Is Heart Disease Lurking in Your Mouth?

Health Writer
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While it's unlikely that many people equate healthy teeth with a healthy heart, at least one study has found that hidden tooth infections may predispose people to heart disease.

The study found that an infection at the root of the tip of a tooth, even if the infection presents with no symptoms, can increase the risk of coronary heart disease**.** The study researchers suggest that acute coronary syndrome is almost three times more likely to occur in adults who have untreated teeth that need a root canal.

The results of the study, published in the Journal of Dental Research, identifies apical periodontitis, caused when the body mounts a defense against bacterial overgrowth, often due to cavities. The infection descends through the interior of the tooth to the root, and can be painless in its early stages. Periodontitis causes inflammation, and previous studies have linked general body inflammation to a host of chronic disease, including heart disease. To date, the research on dental root tip inflammations and its associated inflammation has been limited.

In the Journal of Dental Research study, 508 Finnish adults, mean age 62, already showing symptoms of heart disease, were screened with angiography to examine their coronary arteries. Thirty-six percent of the subjects were diagnosed with stable coronary artery disease, 33 percent were diagnosed with acute coronary syndrome, and 31 percent did not have significant coronary artery disease. The researchers then screened the subjects' teeth and jaws, using panoramic tomography. At least 58 percent were found to have one or more clinically significant inflammatory lesions.

The researchers also noted high levels of serum antibodies related to the bacteria causing the root tip infections. Since heart disease is the number one killer of men and women in the U.S. and is responsible for 30 percent of deaths globally, any risk factors for heart disease need to be addressed and limited when possible.

Via email, I asked Fred L. Weiner, DDS, a practicing dentist in Tarzana, California (and my dentist for 25 years), to comment on the study and to offer some insights into oral health:

Do you think too many people forgo yearly dental exams because other health considerations are more important?_Dr. Weiner: _ About half the U.S. population forgoes yearly dental exams, but from my experience it’s more from fear or financial reasons, not because they think other health considerations are more important.

Are the study findings really new or has this link between oral health and heart disease been recognized for some time?_Dr. Weiner: _ It's pretty much old news in terms of the periodontal inflammation relationship to cardiovascular disease; however, this is the first research I've seen relating periapical lesions to cardiovascular disease.

How significant do you think the study findings are?_Dr. Weiner: _ Hard to say. We definitely do not see one in four patients with periapical lesions that they don’t know about. I would guess the number would be more like one in 20 or 30. It would be hard to do a true scientific study, like blind or double blind, since you would have to let half of the group get cardiovascular disease, which wouldn’t really be ethical.

Are consumers getting the message regarding how oral health or disease links to serious health concerns?_Dr. Weiner: _ Minimally. Really well-informed sections of the population seem to know about it. The rest pretty much are “zero aware.”

How often does the patient present to you with asymptomatic serious dental disease?___Dr. Weiner: _ Really depends on what you call "serious" disease. Lots of people don't know when they have an apical lesion. It probable hurts or swells about two-thirds of the time.

How often do you think dental x-ray screenings should be done?_Dr. Weiner: _ Guidelines depend on the person and their oral health. You also have to weigh the radiation damage potential to the x-ray benefit. Each person should have a different timeline depending on their genetics, oral care, and nutrition.

For patients like me, with a family history of oral disease and a past history of numerous root canals, should screenings and dental visits be more frequent?** Dr. Weiner**: Yes, for sure. Someone who constantly gets decay or gum disease should get their X-rays much more frequently than someone who never has any problems. An example would be a full mouth X-ray every two years versus five years in trouble-free mouths. The general recommendation for check-up and cleaning is, at minimum, once a year, or better still, twice a year.

Considering a recent review of past studies** that suggested that there isn't sufficient evidence to support flossing and other dental habits, what are your thoughts?**_Dr. Weiner: _ Those comments have been a setback for good oral health. The issue is that no real scientific studies were done (on efficacy), just mostly expert opinions were offered. And the reasons are again related to true science, and the type of studies that would be required to defend the current position on recommended oral practices. The best example that I can give you would be a study to prove "the use of a parachute to protect life when falling out of an airplane." Would you like to be in the group that jumps out of the plane without the parachute, to prove the fact? So you don't want to be in the study group that doesn't floss, loses a lot of bone, and develops inter-proximal cavities just to prove a point.

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