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Michael. C. Goldman, DDS
Gum Disease and Heart Disease
....and perhaps other diseases, too.....
For a long time there have been some vague ideas about gum disease being related to heart disease. Physicians not too long ago used to recommend extraction of all teeth for many cardiac patients but that practice gradually stopped, lacking hard scientific evidence of that connection. During the past decade a dozen or so scientific research papers have pieced together most - if not all - of the story. There is a connection!
Not only that, but medical research has been showing more and more that there are connections between infection and other serious, chronic medical conditions. Stomach ulcers are now known to be often caused by bacterial infection. Arthritis is now being treated more as an infection, whereas just a few years ago neither stomach ulcers nor arthritis were thought of or treated as the result of infection. Many other medical conditions are now suspected of also being instigated by infection.
The mouth - teeth and gums and tonsils - has long been recognized as one of the most frequent ports of entry of infection into the body. Gum disease and root canal abscesses are significant bacterial infections that can spread by the bloodstream to remote parts of the body. That spread of infection to other parts of the body is called the focal infection theory.
Recently a book was published centering on the research done about the turn of the century by a remarkable dentist named Weston Price. Dr Price did a lot of very interesting research relating to root canal infection and treatment spanning a period of about twenty-five years with some amazing results.
The basic notion behind his work was the idea of focal infections which was a very big deal in medical thinking at that time. It is the idea that an infection someplace in the body - tonsil, gums, toenail, ear, or root canal - might be able to spread to another perhaps far remote part of the body. There was the feeling that was largely accepted that a gum infection might be able to end up somehow in the heart and result in a life-threatening infection there. That idea, while never disproved, just sort of faded away by and large (although it has made small, sporadic, comebacks here and there).
What happened was that with the advent of penicillin and other wonder-drugs to combat infection, concern for where the infection was coming from was suddenly less important than just which particular germ the infection was. The identity of the germ bacteria dictated which particular wonder-drug antibiotic was needed and that, in a nutshell, was that! "...Next patient!" We got away from treating the cause to treating the symptom .
To read more about the issues with Root Canals specifically and the work of Dr. Price, please read sections on Root Canals listed in Topics.
Some of the research relating to heart disease indicates that for those with major risk factors already present (smoking, high blood pressure, high lipids, diabetes, stress, obesity), having gum disease doubles the risk of developing heart disease.
If you have gum disease, it has been estimated that about 50% of times you brush your own teeth, you stir up the bacteria in the gums and open up bleeding spots in the gum tissue, resulting in bacteremia..... bacterial infection of the bloodstream! And it happens when you eat, too. The vigorous massaging of the gums by the action of the food, tongue and lips can easily stir up the already present infection!
The repeated episodes of bacteremias just from brushing - or even just from eating - cause repeated reinfection of the lining of blood vessels. The cells of the blood vessel lining react to reinfection by "puffing up" to form what has been called "foam cells". It is a structure like foam rubber, or sponge, with holes or spaces which fill up with cholesterol crystals and cellular debris.
This foam cell with its debris embedded in it is then surrounded by connective tissue forming the fibrous plaque with cholesterol in it that we hear so much about as in clogging up the arteries in hypertension, strokes, and heart attacks.
Some of the research has indicated that some of the commonly found bacteria found in gum disease will, when they get into the bloodstream, cause the red blood cells to get "sticky" and stick to each other forming clumps of red blood cells. It seems high lipids makes this more likely to occur.
When these bacteria were introduced into experimental animals with high lipid scores, clumping of the blood cells triggered signs of myocardial infarction ... heart attack.
In moderate gum disease with gum pockets measuring 4 to 5 mm deep throughout the mouth, the surface area of infection in the pockets would be equivalent to creating an infected, ulcerated surface the size of your palm with fingers extended on the side of your face!!!!! Thats pretty gross, but we tend to find it easier to ignore and rationalize when its in the mouth, not so easily seen....
A gum pocket is formed when the gum splits away from the tooth due to infection. When a dentist checks your mouth he or she must always check the depth of the crevice around your teeth. A healthy crevice will always be about one-eighth of an inch or less deep. Thats because when it gets deeper than that, you can no longer keep it clean. It is possible to work with slightly deeper ones if you are very motivated and willing to spend half your life in the bathroom, but for most people with a life ... its a general rule that applies to most of us.
In advanced gum disease, the gum pockets can get 6 to 10 mm, sometimes even deeper!
Until now the process of getting clogged arteries has generally been viewed as chronic, gradual, progressive and steady. In light of this new paradigm described here, it can be seen as episodic; that is, the result of episodes of inflammatory response to repetitive reinfections. Sudden rupture of the fibrous plaque with superimposed thrombosis is the primary mechanism in a heart attack - blockage of a coronary artery by a clump of plaque broken off the lining upstream or now swollen just enough more than it was to obstruct the blood flow enough to cause damage to the heart muscle cells.
The implication is clear... gum disease is bad for you! Not only for your teeth, but for the rest of your body also. Infected gums, root canals or tonsils are bad news for your health.
Read the other sections relating to gum disease listed in Topics to find out more about the treatment of this very common problem.
Michael C. Goldman, DDS
General and Cosmetic Dentistry
3815 East-West Highway
Chevy Chase, Maryland 20815
Phone (301) 656-6171
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Holism in dentistry is an approach to dental treatment, primarily caring for patients' health and safety from both a conventional as well as "alternative healthcare" point of view. It is sometimes called "biological" dentistry or "biocompatible" dentistry. In it's fullest sense, I believe it acknowledges and deals with the mind, body and spirit of the patient, not just his or her "teeth". See Topics / Info.....
Cosmetic dentistry is about doing quality , esthetic dentistry in a way that looks natural to begin with, and furthermore, can even improve one's attractiveness through techniques such as bonding, bleaching, veneers, caps, implants and more. It can be like "instant orthodontics" in correcting crooked, twisted or misplaced teeth in many instances. Dark or misshapen teeth can be restored. Smiles that lack youthful vigor or beauty can be revitalized! See Topics / Info..
Bleaching, veneers, bonding, caps, bridges, and implants are cosmetic dentistry treatments that are also discussed in Cosmetic Dentistry, and more...