Connection+Between+Heart+Diseas+and+Periodontal+Disease




 * 1. Periodontal Pathogens increase risk of nonfatal myocardial infarction LM # 11**It has been suggested that their is a correlation between heart disease and periodontal disease. Though the research is limited many researchers and looking for a marker in order to better correlate these two diseases. In a study comparing periodontal pathogens and myocardial infarction tested six different periodontal pathogens: P. gingivalis, T. forsythesis, P. intermedia, C. recta, F. nucleatum and E. saburreum. These were compared to the odds of having a MI. Results showed that their is an increase risk of having a MI with the following periodontal pathogens: P. gingivalis, and T. forsnthesis. Also individuals that had three or more different periodontal species present have a 2-fols increase in likely hood of having a nonfatal MI versus those that did not have any type of bacterial species. Therefore it is concluded that the presence of T. forsythesis and P. gingivalis and an increase in total amount of periodontal pathogenic species does increase the odds of having a MI. Also is concluded tat more studies need to be conducted in order to determine the relationship between periodontal disease and heart disease.

**2. Research has shown a significant correlation between periodontal disease and cardiovascular disease. MT #18** It is the obligation of the clinician to educate the patient about the correlation between periodontal disease and cardiovascular disease. One may not cause the other but they are a risk factors.

Carranza explains that certain oral bacteria may be involved with the formation of thrombi in the arterial walls. This can be caused by platelet aggregation in the arteries, causing a clot to form and block the artery, potentially leading to serious conditions like myocardial infarction. The platelet aggregation can occur when certain bacteria from the oral cavity enter the bloodstream. Research has shown that certain bacteria, specifically //S. sanguis// and //P. gingivalis,// are known to cause platelet aggregation when in the blood stream. With continual elevated levels of these bacteria in the blood, the risk increases of a thrombus forming. These bacteria have been found in samples of thrombi in studies, which makes a case that there is a strong correlation between periodontal pathogens and thrombogenesis.
 * 3. Oral organisms may be involved with coronary thrombogenesis. MW #19**

Patient education is important., it is important to emphasize the nature of periodontal infections, the increased risk for systemic disease associated with the infection, and the biologically role periodontal infection may play in systemic disease. Studies have shown that there is a correlation between periodontal disease and cardiovascular disease by the risk factors that are involved. Proper knowledge of potential relationships between periodontial disease and systemic health requires the dental professional to expand their horizons.
 * 4. Patient education is priorty. GE #6**

The increase in bacteria in the blood stream, inflammatory markers, in conjunction with other factors such as age, gender, socioeconomic factors, environmental factors, and genetics may even increase the probability according to the data. Research is continuing to find new correlation between periodontitis and cardiovascular disease and with time there may be an even stronger correlation. These possible markers are brachial artery flow-mediated dilatation, and carotid intima media thickness.
 * 5. Research has provided data that periodontitis has a significant influence on cardiovascular health. SR14**

===6. Both chronic periodontitis and and subsequent periodontal treatment alter the serum levels of C-reactive protein (CRP), IL-6, and tumor necrosis factor-alpha (TNF-alpha). AP12 === When the subjects were divided into 4 groups according to thier initial concentration of hs-CRP, only the CRP and IL-6 concentrations of the highest quartile group showed significant reductions after periodontal treatment.

**7. Systemic markers are a risk factor for cardiovascular disease. ** In an attempt to find the correlation between coronary heart disease and peridontitis researchers have studied C-reactive protein (CRP) and fibrogen. C-reactive protein stimulates the complement cascade, further exacerbating inflammation. These markers are also resposible for blood coagulability. The articles that studied C-reactive protein did find that the levels of this markers were elevated in patients with periodontitis when compared to the nonperiodontitis group. According to Carranza elevations in serum CRP and fribrinogen levels are well accepted risk factors for cardiovascular disease. Early detection of C-reactive protein can be used as risk assessment for cardiovascular disease. Patients can be educated on the correlation between periodontitis and cardiovascular disease and the importance of disease prevention. ====**8. Periodontal disease is a contributary factor for cardiovascular disease, that should be discussed with the patient. TL #8 **==== ====According to the Third National Health and Nutrition Examination Survey, the odds of having a history of heart attack increased with the severity of the periodontal disease. Although this link has yet to be proven, there is a correlation. This correlation could be a great motivator factor for patients, especially those with a family history of cardiovascular disease.==== ====Genco, R., Offenbacher, S., & Beck, J. (2002). periodontal disease and cardiovascular disease: epidemiology and possible mechanisms. The Journal of the American Dental Association, 133(1), Retrieved from http://www.jada-plus.com/content/133/suppl_1/14S.full====
 * MC#3**

9. Further Research can provide a stronger relationship between vascular health and oral health. SR 14
Research has provided data that periodontitis has a significant influence on cardiovascular health. The increase in bacteria in the blood stream, inflammatory markers, in conjunction with other factors such as age, gender, socioeconomic factors, environmental factors, and genetics may even increase the probability according to the data. Research is continuing to find new correlation between periodontitis and cardiovascular disease and with time there may be an even stronger correlation.

Patients should be made aware how important maintaining their oral health status is. Although bacteremia can occur through dental procedures overall exposure time is more frequent through daily tooth brushing and chewing. If a patient is in a state of periodontal disease this puts them more at risk for bacteremia. “An estimated 8% of all cases of infective endocarditis are associated with periodontal or dental disease, without a preceding dental procedure” ( Mealey & Klokkevold, 2006, p. 317). It is important during patient education to stress the importance of maintaining dental health for prevention of bacteremia. Mealey, B., & Klokkevold, P. (2006). //Carranza's Clinical Periodontology// (10th ed.). St. Louis, Missouri: Elsevier.
 * 10. Patients' daily routine and oral health status can contribute to bacteremia without prior dental procedures. KT4**

Scientific studies have been conducted to determine if there is an association between periodontal disease and cardiovascular disease. While the exact cause to link them has not been confirmed, the association between both diseases is enough cause for concern. So of the proposed links between periodontal disease and cardiovascular disease are: the relationship between inflammation and the production of C-reactive protein; patients with periodontal disease have significantly higher levels of inflammatory products (fibrinogen and WBC) which are known risk factors for acute heart attacks; and dental bacterial components affect the body’s response to infection and can increase the development of atherosclerosis.
 * 11. Periodontal disease and Cardiovascular disease have a common pathogen RK 7**

Since periodontitis is a persistent bacterial infection causing chronic inflammation in periodontal tissues, it is suggested that it may travel through the bloodstream and increase the risk of acute cardiac syndrome. A study conducted containing 20 individuals with chronic periodontitis found that 13 of the 20 patients presented with bacterial pathogens which are frequently found in both serve chronic periodontitis and atherosclerotic plaque of the coronary vessels. They found that 10 of the participants presented with both atherosclerotic plaque and sub-gingival plaque. In addition these 10 patients had generalized 4mm or greater pocket depths and significantly higher bleeding index. The research concluded that because periodontal and cardiovascular diseases have several common risk factors, more studies are needed to evaluate the strength of association between the two diseases.

In conclusion, periodontal disease is common, preventable, and treatable. By improving the periodontal health of you patient’s you can significantly reduce their risk of developing cardiovascular disease. As a clinician you can suggest daily brushing and flossing, maintaining recall visits, smoking cessation, and nutritional counseling.

Reflection: What does your mouth say about your heart?. (2010). Retrieved from http://www.perio.org/consumer/perio-heart-link.htm

Systemic infections are known to induce an increase in coagulation and viscosity. Fibrinogen levels as well as white blood cell counts are often elevated in people with peiodontal disease. There have been numerous studies conducted to examine the relationship between periodontal disease and cardiovascular health. A meta-analysis conducted by Janket et al. concluded that people over the age of 65 who had periodontal disease had a 44% increased risk of cardiovascular events than those who did not have periodontal disease.
 * 12. Periodontal infections may affect the onset or progression of athersclerosis and CHD through certain mechanisms. Periodontitis and athersclerosis both have complex etiological factors, combining genetic and environmental influences. CE5**


 * 13. The association or the correlation between periodontitis and cardiovascular disease could be divided to having direct causal relationship between the two disease and an indirect relationship between the disease. A direct association between the two diseases was that moderate and severe periodontitis increases the level of systemic inflammation as in RA or systemic lupus. The indirect realtionship between the two diseases are due to risk factors such ascigarette smoking, diabetes, possibly obesity, high cholesterol level, and hypertension. LL#9.**