TIMES NEWSPAPERS
By Dr. Robert A. Levine
Sounds ridiculous, doesn’t it? How could yourmouth hurt your heart? Especially since I don’tmean something you really regret saying to yourspouse, your best friend, or your child. But theanswer, regrettably, is YES.
Gum disease – an often hereditary infection ofthe gums that eventually infects the jawboneanchoring the teeth – can send oral bacteriathrough the bloodstream, which may be depositedin the heart valves and arteries. Once deposited,research strongly suggests that these oral toxinscontribute to heart disease (heart valve infectionand hardening of the arteries.)
In fact, it’s such a recognition of the harmfulinteraction between mouth bacteria and the heartthat has made it standard practice to administerantibiotics, prior to most dental procedures, topatients who have a heart murmur. (This is becausedamaged heart valves are at highest risk for aninfection known as “infective endocarditis,” aninflammation of the interior lining of the heart andheart valves.)
Not coincidentally, researchers have concludedthat people with gum disease, also called periodon-tal disease, are twice as likely to suffer from coro-nary artery disease. (Oral bacteria attach to the fattyplaque build-up in the coronary arteries and maycontribute to arterial clot formation.) Periodontaldisease is, in fact, now believed to be an importantrisk factor for heart problems – in concert with suchother risk factors as age, smoking, diabetes, hyper-tension and elevated blood cholesterol.
And heart disease (like periodontal disease) isvery common in this country. The American HeartAssociation estimates that 58 million people sufferfrom cardiovascular disease. That’s one person inevery five. Small wonder it’s the number one causeof death among Americans.
But, like all the other risk factors for heart dis-ease (except age) gum disease can be treated andoften reduced in its risk, if not eliminated, as a fac-tor in the development of heart disease.
How? First, you have to know whether you haveit. A number of commonly experienced symptomsexist. Most often, what you may notice is red,swollen, or sensitive gums, and/or bleeding whenbrushing or flossing your teeth. Later on, if ignoredand left untreated, you may find that your gums arepulling away from your teeth, or that you have looseor separating teeth, or even pus appearing betweenyour gums and teeth. Other signs include persistentbad breath, a change in the way your teeth fit togeth-er, or a change in the fit of partial dentures.
All of the above are signs of a progression of thebacterial infection causing periodontal disease. Butperhaps the “clue” easiest to remember is thathealthy gums do not bleed when teeth are brushed orflossed; so, if you notice blood, don’t ignore it. Takeit seriously as a symptom of gum disease.
On the other hand, you may have no symptoms atall. Gum disease is always painless. And like highblood pressure, can be symptomless in its earlystages. Smokers, in particular, experience no bleed-ing when they brush or floss because their bloodvessels are constricted by the chemical agents in cig-arettes. Yet smokers are five times more likely tosuffer from periodontal disease than are non-smok-ers and, as a result, when smokers quit smoking,they sometimes find blood on the pillow as theirgums “refind” the ability to bleed, once nicotine andother chemical agents are no longer being ingested.
Of course, the best way to find out whether youhave gum disease is to visit a dentist and ask for aperiodontal screening and evaluation. After the ageof 18, it’s also wise to check with a periodontist –especially if you have, or have had, such compellinghealth factors as hereditary or non-hereditary heartproblems, diabetes, or respiratory illness like pneu-monia, bronchitis or emphysema.
But let’s say your gums begin to bleed when youfloss. What then? Once your dentist or periodontist
confirms the presence of a periodontal infection,you may learn that it’s actually a “fortunate” timeto have gum disease: because state-of-the-art ther-apies now exist, and more are regularly beingdeveloped.
Depending on the severity of your periodontaldisease, treatment may include nonsurgical therapysuch as scaling and root planing (to remove thebuildup of tarter that contributes to infection, andsmooth the root surfaces to allow the gums to healand reattach to the root.) It may involve bacterialcultures to isolate the specific oral bacteria causingyour specific infection. A DNA probe analysis isalso utilized to qualify what specific bacteria arepresent. And antibiotic susceptibility testing is usedto “target” your specific infection with the correctantibiotic regimen. It is important to point out thatantibiotics by themselves are not enough.Treatment is necessary to gain the long term bene-fits of “targeted” antibiotic therapy such as nonsur-gical and/or surgical periodontal therapy (whichmay include regenerative therapy to rebuild the lostjawbone.)
Much can be done, in other words, to restoredamaged gums, bone loss and lost teeth that canresult from gum disease left untreated over time.But the most important thing- if you do, indeed,have gum disease – is to start treatment beforewhat goes on in your mouth has an adverse effecton your heart.
Dr. Robert A. Levine maintains a full time pri-vate practice in the Einstein Center One Buildingin Northeast Philadelphia focusing on surgicalimplant placement, cosmetic oral plastic surgeryprocedures and reconstructive and regenerativetherapy. He is presently a Clinical Professor inPost-Graduate Periodontics and DentalImplantology at the Temple University KornbergSchool of Dentistry. Dr. Levine is a Diplomate ofthe American Board of Periodontology and aFellow of the College of Physicians in Phila -delphia. He has lectured extensively both national-ly and internationally and has been featured on sev-eral local and national television and radio shows.Dr. Levine serves on the Editorial Boards ofnumerous international scientific dental journalsand has authored over 60 articles and 4 book chap-ters. He is a Fellow of the International Team forImplantology (ITI) of Basel, Switzerland and wasone of 100 representatives from around the worldinvited to participate in both the ITI 4th ConsensusConference in Stuttgart, Germany (2008) and the5th Consensus Conference in Bern, Switzerland(2013) to establish treatment protocols for implantdentistry worldwide. Dr. Levine is President,founder and Program Chairman of the NEPhiladelphia Dental Implant and Perio-ProsthesisStudy Club and the Greater Philadelphia DentalHygiene Study dedicated to providing state-of-the-art continuing education courses to the area’s den-tal community. One of the pioneers of the “imme-diate load” revolution in dental implants, Dr.Levine is one of only a handful of periodontistsnationwide who have been performing this proce-dure since 1994. His SameDay Smile® allowspatients to complete an implant surgery and leavethe dental chair with beautiful, functional teeth in asingle visit.
Can your heart be hurt by your mouth?
Robert A. Levine, DDS, FCPP
Dr. Robert A. Levine is a renowned implant surgeon and periodontist, highly
respected in the dental community for his extensive training and expertise.
Clinical Professor in the Department ofPeriodontology and Oral Implantology at
Temple University Kornberg School of Dentistry.
Clinical Associate Professor in Periodontology, Post-Graduate Periodontics, Periodontal Prosthesis and Implantology, University ofPennsylvania School of Dental Medicine.
Pennsylvania Center for Dental Implants and Periodontics
Einstein Center One • Suite 2119880 Bustleton AvenuePhiladelphia, PA 19115
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