Doctor’s Tip: How dental issues can cause heart attacks
Enjoy a free showing of “Fixit,” a documentary about a single-payer health care system for all, at 7 p.m. Thursday, Sept. 6, in the Calaway Room at the Third Street Center in Carbondale. Panel discussion to follow afterwards with retired neurosurgeon George Bohmfalk, M.D.; retired occupational medicine physician Steve Hessl, M.D.; and retired family physician Greg Feinsinger, M.D.
Heart attacks remain the number one cause of death in the U.S., despite the fact that almost all of them are preventable. Brad Bale, M.D., and Amy Doneen, PhD., authors of “Beat the Heart Attack Gene,” are recognized nationally and internationally as experts in heart attack prevention. In their book and their preceptorship courses they emphasize the importance of the mouth-vascular connection.
Most dentists are aware of the mouth-vascular connection, but unfortunately most physicians aren’t. Many dentists have taken the Bale-Doneen Method preceptorship, and we are fortunate to have one such dentist in the valley: Lauren Roper, DDS, who opened New Castle Dental over a year ago. I am honored to have her co-author this column with me.
Heart disease, like many other illnesses, is linked to acute and chronic inflammation. Chronic inflammation contributes to developing hardening of the arteries (atherosclerotic plaque), and acute inflammation contributes to plaque rupture — the actual cause of heart attacks and most strokes. Several factors contribute to inflammation, including smoking, unhealthy diet, high blood pressure, high cholesterol, diabetes, sleep apnea, stress and inflammatory diseases such as rheumatoid arthritis. Another cause of inflammation is unhealthy bacteria in the mouth. (Note that, as with the gut microbiome, the mouth microbiome can include both “good” bacteria and “bad” — harmful — bacteria).
Periodontal means “around the teeth,” and refers to the gums (also known as gingiva), the jaw bones that surround the teeth, and the ligaments that hold the teeth in place. Periodontal disease causes bleeding gums and loss of bone support around the teeth. As the gums become inflamed, deep pockets develop around the teeth, and oxygen-poor ecosystems are created in which harmful bacteria flourish. These bacteria have recently been proven to cause heart disease, and Bale and Doneen cite studies in which autopsies were done on people who died of heart attacks — and 100 percent of the ruptured plaque had DNA evidence of harmful mouth bacteria.
In November 2016, Drs. Bale and Doneen published an article in the British Medical Journal describing new evidence linking periodontal disease and heart disease. They showed that bad mouth bacteria that cause periodontal disease not only cause atherosclerosis, but that these bacteria can cause arterial plaque to rupture.
Arteries are lined by an organ called the endothelium, which is one-cell thick. Bacteria that cause gum disease damage this lining, especially in the setting of high LDL (bad cholesterol). The manner in which the bacteria get into your bloodstream from your mouth is similar to the manner in which they get into the walls of your arteries. Inflammation stretches the thin gum tissues, allowing them to open and bleed. When the gums are open and bleeding like this, the bacteria have a pathway into the bloodstream and access to the rest of your body via the network of blood vessels.
The inflammation in the mouth can be recognized by gingiva that is dark pink or red and glossy — a condition known as gingivitis. Gums of gingivitis sufferers tend to bleed easily when touched with a toothbrush, floss, or measuring devices used in dental offices. Gingivitis is the precursor to periodontitis, the difference being that in periodontitis there is an irreversible loss of attachment of the gum tissues and bone loss.
Other signs and symptoms of an oral infection can include bad breath, receding gums, loose teeth, a change in how your teeth fit together when you bite, and gums that hurt when you brush or floss. The CDC estimates that approximately 47 percent of American adults have some form of periodontal disease.
Before your mouth reaches the tipping point in which inflammation, bleeding gums and bone loss are present, the bacterial burden starts building up silently. It is possible to know what your levels of bacteria are — and whether these are good or bad bacteria. Dentists can prevent and treat gingivitis and periodontitis, thereby preventing heart attacks.
Your dentist can test for bacteria in your mouth that are known to cause periodontal disease through a DNA test (such as MyPeriPath or OraVital), which simply involves collecting saliva to send to the lab. If you have heart disease or risk factors for heart disease, see your physician and request a blood test called a Cleveland Heart Lab, read “Beat the Heart Attack Gene” by Bale and Doneen, and ask your dentist for a thorough periodontal assessment and a salivary DNA test.
Prevention is the easiest and best course of action. You are much less apt to have heart-attack-causing gum and tooth disease if you avoid sugar, brush after meals, and floss and use a water pick at night.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and other medical issues. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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