Cochin Cardiac Club

Health Blog by Dr.Uday Nair


Gum Disease
Teeth are covered by sticky plaque, made up of food, bacteria and bacterial waste products. If plaque is left on the teeth the gums become irritated and may bleed when you brush. This early stage of gum disease is called gingivitis.
If gum disease is not treated, the gums may swell, forming a little pocket around the tooth. Plaque collects in this and cannot be removed by a toothbrush. When plaque is left on the teeth it may harden to form tartar (calculus).
As time goes on the pockets get deeper, trap even more plaque and tartar and may become infected. Over time gingivitis can develop into chronic (long term) periodontitis, in which the jaw bone can become infected and damaged, causing teeth to loosen or fall out.
Also researchers found diseased gums released significantly higher levels of bacterial pro-inflammatory components, such as endotoxins, into the bloodstream in patients with severe periodontal disease compared to healthy patients. As a result, these harmful bacterial components in the blood could travel to other organs in the body, such as the heart, and cause harm.
The disease is called subacute bacterial endocarditis, a severe infection of the heart lining. In this condition bacteria collect at a previously-damaged site within the heart. The prior damage can be from rheumatic fever, congenital defects, and other causes. Frequently, victims are unaware of this pre-existing damage.

Bacteria enter the body through a failure of natural defensive barriers. One such barrier is skin. Another is the tooth structure. These surfaces are not, themselves, vulnerable to germs; and they prevent germs from access to inner tissues which have no natural immunity, no defense.


What's the connection between oral health and overall health?

Your mouth is teeming with bacteria — most of them harmless. Normally the body's natural defenses and good oral health care, such as daily brushing and flossing, can keep these bacteria under control. However, harmful bacteria can sometimes grow out of control and cause oral infections, such as tooth decay and gum disease. In addition, dental procedures, medications, or treatments that reduce saliva flow, disrupt the normal balance of bacteria in your mouth or breach the mouth's normal protective barriers may make it easier for bacteria to enter your bloodstream.


What conditions may be linked to oral health?


Your oral health may affect, be affected by or contribute to various diseases and conditions, including:

  • Endocarditis. Gum disease and dental procedures that cut your gums may allow bacteria to enter your bloodstream. If you have a weak immune system or a damaged heart valve, this can cause infection in other parts of the body — such as an infection of the inner lining of the heart (endocarditis).
  • Cardiovascular disease. Some research suggests that heart disease, clogged arteries and stroke may be linked to oral bacteria, possibly due to chronic inflammation from periodontitis — a severe form of gum disease.
  • Pregnancy and birth. Gum disease has been linked to premature birth and low birth weight.
  • Diabetes. Diabetes reduces the body's resistance to infection — putting the gums at risk. In addition, people who have inadequate blood sugar control may develop more-frequent and severe infections of the gums and the bone that holds teeth in place, and they may lose more teeth than do people who have good blood sugar control.
  • HIV/AIDS. Oral problems, such as painful mucosal lesions, are common in people who have HIV/AIDS.
  • Osteoporosis. Osteoporosis — which causes bones to become weak and brittle — may be associated with periodontal bone loss and tooth loss.
  • Alzheimer's disease. Tooth loss before age 35 may be a risk factor for Alzheimer's disease.
  • Other conditions. Other conditions that may be linked to oral health include Sjogren's syndrome — an immune system disorder — and eating disorders.

Be sure to tell your dentist if you're taking any medications or have had any changes in your overall health — especially if you've had any recent illnesses or you have a chronic condition.


Can poor oral health cause heart disease? Will taking care of my teeth help prevent heart disease?


Poor oral health — not regularly brushing or flossing — is unlikely to be the primary cause of heart disease. But poor oral health combined with other risk factors may contribute to heart disease.Bacteria on your teeth and gums could travel through your bloodstream and attach to fatty plaques in your arteries (atherosclerosis), making the plaques become more swollen (inflamed). If one of the plaques bursts and causes a blood clot to form, you can have a heart attack or stroke.

It's possible that swelling in gums leads to swelling in other parts of your body, including your arteries. This swelling can also contribute to heart disease.

Regardless of whether you have heart disease, it's important to take care of your teeth and gums.

So a Dentist can detect a heart problem?

A dentist may be the first one to suspect health problems, including heart disease. A sore or painful jaw is one indicator of heart disease. There's also a connection between gum disease and heart problems. By eliminating a local infection involving a tooth or the gums, patients have been able to decrease blood pressure medications and improve overall health. New research is suggesting that people with gum disease are at higher risk for heart attacks. If bacteria in the infected gums dislodge, they can enter the bloodstream, attach to blood vessels and increase clot formation. That in turn decreases the blood flow to the heart, increasing chances of a heart attack and aggravating high blood pressure

When to Have Dental Treatment After a Heart Attack?

The percentage of reinfarction is unusually high for the first 6  months after an MI.  During this time avoid anything but absolutely necessary emergency dental treatment and with close consultation with the cardiologist. While the six month rule is a good starting point checking with the cardiologist is a good rule to follow. If treatment is really absolutely needed before the 6 month time period,  hospital dentistry then becomes the location to have the emergency procedures done.

 How can I protect my oral health?

To protect your oral health, resolve to practice good oral hygiene every day. For example:
  • Brush your teeth at least twice a day.
  • Replace your toothbrush every three to four months.
  • Floss daily.
  • Eat a healthy diet and limit between-meal snacks.
  • Schedule regular dental checkups.
Also, watch for signs and symptoms of oral disease and contact your dentist as soon as a problem arises. Remember, taking care of your oral health is an investment in your overall health.

Please Note-

Before any kind of dental procedures,please inform your dentist if you are taking any anti-platelet or blood thinning drugs like clopidogrel.

People who have had surgeries, especially surgeries that used artificial valves, conduits or stents absolutely need antibiotic treatment prior to receiving any type of dental  treatment, even a teeth cleaning. It is always important to talk to your dentist about heart conditions or surgeries you’ve had, and to ask your cardiologist if you need what are called prophylactic antibiotics prior to seeing the dentist. This large single dose of antibiotics taken an hour prior to dental work does prevent the greater risk of developing bacterial endocarditis.

Tell your dentist if your health status has changed since your last dental visit or if any of the following apply to you:

    Had heart surgery within the past six months;
    Had vascular surgery within the past six months;
    Have a pacemaker;
    Have a history of rheumatic fever
    Have a history of heart murmur
    Had previous bacterial endocarditis
    Have a systemic pulmonary shunt
    Have a congenital heart defect
    Have acquired valvular dysfunction
    Have been diagnosed with other heart ailments

    Your dentist may consult with your physician or cardiologist to determine which antibiotics you should take.
    As you know all things in our organism are bound up and it’s not astonishing that gum disease can cause heart problems.So,

    Take care of your teeth and gums, take care of your heart.

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