Wednesday, December 3, 2008


Brush your teeth and avoid heart attacks and Dr. D. P. Atukorala

It is common knowledge among medical personnel that risk factors for heart attacks are smoking, high blood cholesterol, diabetes, hypertension, obesity, lack of exercise, family history of heart attacks and stress. In addition to common risk factors mentioned above, new research shows that neglected gums and teeth are another risk factor for heart attacks.

According to the World health Organisation heart disease is the number one killer worldwide claiming about 17 million lives every year and is the leading cause of death both in the developed and developing countries and in spite of all the precautionary measures taken by all the governments, the coronary heart disease epidemic is getting worse.

The WHO now recognises that bacterial infections of the gums and periodontal infection is an independent risk for heart attacks. In other words it does not matter how fit and healthy you are, you are adding to your chances of getting heart disease by having bad teeth and bad gums.

There are up to 700 different bacteria in the human mouth and failing to scrub one’s teeth helps those germs flourish. Most of the germs in your oral cavity are benign. Some are essential to good health, but a few can trigger a biological cascade leading to diseases of the arteries linked to heart attacks and strokes according to new research by Howard Jenkins of the University of Bristol (UK).

The mouth is the dirtiest place in the human body and is dirtier than anus, rectum and vulva. According to Steve Kerrigan of the Royal College of Surgeons in Dublin if you have an open blood vessel from bleeding gums, bacteria will gain entry to your blood stream and once inside the blood, the bacteria stick on to certain "cells" called platelets causing them to clot inside the coronary vessels and thus decreasing blood flow to the heart.

Out of the oral bacteria, streptococcus gordanii and Streptococcus Sanguines are common bacteria that can cause heart attacks according to Professor Jenkins from the University of Bristol (UK).

It has been shown that gingivitis if untreated can lead to atherosclerosis which, as the readers are aware is the thickening, tortuosity and build up of fatty plaques within arteries. In about 98% of patients with heart attacks, primary cause of heart attacks is atherosclerosis.

A research team headed by Professor Symour, the Dean of the Faculty of the Dentistry at the University of Otago based their findings on an analysis of the effect of regular tooth brushing in a group of patients who were potential candidates of heart attacks. Symour explained that a variety of proteins produced by the bacteria initiates atherosclerosis and helps it to progress. According to the World Health Organisation neglected teeth can be considered as an independent risk factor for heart attacks and strokes as mentioned earlier.

Chronic Infection And Coronary heart Disease

There is scientific evidence to show that chronic infection (e.g) periodontal disease could increase the systemic inflammatory response and directly increase the risk of heart disease and stroke. Major infectious organisms are Chlamydiae pneumonia, Cytomegalovirus and heliobactor pylori. Well-known periodontal pathogens include Porphyromonas gingivalis, Treponema denticola and Actionbacillius.

There is scientific evidence to show that Gram-negative flora associated with periodontal disease play a significant role in atherosclerosis and coronary heart disease (angina and heart attacks).

There is also evidence to show that patients with coronary heart disease (CHD) have significantly increased prevalence of Gram-negative anaerobic bacteria on tooth surface compared with periodontally healthy reference group. Dental plaques containing Gram-negative organisms are significantly higher on individuals who have experienced either unstable angina or a myocardial infarction just before the dental testing. Majority of patients with CHD and Gram-negative Organisms tested at university dental clinics in Michigan University had periodontal disease.

In the CHD group, there was 65% rate of periodontal disease in patients with acute myocardial infarction (heart attacks).

In 2 separate case control studies involving 100 patients with acute myocardial infarction and 102 controls (from the community selected at random) indices of dental health were significantly worse in patients with acute myocardial infarction than in controls.

Subsequently in a prospective study of 214 individuals with CHD followed up for 7 years, dental health was significantly a predictor of coronary events when controlled for following factors: age, sex, socioeconomic status, smoking, hypertension, number of previous infacrs, diabetes, BMI, and serum lipids (Clinics of Infectious diseases 1998, 26, 719-734).

In a recent study periodontal disease was found in 48% of patients with myocardial infarction, compared with 17% of controls (American Heart Journal 2004, 147).

Major clinical implications from these studies apply to both primary and secondary prevention of CHD. A strong (20-30%) reduction in coronary events and strokes can expected both in healthy persons and in those with CHD and strokes who achieve and anti-risk life style changes including use of statins and blood pressure control.

At present there is no proof that anaerobic periodontal infections can be treated with short term sue of metranidazole given for a period of 5 years. Whether improving periodontal health will reduce CHD requires controlled trials Nevertheless,e the prevention and treatment of periodontal disease merits consideration.


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