In the dental office, we know that a robust dental hygiene department is vital for a profitable practice. We encourage our patients to make the most of their dental insurance benefits and to keep their regular hygiene appointments both for their oral health and the health of the practice. But the benefits to the patients’ health gained by maintaining optimal oral care are much more far-reaching than simply having a clean and healthy mouth.
Naturally teeming with over 400 species of bacteria, the mouth is the gateway to the body. The vast majority of the bacteria present in the mouth are harmless, and many that are not are controlled by the immune system and good home care. However, when oral hygiene is neglected or is less than optimal, or when the immune system is compromised, the bacteria flourish. The resulting infection and inflammation affects not only oral health but systemic health, as well. Researchers have learned that people with periodontal disease are much more likely to suffer from cardiovascular disease than those without periodontal disease.
Heart disease is the leading cause of death of both men and women in the United States. Approximately 610,000 Americans die from heart disease annually. In the U.S. someone has a heart attack every 43 seconds and each minute someone dies from a heart disease related event.
The American Heart Association evaluates the health of Americans by using seven lifestyle factors and health measures that increase risk for cardiovascular disease. They include blood pressure, blood sugar, cholesterol levels, weight, diet, physical activity, and smoking. The AHA calls these seven factors “Life’s Simple 7” but the inclusion of an eighth factor, oral health, may be indicated given the significant impact oral disease can have on heart health.
Dental practitioners must understand the connection between periodontal disease and heart disease so we can protect the health of our patients. Periodontal disease, ranging from gingivitis to periodontitis, is an inflammatory disease of the supporting structures of the teeth caused by specific pathogenic bacteria that trigger the inflammatory response. Although there are many contributing factors to the development of heart disease, inflammation is the critical factor and the mouth is said to be the biggest source of inflammation in the body.
When oral pathogenic bacteria enter the body’s circulatory system through ulcerated periodontal tissues or “pockets” these bacteria can cause secondary infections resulting in inflammation and contributing to diseases in various organ systems or tissues.
Periodontal disease increases the number of inflammatory mediators in the body, including those in the endothelial cells lining the coronary arteries and in the plaque building up within the artery walls and within the arteries themselves. This continual deluge of inflammatory molecules fuels the development of arterial plaque and results in the heating up of the plaque already present in the artery. This “hot” plaque is unstable and prone to rupture resulting in a heart attack.
The pathogenic bacteria damage the blood vessel lining increasing its permeability and making the endothelium “leaky” enabling more damaging molecules to enter the artery and increasing the risk of heart attack. Some oral bacteria make blood more prone to clotting, also increasing risk for heart attack.
In a study reported in 2006, researchers found that treating moderate to severe periodontal disease resulted in significant improvements in endothelial function as well as decreases in inflammatory mediators. Periodontal treatment was also associated with decreases in C-reactive protein, an important marker of systemic inflammation. Although more definitive studies are needed, these finding suggest that treating periodontal disease not only improves oral hygiene but also improves cardiovascular health.
In recognition of the serious potential risk of heart disease in patients with periodontal disease and the potential benefits of dental hygiene care, dental health care practitioners must educate their patients regarding this oral-systemic link. Regular preventive maintenance procedures are vital in the prevention of periodontal disease. Aggressive treatment of existing periodontal disease and consistent maintenance procedures are critical in reducing damaging inflammation in the body. By helping to create and maintain optimal oral health for our patients, we are serving to protect heart health and prevent heart attack. We are not just cleaning teeth. We are saving lives.
Kathryn Gilliam’s interest in the medical side of dentistry led her to years of advanced study into the oral-systemic link, including graduating from the prestigious Bale Doneen Preceptorship. Her company, PerioLinks, LLC, was born out of her desire to train dental teams to transform their practices to care for the total health of their patients through comprehensive periodontal treatment.