a cardiovascular event.  Periodontal disease increases CRP levels.  Periodontal treatment reduces CRP levels.

CONCLUSION:  MULTIPLE STUDIES SHOW PERIODONTAL DISEASE TO BE A RISK FACTOR FOR
HEART DISEASE.

Please provide us with a comprehensive and accurate medical history, including any problems you are aware of with your heart.  Some existing heart conditions such as a history of rheumatic fever, mitral valve prolapse or heart murmur may require antibiotics prior to dental procedures.  Furthermore, some commonly prescribed heart medications can cause dry mouth, increased plaque or enlarged gum tissue.  These conditions frequently result in bacterial infections under the gum line, causing bleeding gums and bad breath.  Your physician and we can work together to help you protect both your gums and your overall health.

 

 

 

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