Ask Your Periodontist About Periodontal Disease & Heart Disease

Risks for heart disease include smoking, being overweight and having high cholesterol or high blood pressure levels. Now evidence is mounting that suggests having periodontal disease may increase your risk for heart disease. For example, recent studies suggest that people with periodontal disease may have nearly twice the risk of having a fatal heart attack as those without periodontal disease.

What is periodontal disease?

Almost half of American adults have some form of periodontal disease. However the majority of these people do not even realize they have it. Periodontal disease (also known as gum disease) is a bacterial infection of the gums, bone and periodontal ligament (attachment fibers that support the teeth and hold them in the jaw).

Periodontal disease is usually painless and silent, until its advanced stages. If left untreated, symptoms can include:

• persistent bad breath.
• gums that bleed when you brush your teeth
• red, swollen and tender gums
• gums that have pulled away from the teeth
• loose or separating teeth
• pus between the gum and tooth
• a change in the way your teeth fit together when you bite

Periodontal disease can be diagnosed and treated by your dentist and/or periodontist. A periodontist is a specialist with advanced training in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth.

Why should I be aware of the link between heart disease and periodontal disease?

Healthy hearts and healthy gums play vital roles in maintaining a healthy body. Because periodontal disease is a bacterial infection, periodontal bacteria can enter the blood stream and travel to major organs and begin new infections. The heart is one of the most susceptible organs. Heart disease (or cardiovascular disease) affects more than 60 million Americans. It is the leading cause of death in the United States. Yet many types of heart disease may be prevented. Taking care of your periodontal health may be one important step toward prevention, along with controlling the well-known risk factors for heart disease.

How does periodontal disease increase my risk for heart disease?

Several theories exist to explain the link between periodontal disease and heart disease. One theory is that oral bacteria can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries (heart blood vessels) and contributing to clot formation. Coronary artery disease is characterized by a thickening of the walls of the coronary arteries due to the buildup of fatty proteins. Blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks.

Researchers have found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

What precautions should be taken before dental treatment?

Periodontal disease can affect the heart in other ways. Some existing heart conditions can put people at risk for infective endocarditis. Infective endocarditis is characterized by inflammation of the lining of the heart and heart valves. Those patients with a history of rheumatic fever, mitral valve prolapse or heart murmur may require antibiotics prior to dental procedures. Your periodontist and cardiologist will be able to determine if your heart condition requires use of antibiotics prior to dental appointments.

The American Heart Association has identified guidelines to help protect patients most at risk for infective endocarditis. These people may be especially prone to problems with their heart following a dental procedure.

If you are at risk for infective endocarditis, your dentist and/or periodontist may take steps to help limit the entry of bacteria into the blood stream during dental procedures, including:

• treatment of any existing periodontal infection
• prescribing antibiotics prior to the procedure
• asking you to make more regular maintenance visits
• helping you to prevent periodontal disease by reviewing proper home care for your teeth

If you know that you have heart disease or currently receive treatment for a cardiovascular complication, it is especially important for you to have good periodontal health. See a periodontist for a periodontal evaluation.

Periodontal disease also has been linked to other significant health problems, including respiratory diseases, diabetes, osteoporosis and premature and underweight births. It is very important that you always provide your periodontist with a comprehensive and accurate medical history, including any problems you are aware of with your heart. Your periodontist and physician can work together to help you protect both your gums and your overall health. As former Surgeon General C. Everett Koop said, "A person is not healthy without good oral health."