Open Wide and Let Me Check Your Heart
By Carl Hartman, MD
We’ve always been told to brush our teeth, floss regularly and get regular dental check ups. For many of us, our hope for good dental health is that we stay out of the dentist’s chair listening to the hum of a drill. But there are much greater implications to maintaining a healthy mouth that go far beyond having a winning smile.
As I approached this column, I spent a fair amount of time talking with local experts in periodontology and dentistry as well as reviewing several studies that have been conducted over the past several years analyzing the link between chronic inflammation and infection in the mouth and the incidence of heart disease and other related complications that can lead to increases in stroke, heart attack and significant heart valve complications.
Increasingly, we are seeing a strong connection between oral health and heart health and this drives clinical practice changes for both cardiologists and dental health experts everywhere.
Just last year, Sentara Heart Hospital surgeons performed a quadruple valve replacement on an Eastern Shore patient. When talking with the surgeon, Kirk Fleisher, MD, it was interesting to learn that chronic oral infection in this patient had caused chronic infection on several of his heart vales causing severe malfunction. The patient, who was critically ill when he came to Sentara Heart Hospital, had to undergo some very intensive antibiotic treatments in the weeks leading up to surgery in order to better address the oral health issues before performing surgery to replace all four valves in his heart. While this example is extreme, it underscores the need to address how health professionals and patients work together to recognize risk factors, make the appropriate clinical decisions and intervene early to prevent much bigger problems down the road.
These heart problems can take many forms. There is also evidence linking cardiovascular disease – the kind that leads to heart attacks, stents and open heart bypass surgery – to oral health.
Stephen Konikoff, DDS, has been practicing dentistry in the area for more than 35 years. During his time in practice, he has spent a great deal of time educating patients about the importance of good oral hygiene. Dr. Konikoff points to the medical literature that cites periodontal disease as a risk factor for many diseases and complications, including heart disease. Having inflamed and bleeding gums is a sign of periodontal disease and, if left untreated, can negatively impact overall health - particularly heart health.
Prevention is often the best medicine and Dr. Konikoff recommends daily maintenance in the form of brushing and flossing, having regular dental check ups to identify potential problems that may arise and seeking emergency dental care as problems develop.
Local Board Certified Periodontist, Gary Hartman, DDS, MS, has read and evaluated the study reviews published recently in the Journal of Periodontology and concurs that accurately diagnosing and treating periodontal disease aggressively is in the best interest of patients’ general health. Specifically, the consensus report that was published in both the Journal of Periodontology and The American Journal of Cardiology stated that periodontal disease, especially the more severe form, is an independent risk factor for the development of cardiovascular disease. Simply put, practicing good dental health and immediately addressing oral complications like gum disease are imperative to decreasing your risk for heart disease, diabetes, and pre-term low-birth weight babies.
The message to patients, adds Dr. Hartman, is not that bad teeth and gums cause heart attacks, but that there is a significant, well-studied association between the two. It is important for patients to understand that the oral bacteria that infect the gum and bone tissue around the teeth can and do enter the blood stream and negatively affect overall systemic health. Therefore, routine dental checkups, including a thorough periodontal exam is the idea, as well as following through with any recommended preventative or corrective treatment, especially for patients with any form and severity of gum disease.
For patients, this means an awareness of the added risks associated with poor dental health. For medical professionals, we need to be vigilant about the diagnosis and treatment of periodontal diseases as well as any resulting health conditions that may stem from poor oral health. Like so many other pieces of advice that I give to patients, the take away is that you must be the champion of your heart health by knowing risk factors and taking steps to minimize that risk. This includes a healthy diet, exercise, eliminating tobacco use, moderation in alcohol consumption and, yes, regular dental check ups.
Carl Hartman, M.D. is a board certified cardiologist practicing with Cardiovascular Associates. He serves as the medical director of Cardiac Services at Sentara Heart Hospital in Norfolk, Virginia. Dr. Hartman is also an Associate Professor of Medicine at Eastern Virginia Medical School. He received his Doctor of Medicine (MD) degree at State University of New York at Syracuse and completed his postgraduate training at Duke University.