Brushing up on gum disease: How it affects heart health

Dr. Carl Block and dental assistant Donna Wilson perform supportive periodontal therapy on Shirley Vaughn.

Brushing and flossing twice a day can keep gum disease and heart disease away. Research has documented that having periodontal (gum) disease can increase - perhaps two-fold - the risk of heart attack and stroke, says Dr. John M. DiGrazia, cardiologist and co-chief of cardiology at CJW Medical Center.

Gum disease is an infection of the gum tissue that supports the teeth. The inflammation is the likely culprit. Doctors are continually finding evidence that this age-old defense mechanism called inflammation plays a larger role in chronic diseases, such as heart disease, than they thought.

The New England Journal of Medicine published a recent study showing that gum disease is linked with higher levels of blood vessel inflammation.

Researchers found higher blood levels of C-reactive protein (CRP), a sign of inflammation, in gum disease patients. Elevated CRP is associated with increased risk of heart attack and stroke, declares DiGrazia. Ultimately, treating the gum disease led to reduced inflammation levels in the heart.

Gingivitis, the beginning stages of gum disease, literally means inflammation of the gums. "A lot of diseases have oral manifestations initially, such as tuberculosis, diabetes, HIV and cancer," states Carl Block, DDS, a board-certified periodontist. "It gives us reason to believe that bacteria from these diseases and inflammation from infection will show up elsewhere in the body."

"If you have a chronic disease such as diabetes, you have to work harder to keep gum disease at bay," explains Dr. Jeff Blackburn at South River Dentistry. "Any case in which the immune system is compromised is a potential problem and increases your risk of gum disease."

Genetics also plays a major role. No matter how well you care for your teeth, if your parents had gum disease, you may not be able to prevent it, says Dr. Rebecca Angus with Angus Dentistry.

The root cause

While plaque build-up on teeth is the most common cause of gum disease, other risk factors include tobacco use, hormonal changes, crooked teeth, poor diet and drugs such as steroids, oral contraceptives and certain antiepilepsy, cancer therapy and blood pressure drugs.

"Every day we treat periodontal disease - and we treat it all day long," states Blackburn.

Angus sees gingivitis in about 90 percent of her patients. Angus Dentistry sees about three or four patients a day with active periodontitis, which usually starts with bone loss at the base of the "pocket."

"The pocket is like a nail cuticle. If the skin is tight and healthy, it's normal. You can't get anything under it. When a pocket reaches 4mm deep, that is when we become concerned," Angus says.

"The goal of treating gum disease is not to reverse it, but to halt it," she adds.

Once the tooth begins to pull away from the gum, the pocket becomes deeper. Your toothbrush and floss cannot get down into the pocket to clean it. It is something that has to be managed in a dental office, explains Angus.

The first step in treating gum disease is to remove the plaque. "Scaling" cleans off the bacteria, and "root planning" smoothes the tooth's surface to prevent tartar build-up. Maintenance cleanings are scheduled every three to four months for gum disease patients.

Dentists often recommend antiseptic mouth rinses to keep bacteria levels low or topical antibiotics to apply to the pockets to prevent further bone loss.

Bridging the gap

 

Preventing gum disease is not just a dentist's domain. DiGrazia encourages his heart patients to see a dentist if they show signs of gum disease such as discolored or loose teeth. Likewise, Block sends dental patients to their physicians if he detects potential medical problems.

The link between gum disease and heart disease and other health problems has gained notability in the media the past few years. Block's patients are beginning to ask, "Am I at risk for heart disease or diabetes?" He responds, "Absolutely. It doesn't mean you're going to get it, but gum disease makes you susceptible."

Yet, many of his patients ignore the signs of gum disease. They say, "It's just a tooth." Block compares, "The surface area of the gum tissue that touches the teeth is about the size of both palms of the hands. If you had an infection that big, you wouldn't ignore it."

People are starting to think about dental care differently, Block believes. They say, "I have an infection in my mouth. How can it affect the rest of my body?"

DiGrazia figures, "There is no downside to having better teeth and gums." The upside to a healthy smile is a healthy heart.

The silent disease

Some people do not show signs of gum disease until it is too late. Ask your dentist to perform a periodontal screening at least once a year.

Check your teeth regularly for signs of gum disease including: • Loose or separating teeth • Persistent bad breath • Red, swollen, tender gums • Gums bleed easily while brushing/ ossing • Receding gums (long teeth) • Changes in bite or fit of teeth Resources: American Dental Association www.ada.org American Academy of Periodontology www.perio.org American Heart Association www.americanheart.org