Heart disease and Gum disease: A Killer Connection

By Dean Mourselas, DDS

In 2000, the US Surgeon General declared the state of oral health in America a “silent epidemic.” One of the many reasons this is being taken so seriously is that poor oral health can have dramatic effect our on health in general. One unavoidable link is that of gum disease to heart disease.

“Gum disease” is kind of a generic word for something that is basically two separate conditions. First is the more commonly known gingivitis. This literally means an inflammation of the gums themselves. The second is the more serious periodontitis (or periodontal disease). This is a more progressed version of gingivitis in which the infection progresses to the underlying bone that holds our teeth in our jaws, and not just the gums. In both cases, plaque-causing bacteria collect themselves along the gumlines of our teeth. If left undisturbed for 24 to 48 hours, plaque hardens into tartar (calculus). This calculus is glued to the teeth hand helps facilitate the easier formation of more plaque and calculus. It becomes an endless cycle. Obviously brushing and flossing regularly prevents this but neglect an area and the cycle starts. Unfortunately, once calculus is formed in an area it is very difficult to remove and needs to be scaled off by a dental hygienist or dentist. But once there, the bacteria have an ideal home, and start to form toxins that cause gum irritation and eventually start to destroy the bone.

Bone destruction? That can’t be me, I would know, that sounds painful, right? Well, unfortunately, that is wrong. Believe it or not this is usually a painless disease, until the bone loss reaches a point of no return. Most people that have periodontal disease do not know they have it. In fact, once symptoms start, this is a sign that the disease has progressed to a point in which the tooth needs to be removed or extracted. Although, besides pain there are other signs to look for; bad breath, bleeding gums (especially when brushing and flossing), and loose or mobile teeth.

You dentist checks for it by looking for bone loss with bitewing X-rays and using an instrument called a probe. A probe is basically a millimeter ruler that is used to slide between the gum and the tooth to determine of a pocket or bone loss is present. A healthy patient has a probing depth of usually 3mm or less; we call it disease for anything over 5 mm.

Multiple studies conducted in this area have found that when people have heart disease, they tend to have periodontitis as well. In any case, these bacteria and their toxins eventually find their way into our bloodstreams. People with periodontitis tend to have higher numbers of bacterial toxins in their blood stream. Our livers then start producing higher levels of something called C-reactive proteins as a result of increased bacterial related components in our blood. People with high levels of this are also said to have an increased risk of heart disease. In fact, in some cases, when surgeons remove the plaques and clots that block our arteries, they tend to find some of the same bacterial toxins found in our mouths. In addition, patients with already existing heart conditions, can be subject to infective endocarditis (IE). This is a bacterial infection of the heart that is transmitted from the bacteria in our mouths. For years now, the dental profession has treated our patients with a known higher risk with a loading dose of antibiotics usually an hour before dental work. This way bacteria in the blood or a “bacteremia” is prevented. However, patients with frequent bleeding gums create this bacteremia for themselves which causes undue stress on the immune system as well as the heart.

Regardless, neither condition is good. Gum disease in its varying forms is treatable and preventable. The problem is this is painless and while the infection is left to progress, the damage is occurring, and not just in our mouths. It generally takes years of neglect develop to the point of tooth loss. However, this painless disease has dramatic effects on our entire bodies, including quantifiably increasing the risk for the number one killer in the US, heart disease. Such a simple concept to prevent a deadly disease, since all that is really needed is a toothbrush, toothpaste, floss, and a visit to a dental hygienist every few months.