Heart Health – Deborah lyle

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  Posted by: Dental Design      4th May 2019

Cardiovascular diseases (CVDs) are the number one cause of death globally.  This is unsurprising when you consider that the biggest risk factors of CVDs are tobacco use, an unhealthy diet and physical inactivity.[i]Obesity increases the risk of developing a CVD by two and a half times when compared to healthy individuals. Currently 1 in 4 British adults are obese and if current rates continue, it is estimated that by 2030 there will be 6.5million new cases of CVDs annually attributed to obesity.[ii]

It is becoming far more frequent for us to see patients making big changes in order to improve their general health. Patients will tell you about the new diet they are trying or a new fitness class they have joined, this is usually followed up by a comment on how it will help them control their diabetes or lose some weight. Improving our general health is something that we are a lot more comfortable discussing, we see it in the media daily and links between obesity, diabetes, smoking and cardiovascular disease are well known. So, is it time that we started to speak to our patients about the links between oral and general health?

But how does oral health factor into this? There is no clear direct link between gum disease and CVDs, however there is consistent epidemiological evidence that periodontitis can increase future risk for CVDs.[iii]Periodontitis and CVDs often occur together due to diabetes or smoking. Furthermore, research reveals that periodontal disease increases the risk of developing type 2 diabetes by 69 per cent,[iv]and type 2 diabetes increases the risk of developing CVDs.

High blood glucose levels allow for easier movement of bacteria within the blood stream. When you have periodontal disease, periodontal pathogens enter the circulation during daily function, eating, tooth brushing, flossing and scaling. When bacteria reach the heart they can easily adhere to arteries and valves where inflammation can occur. Sustained inflammation of this kind can permanently damage the heart leading to, or worsening CVDs. Oral bacteria can also damage blood vessels and cause blood clots by releasing toxins that resemble proteins found in arterial walls or the bloodstream. In response to this, the immune system is able to form blood clots more easily, increasing the risk of strokes. If an individual is a smoker or has diabetes they may also suffer from delayed healing, making recovery from inflammation of cardiac tissue a drawn-out process or something they may never fully recover from.

As we know periodontitis is an inflammatory disease. New evidence shows that adipose tissue (fat) can store inflammatory cytokines, therefore increasing the likelihood in obese patients of an active inflammatory host response in periodontal disease. Several recent studies from Japan, Brazil and the US also show a correlation between obesity and periodontal attachment loss.[v]

Due to the potential risks of periodontal disease on heart health the British Heart Foundation are funding several research projects investigating the links. They now advise brushing twice daily with fluoride toothpaste and daily flossing. The European Federation of Periodontology have also teamed up with the World Heart Foundation for a workshop in February 2019, which will explore the links between periodontal disease and cardiovascular diseases. The workshop will bring together 21 experts from the two organisations; they will review scientific papers and produce consensus reports, which will be published in the Journal of Clinical Periodontology.[vi]

Brushing twice daily and cleaning interdentally daily is a mantra we’ve been saying for years. If a patient struggles with this we should try to help them find solutions. Switching to an electric toothbrush will make brushing much more effective for most of our patients.[vii]Similarly, if a patient has difficulties using floss they could use a Waterpik®Water Flosser which has been found to be up to 29 per cent more effective than string floss for overall plaque removal.[viii]

As dental professionals we should empower our patients to make a change. The biggest improvement in gingival health comes when the patient takes responsibility for their own oral health. Prevention and early treatment of periodontitis plays an important role in reducing a patient’s risk of CVDs so we should advise our patients accordingly. If we see them making improvements in their general health why not inform them that improving their oral hygiene will also improve their heart health. The majority of our patients do not make the connection between oral health and general health; it is our place to make that connection for them.

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[i]World Health Organisation. Cardiovascular diseases (CVDs). https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds) [Accessed 11thFebruary 2019]

[ii]Renew Bariatrics. UK Obesity Statistics in 2017. https://renewbariatrics.com/uk-obesity-statistics/[Accessed 11thFebruary 2019]

[iii]Maurizio S. Tonetti, Thomas E. Van Dyke. Periodontitis and artherosclerotic casrdiovascular disease: consensus report of the joint EFP/AAp Workshop on Periodontitis and systemic diseases. April 2013. European Federation of Periodontology and American Academy of Periodontology.https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12089[Accessed 11th February 2019]

[iv]Roberta Santos Tunes, Maria Cristina Foss-Freitas, Getulio Nogueira-Filho. Impact of Periodontitis on the diabetes-related inflammatory status. August 2010.J Can Dent Assoc. 76:a35.http://www.jcda.ca/article/a35[Accessed 11th Feburary 2019]

[v]Christine Seel Ritchie. Obesity and Peridontal disease. May 2007. Periodontology 2000 44, 154-163. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1600-0757.2007.00207.x[Accessed 11th February 2019]

[vi]European Federation of Periodontology. Perio-Cardio Workshop 2019. http://www.efp.org/publications/projects/perio-cardio-workshop-2019/index.html[Accessed 19th February 2019]

[vii]P.G.Robinson, C.Deery, M.Heanue, S.Deacon, A.D.Walmsley, H.Worthington, W.Shaw, A.M.Glenny. The effectiveness of manual versus powered toothbrushes for the dental health: a systematic review. March 2004. 32(3):197-211. https://www.sciencedirect.com/science/article/pii/S0300571203002112[Accessed 11th February 2019]

[viii]Goyal CR, Lyle DM, Qaqish JG, Schuller R. Evaluation of the plaque removal efficacy of a water flosser compared to string floss in adults after a single use. J Clin Dent. 2013 24(2):37-42. https://www.ncbi.nlm.nih.gov/pubmed/24282867[Accessed 11th February 2019]

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