PROPER ORAL HYGIENE WILL MAKE YOU AWAY FROM HEART DISEASE

Subash L

    INTRODUCTION 

    Oral disease like periodontis and various other gum disease have placed a important role in various cardiovascular disease like atherosclerosis atrial fibrilation ect.,

    Studies suggest that periodontal infection are a number one culprit that are related to CVD

    The periodontal diseases are highly prevalent and might affect up to 90% of the worldwide population.

    Gingivitis, the milder type of periodontitis is caused by the bacterial biofilm (dental plaque). The association of coronary heart condition and periodontitis could also be because of an underlying response trait, which places a private at high risk for developing both periodontitis and atherosclerosis.

    It was suggested that periodontal disease, once established provides a biological burden of endotoxin (lipopolysaccharide) and inflammatory cytokines, especially thromboxane A2, prostaglandin E2, 2interleukin (IL)1L=1α,and tumor necrosis factor-beta, which serve to initiate and exacerbate atherogenesis and thromboembolic events

    Cardiovascular diseases (CVD), including acute myocardial infarct and angina are major health problems in developing countries, and are considered amongst commonest medical problems within the general population.

    Annual mortality from CVD is about 12 million cases per annum and are chargeable for 30% of all deaths within the u. s.

    Photo credit: https://summitdentalhealth.net/gum-disease-and-heart-disease-whats-the-link/ 


    PERIODONTITIS 

    There are evidences that dental infection, notably disease, is feasible a risk issue for hardening of the arteries coronary artery diseases. 

    Patients who have valvular defects (congenital or noninheritable as results of post-rheumatic fever) or another nonheritable defects such a septate defects or who have prosthetic valves, ought to receive antibiotic medical aid as bar before dental extraction (high-risk group), scaling or periodontic surgery. 

    These are likely to release a significant number of bacteria from the gingiva, particularly periodontal disease. 

    The role of periodontic infection/ inflammation may be a risk issue for hardening of the arteries.

    A recent review of the medicine pattern of periodontal disease report a spread in prevalence of severe periodontitis from 1% among 20-29 years to 39% among people quite sixty five years aged.

    Poor periodontic standing was considerably related to exaggerated C-reactive protein (CRP) and coagulation factor levels. Another cluster investigated the association between periodontal disease and subclinical hardening of the arteries, usually measured by means that of arteria intima-media thickness (cIMT) assessments .

    Several studies have shown that periodontic diseases are related to cardiovascular disease. 

    While a cause and result relationship has not nevertheless been evidenced. 

    Patient in danger for infective carditis could need antibiotic before a medical procedure. 

    Cardiologist and dentist can decide if the prevailing cardiovascular disease needs the employment of antibiotics before medical procedure.

    Extra studies have noted to a relationship between disease and stroke. 

    In one study that looked out the cause relationship of oral infection as a risk issue for stroke, folks diagnosed with acute vessel ischemia were found additional probably to own associate oral infection when put next to those within the management group.

    Photo credit: https://www.msdmanuals.com/home/mouth-and-dental-disorders/periodontal-diseases/introduction-to-periodontal-diseases 


    PATHOGENIC MECHANISM


    Photo credit: https://intownsmilestudio.com/2017/04/12/cardiovascular-disease-part-1/


    Photo credit: https://www.dentistryiq.com/dentistry/article/16366436/the-surprising-link-between-periodontal-disease-and-heart-health-what-dental-professionals-need-to-know


    • There are several pathways which have been proposed as a potential link between CVS and PD.
    • Indirect Mechanisms: Systemic Inflammation
      • Atherosclerosis may begin during childhood with initial infiltration of the endothelium with fatty substances and progress over many decades. 
      • Plaques that contain a soft atheromatous core are unstable, and their rupture will expose highly thrombogenic contents to blood, with activation of thrombosis and ensuring ACS, MI or stroke.
      • The link between ASVD and inflammatory mediators in blood is well-established, with consistent associations between levels of systemic inflammatory markers and increases in clinical events, such as MI and nonhemorrhagic stroke, and in surrogate markers such as increased cIMT.
      • A well-studied inflammatory marker is CRP. Many studies of individuals with no prior history of ASVD have demonstrated that a single nonfasting measure of CRP is a predictor of future vascular events, including MI, stroke, peripheral arterial disease, and sudden cardiac death.
      • Additional inflammatory markers associated with CVD include lipoprotein-associated phospholipase A221 and tissue inhibitor of matrix metalloproteinase,myeloperoxidase, and fibrinogen.Periodontal inflammation is associated with systemic markers such as CRP, tumor necrosis factor alpha, IL-1, IL-6, and IL-8.
      • Systemic inflammation is similarly associated with cellular activation that involves cellular adhesion molecules, toll-like receptors, matrix metalloproteinase, and nuclear factor-k beta activation. The resulting interplay between endothelium, monocytes and platelets might be proatherogenic,contributing indirectly to atherogenesis or adverse cardiovascular outcome related to atheromatous plaque rupture in a subject with periodontitis.

    Photo credit: https://jada.ada.org/article/S0002-8177(14)62727-6/fulltext


    • Indirect Mechanism: Mimicry
      • Molecular mimicry is thought to occur when sequence similarities between foreign and self-peptides produce cross-activation of autoreactive T or B cells that can lead to tissue pathology or autoimmunity.
      • Expression of host protective heat shock proteins (HSPs) such as HSP60 on endothelial cells may be induced by a variety of factors, including cytokines and shear stress and antibodies to HSP60, which have been associated with higher morbidity and mortality from atherosclerotic ASVD.
      • Proponents of molecular mimicry as a link between PD and ASVD suggest that endothelial damage may be aggravated by an immune response to bacterial HSP, such as molecular chaperone GroEL present in P. gingivalis and other periodontopathic bacteria.

    Photo credit:Infection or inflammation: The link between periodontal and cardiovascular diseases - Scientific Figure on ResearchGate. Available from: 

    https://www.researchgate.net/figure/Molecular-mimicry-as-a-possible-link-between-periodontal-infection-and-atherosclerosis_fig1_24282175[accessed 30 May, 2020] 


    Photo credit: https://nutritionreview.org/2014/07/promising-new-approach-for-gum-disease-treatment-identified/


    • Direct Mechanism: 
      • Bacteremia and Vascular Infection by Periodontal PathogensBacteremia that originates from the oral cavity is a common event that can occur during chewing and tooth brushing. 
      • It potentially occurs multiple times per day in individuals with some degree of gingivitis and periodontitis.
      • A comprehensive search of literature provides a list of more than 275 bacterial species that have been identified in blood cultures after routine daily events or dental procedures. 
      • Viridans group streptococci represent a significant proportion of flora around teeth, particularly in the dental biofilm that grows about the gingival crest. 
      • From there periodontal organism circulates in the blood stream either within phagocytic cells or extracellularly and subsequently are deposited in an atheromatous plaque. 
      • Common PD pathogens including P. gingivalis adhere to and invade various human vascular cells in culture.
      • Numerous studies have examined the effect of antichlamydial antibiotic therapy on outcomes in patients with coronary artery disease. Of note systemic antibiotics alone would not be expected to lead a long-term resolution of chronic

    Photo credit https://www.cell.com/trends/endocrinology-metabolism/comments/S1043-2760%2815%2900045-4


    Photo credit: www.periobasics.com



    CONCLUSION

    It is now clear from the epidemiologic studies that a possible link does exist between PD and CVD.

    Oral healthcare professionals can identify patients who are unaware of their risk of developing serious complications as a results of CVD and who are in need of medical intervention.

    Prospective interventional studies are required to work out the exact link between PD and CVD similarly on evaluate whether periodontal treatment may reduce the chance of developing. 

    Some studies which are ongoing to guage the moderation of vascular disease (ATH) because of interventional periodontal therapy and therefore the extent to which it (ATH) is accountable for triggering cardiovascular events.

    However, the challenge remains whether PD may be considered one of the normal risk factors for CVD because the link established from different studies isn't limited to a recent CVD.

    Overall, PD seems to be related to no over a modest increase (~20%) in cardiovascular risk within the general population.

    • It seems from the scientific evidence gathered to this point that interventional periodontal care remains invaluable not just for oral health except for general health similarly.


    REFERENCE 

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