Link between periodontal disease, heart health

Healthy gums do more than improve your smile — they might save your life.

Researchers have known for several years that people with infected, bleeding gums are at a greater risk of heart attack.
Now a University of Connecticut scientist has found that treating periodontal disease actually reduces the build-up of plaque in coronary arteries and makes the vessels more supple.

Scraping away the festering gunk below the gum line, taking antibiotics, and removing moribund teeth, can apparently ease hardening of the arteries.

Physicians are not sure how mouths relate to hearts, but the relationship emphasizes the complex interaction between inflammation and the vascular system in the human body, doctors said.

Dr. Maurizio S. Tonetti, of the department of oral health and diagnostic sciences at the UConn Health Center in Farmington, led a study of 120 patients with severe gum disease.

Half received community-based periodontal care, while the rest underwent intensive treatment.

Six months later, the comprehensive treatment group, which received up of six hours of scaling, root planing, local delivery of antibacterial medicines, and extraction of hopeless teeth, had healthier arteries.

"This study showed that intensive treatment of periodontitis, a common potential source of low-grade inflammation, results in an improvement in endothelial function," Tonetti wrote in the study, which was published in the New England Journal of Medicine.

Cleaner and more elastic arteries are less prone to the narrowing or forming of clots that result in heart attacks. About 12 percent of Americans suffer from a cardiovascular disease.

Dr. Harvey M. Kramer, director of cardiovascular disease prevention at Danbury Hospital, and assistant clinical professor of medicine at Yale, said that apparently people with inflammation anywhere in their bodies are at great risk for atherosclerosis, or hardening of the arteries.

A diseased mouth is simply one source of inflammation, he said. Local inflammation, from gum disease to rheumatoid arthritis and chronic intestinal disorders flood the blood with white blood cells and the chemicals they produce, including cytokines, interleukins, histamine, and prostaglandins.

Normally these proteins protect the body and promote healing by causing inflammation.

"We know there is an association between inflammation and heart disease, but we’re not sure how to prove cause and effect," Kramer said. "The mouth-heart connection is part of a larger, more general set of questions."

Among the conundrums in this relatively new field: aspirin reduces the chance of heart attack, while ibuprofen seems to increase it. Both are anti-inflammatory drugs, but work in different ways.

Likewise, cholesterol-lowering statin drugs apparently reduce inflammation. "So do statin drugs help reduce heart attacks by cutting cholesterol, or by reducing inflammation?" Kramer said.

"It’s probably a combination of both," he said.

While gum disease may increase the risk of heart attack, it is probably not among the highest risk factors, Kramer said. "Stick to the fundamentals. Lose weight, lower cholesterol, control blood pressure, exercise, and control diabetes," he said.

Dr. Jeffrey S. Klein, a periodontist at Dental Associates in Danbury, New Milford and Newtown, said bacteria in the mouth take about 24 hours to form a biofilm matrix called plaque.

Plaque works down the tooth and into the bloodstream, he said. "No one knows at what level periodontal disease is dangerous" in terms of raising the risk of heart attack, Klein said. "It makes sense to be checked."

Toxins produced by the bacteria also enter the blood, perhaps aggravating inflammation, he said.

Unfortunately, there is no way to eliminate oral bacteria, Klein said. "The second you opened your mouth they’d all be back," he said.

"You can’t take antibiotics forever," Klein said. The longer they’re taken the higher the likelihood of developing resistant bacteria.

Chronic exposure to an antibacterial agent such as chlorhexidine, found in many rinses and other dental products, can stain teeth and alter the sense of taste, Klein said.

"Keep your mouth clean, and if there’s a problem consult a professional," Klein said.
source:www.nhregister.com