FAMILY GENERAL DENTISTRY CAN HELP PREVENT CARDIOVASCULAR DISEASE

Heart disease has affected my family and it affects all families so I decided that I would start this section with a personal story about how death of my young sister changed my emphasis on heart disease. Included are a section on Chemotherapy and Radiation treatment. The excerpt is taken from the book How to Overcome Fear of the Dentist by Bertrand Bonnick DDS MAGD AFAAID DDOCS.

My youngest sister was born with a heart defect. She had repeated visits for monitoring and did well enough through school and into early adulthood. Her diagnosis was mitral valve prolapse, however the doctor’s thought we should consider valve replacement to give her a better quality of life. My parents wrestled with the decision, but like most caring parents had a hard time signing the consent form that had death as one of the possible complications of surgery.

 

When my sister turned sixteen and I opened my first dental office she worked with me as a part-time dental assistant. When she turned eighteen she was still being followed by the cardiologist at a local hospital, and made a decision that she would not have surgery unless it was unavoidable. At twenty-two she was living at home and continuing her college education. On a day I will never forget, my receptionist told me my mom was on the phone.

 

“Bertrand it’s your sister!” Mom started.

 

“What’s happening?” I queried.

 

“They’re working on her. The EMS.”

 

“Is she alright?”

 

“She’s gone, I can’t…”

 

“Where are they taking her?”

 

“Kings County Hospital.”

 

“Mom, I’ll meet you there.”

 

My mother’s voice was in a tone that I never heard before or since. It was sure the result was not going to be good. I rushed back and forth, told my receptionist to cancel all remaining appointments, and rushed to the hospital.

 

At the hospital the last sight I saw of my sister was her body passing by on a gurney as one Emergency Medical Technician was performing chest compressions.

 

Several days later my Dad and I went to identify her body in the morgue, and holding each other up for support in silence and choked up we wobbled to the car. It was over for this young child, and it was uncertainty for the young two year old child she left behind. We could not believe it.

 

The death certificate stated as cause of death “Floppy mitral valve.” The rest of the family was subjected to ECG, Echocardiograms, and Stress tests. I had a “functional heart murmur.” Needless to say my concern for patients with heart problems increased to the point where I became Advanced Cardiac Life Support Certified.

 

The connection between the heart and the mouth has long being established, and anyone with a heart murmur or artificial joint knows that they may have to take antibiotics prior to dental treatment. Antibiotic prophylaxis is medication taken in high enough doses to prevent bacteria from the mouth getting into the bloodstream and damage the heart or artificial valves. The mouth, throat, and sinuses are places that are conducive to the breeding of viruses, bacteria, and fungus that can spread throughout your body if your immune response is compromised.

 

 

My best advice is to take prevention of gum disease and cavities seriously. Make sure your oral health is in the best of shape before doing any elective surgery, or prior to the need for chemotherapy, or radiation treatment. So let us review the April 2007 recommendations by the American Heart Association.

Increased use of antibiotics also increase the risk of an allergic reaction to a specific antibiotic and that can be even more immediately life threatening than bacteria in the bloodstream. Consult your physician if you are uncertain about needing antibiotics prior to dental treatment. The following are basic guidelines for needing antibiotics prior to treatment.

 

1.      Prosthetic cardiac valve

2.      Previous bouts of infective endocarditis

3.      Certain congenital diseases (Unrepaired cyanotic CHD , first six months after prosthetic repair of CHD, repaired CHD with residual defects, palliative shunts and conduits, etc)

4.      Cardiac transplant recipients who develop valvulitis

5.      Mitral valve prolapse with associated defects that your physician thinks may put you at risk for endocarditis.

 

In addition to the above certain cardiac surgical procedures may require that you wait six months prior to having a dental procedure, providing you do not have a life-threatening dental infection.

NEW STUDY FURTHER STRENGTHENS LINK BETWEEN GUM DISEASE AND EARLY INDICATORS OF CARDIOVASCULAR DISEASE

Research Published in New England Journal of Medicine Demonstrates Benefits of Intensive Periodontal Treatment

 

WARMINISTER, PA, March 1, 2007 - Researchers may be one step closer to establishing a link between periodontal disease and cardiovascular disease (CVD) - the number one cause of death worldwide. According to a new study unveiled today in the New England Journal of Medicine, periodontal disease contributes to blood vessel dysfunction, which was improved by an intensive regimen of periodontal treatment. The research team, led by Maurizio Tonetti, D.M.D., Ph. D., Executive Director of the European Research Group on Periodontology, demonstrates a link between early indicators of arteriosclerosis (hardening of the arteries) and periodontal disease.

The study enrolled 120 otherwise healthy patients with a severe form of periodontitis in a six-month trial and compared the effects of regular tooth cleaning with those of intensive periodontal treatment (scaling and root planing, locally administered antibiotics and tooth extraction, when necessary). The intensive treatment group showed important and statistically significant improvements in blood flow (as measured by brachial arterial dilation) within two months of treatment. The improvement was greater six months after treatment.

"In recent years, there have been numerous hypotheses linking periodontal infections to atherosclerosis - the process that leads to blockage of blood vessels," notes Dr. Tonetti. "This study validates the effectiveness of intensive periodontal treatment in affecting vascular health."

Currently, more than one in three Americans over age 30 have some form of periodontitis, according to the American Academy of Periodontology. CVD is the single largest killer of American adults; in 2003, it caused one of every five deaths in the United States. Unfortunately, periodontal infections often go untreated, creating a chronic inflammatory burden that may result in systemic inflammation, possibly contributing to broader health problems.

"The study published in the New England Journal of Medicine is promising for patient, as well as for the medical and dental communities," notes periodontist Michael C. Lynch, DMD, PhD, Director, Clinical Research Rx, New Technology Oral Health Care R&D, of OraPharma, Inc., whose locally applied antibiotic, ARESTIN (Minocycline HCL) Microspheres, 1mg, was selected by Dr. Tonetti for use in this study. "While researchers continue to study the link between systemic disease and oral health, this study adds to the growing body of evidence and underscores the potential impact of infection and subsequent inflammation on systemic diseases."

The article continued to elaborate on the company and their research with periodontal disease and ARESTIN, and more information can be found at www.orapharma.com. Our protocol for using ARESTIN can be discussed with our family general dentists.  Our Registered Dental Hygienists (RDH's) are trained to administer the treatment in conjunction with the dentist's diagnosis.

Therapy can be repeated in areas of your gums that are infected and referral to a Periodontist will be done if indicated. Give our family general dentistry practice in North Carolina a call at 336-841-0000. For further information also see our sections on Mouth Infections, Lack of dental care is expensive, as well as Oral and Health Connections.