Periodontal Disease And Cardiovascular Disease, Is There A Link?

Periodontal Disease and Cardiovascular Disease

A periodontal disease is broadly viewed as that type of disease that affects the gums and it is largely caused by poor dental hygiene. Our teeth are not connected to the gum directly, rather, they are attached to a low cleft in the gum known as the sulcus and this is the point that the infectivity of the periodontal disease occurs. As the tissue around the tooth undergoes damage, the teeth often become loose depending with the level of infection and if left untreated, it may lead to loss of teeth.

The classification of periodontal diseases is done according to the severity of the illness and it usually takes either of the following two forms. Gingivitis is a mild form of gum infection which when not controlled in its early stages often leads to a more serious condition known as periodontitis. The distinguishing factor in both diseases is the erosion of the bone structure supporting the gum. Cardiovascular diseases on the other hand refer to the type of diseases that affect the heart and the blood vessels. These diseases are known to lead to the narrowing of the arteries and/or veins, infection to the heart’s muscle and regulators, and the pulse rate. Having familiarized ourselves with these terms, is there any link that exists between periodontal and cardiovascular diseases?

It is quite hard to believe that such unrelated topics and diseases have a causal link/ relationship. Abou-Raya, Naeem, Kheir, Abou-El & El Beltagy, (2002) says “Numerous scientific studies have been conducted to verify if there truly exists a relationship between periodontal diseases and cardiovascular diseases.” The first of such an experiment was conducted in Finland in the year 1989 and found that there was an association between dental diseases and the occurrence of heart attacks and strokes. In a most recent research conducted this year, there is overwhelming prove to this association believing that inflammation provides the basis for such occurrences. More to this, other extensive views have been shared as to what causes the link in both diseases. Reviewing of the periodontal diseases will be done in a deeper way to try and establish all the points which act as links to the cardiovascular disease spread from gum infections.

Gum disease as already pointed out occurs due to poor dental and oral sanitation. With the much food intake that a human takes in any given day, a lot of food particles end up being lodged in the teeth. A lot of helpful bacteria are also present in the mouth to aid with the digestion and braking down process of food particles. In the words of Wu, Trevisan, Genco, Dorn, Falkner& Sempos, (2000), “imbalances that arise between the levels of harmful and useful bacteria levels in the mouth act as the basis for the attack of a periodontal disease.”  Microbial plague is the group of bacteria that is accountable for periodontitis. This type of bacteria thrives and grows on the surfaces of teeth with specialty underneath the gum line. The crown of the tooth is directly attached to the jaw bone by the root part of the tooth. The gum (gingiva) then acts as a protective cover over it. The uppermost part of the gums is known as the gingival crest which borders the sulcus where the disease is notorious for attacking. The plaque in which the bacterium that causes gum disease thrives in is very sticky in nature and gives it an advantage of being able to stick on teeth and give it strategic working environment for its destructive work.

Onset of the periodontal disease is usually marked with the bleeding of gums and it is not usually painful. As the infection properties and levels tend to rise from the increased activity of the bacteria, reddening and puffiness of the gum follow as warning sign of the inflammation process. In addition, it usually occurs as an indication of white blood cells being discharged by the immune system as a defensive mechanism to the rising disease level. The enzyme factor, proteolytic, that is responsible for the active combating of the bacteria is subsequently directed into the gums so as to resist the build up. Unfortunately, upon the completion of the attack, the immunity cells tend to die off while the bacterium mostly survives. Another negative repercussion is recorded in the erosion of the gum tissue since it just goes to make the original situation worse off for it leads to its disintegration from the teeth creating deeper clefts which allow the bacteria to breed in even bigger numbers. Elter, Champagne, Offenbacher, & Beck, (2004), believe that “If the former mild stage of a periodontal disease is not treated, it will lead to serious consequences of teeth loss marking the last stages of the disease since it is now irreversible.” Note that, all these hazards may arise without any symptoms like pain associating with them.

The first causal linkage between periodontal and cardiovascular diseases is presented as follows. During the time that the gum infections scale at high levels, the bacteria and toxins may find their way in to the individual’s blood stream and access their way into the heart. Once there, they tend to attach themselves to the oily plague that is present in the cardiac arteries which are responsible for all the blood that flows into the heart with an exception of the pulmonary artery which facilitates the flow of blood out of the heart and into the lungs for oxidation. With the progressive accumulation of this disease causing micro organisms, the walls of these blood vessels tend to thicken from the inside with the deposition of fats (Beck, Elter, Heiss,Couper, Mauriello & Offenbacher, 2001).Blood level that flows through them tends to be reduced and the speed of flow reduces significantly with the amount of deposits. That is, the higher the accumulation, the slower the blood movement. This condition favors the formation of clots in the blood vessels which is very dangerous. The nutrient and oxygen levels into the heart are also restricted and it follows that this vital organ may now be faced with different heart ailments.

Heart attack is one possible ailment that may sprout from this scenario since it is caused by the lack of sufficient oxygen supplies causing the collapsing and possible death of the affected heart muscles. Blockage is not limited to the heart only and it is important to note that it may also occur at other blood vessels of the body. In the case where toxin laden blood is pumped by the blood from the oxidation point and to the brain, possible deposition may occur at the carotid artery located in the neck to supply nutrients and oxygen to the brain. Beck, Elter, Heiss, Couper, Mauriello, & Offenbacher, (2001), assert that “…the hardening of the blood vessels leading to the accumulation of fats and toxins often leads to blocking and clot formation and is the main cause of heart attack and stroke.”

The second explanation which is mostly the stronger and more acceptable views is given by the inflammation view. Although plagues that exist in gums and arteries are different, it has been found that the accumulation of plaque in the gums has a way of creating a subsequent rise in the level of plaque accumulation in the arteries through the inflammation concept. The former is in most cases usually an indication of the presence of the latter. Possibly, the bacterium responsible for the periodontal infections act as an express prompt to the inflammatory of arterial plaques which are known to lead to rupturing of blood vessels and subsequent heart attack. Alternatively, the effects of the centralized inflammation at the gums only may also overflow to other parts of the body resulting to a body-wide irritation. Severe inflammation is a fundamental cause for a variety of ailments. Other than giving rise to heart diseases, the periodontal diseases can also intensify the heart diseases that an individual may be suffering from. Endocarditis is a rare type of heart condition that causes the inflammation of the endorcadium layer of the organ which is the inner lining (Elter, Champagne, Offenbacher & Beck, 2004).

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This membrane covers the four heart compartments and the four heart valves as well. The most common disease organism to this condition is bacteria though fungi and other disease causing microbes can also be responsible in the causing of this heart condition. This ailment takes place when the causative agent finds its way through the blood stream and into the heart. The origin of the microbes is usually different parts of the body system but the mouth is the most common. This disease condition causes the growth of clustered bacterium and/ or cells on the valves of the heart putting constraints in the proper working of the heart structure. This infection may in some cases extend over to other body organs like kidneys, brain and the lungs. Abscess formation in the cardiac muscles is also a possible aftermath. When the infection is left without proper medical attention, damaging of the valves occurs and at the most extreme end it is usually fatal. The good news is that it is a very rare occurrence in individuals with healthy hearts and just poses risks to those people that already suffer from any form of heart ailment or condition like an anomalous heart valve or damaged heart ligaments. The aggravation of this heart condition by periodontal infections like gum bleeding is caused by the enhanced environment for the breeding and spread of the bacteria to the heart through the use of the bloodstream. On an ordinary situation like this, the body releases white bodies in the blood system to deal with the bacteria in it. The attack on most of the occasions proves to be successful but heart patients have a higher affinity for the deposition of the bacterial clusters in the harmed part of the cardiac tissue. Hence, it is of uttermost importance to ensure such patients are put under antibacterial medication in a case like dental processes that cause bleeding to occur (Abou-Raya, Naeem, Kheir, Abou-El & El Beltagy, 2002).

At the early effecting of trying to draw a link between the two types of diseases, led to a disparity of whether any relationship truly existed. Some of the scientists and professionals in the field believed that none or a very weak link existed between periodontal and cardiovascular ailments while others were for the idea that there truly existed a strong correlation. A better level of agreement has been reached with the scientific evidence that has been found on the recent studies that have been conducted with the aim of proving whether a possible strong link is present. The studies have also been done in an upgraded manner with the involvement of the factors that lead to the cause of both diseases so that the data is presented as error free as possible. The results have indicated that a clear-cut and distinct relationship occurs between the two and better still it has been found that periodontal disease single-handedly is a powerful forecaster of heart ailments and stroke. Advanced phases of the periodontal disease in patients have indicated that the individuals have been victims of the cardiac ailments and the risk is always higher in smokers. Males who are of 45 years and above and smoke are at higher risks of contracting heart diseases from gum infections than their women counterparts (Bergström, (2003).

The advancement in the existence of this link has led medical practitioners to invent an index that helps them in determining the presence of a heart ailment from the level of gum infections. This index analyzes the possibility of a heart disease founded on the basis of the occurrence of oral bacteria that is responsible for causing gum ailments in an individual with the number of teeth that he may have lost, that are decayed or replaced and the bone loss that his jaw might display.  With the data that was collected from the analysis of comparing individuals with the gum diseases to the possible presence of a heart ailments in their lives, it was noted that there existed a positive relationship between the variables that were being compared with the causal factor to the heart diseases not in any way connected to other factors like unhealthy eating habits or smoking.

References:

Abou-Raya, M., Naeem, A., Kheir, H. A., Abou-El, H. & El Beltagy, H. (2002). Coronary Artery Disease and Periodontal Disease: Is There a Link? Angiology, 53 (2), 141-148.

Beck, J. D., Elter, J. R., Heiss, G., Couper, D., Mauriello, S. M. & Offenbacher, S. (2001). Relationship of Periodontal Disease to Carotid Artery Intima-Media Wall Thickness. Arteriosclerosis, Thrombosis, and Vascular Biology. 21 (11),1816-1822.

Wu, T., Trevisan, M., Genco, R. J., Dorn, J.  P., Falkner, K. L. & Sempos, C. T. (2000). Periodontal Disease and Risk of Cerebrovascular Disease.  Arch Intern Med.,160 (18), 2749-2755.

Bergström, J. (2003). Tobacco smoking and risk for periodontal disease. Journal of Clinical Periodontology, 30 (2),107 – 113.

Elter, J. R., Champagne, C. M. E., Offenbacher, S. & Beck, J. D. (2004). Relationship of Periodontal Disease and Tooth Loss to Prevalence of Coronary Heart Disease. Journal of Clinical Periodontology, 75 (6),782 – 790.