PART 2: Health Gums and a Healthy Heart

Drs. Todd & Amy Kinney, DDS

The Department of Health and Human Services has selected oral health as one of the 12 LeadingHealth Indicators for Healthy People 2020. Oral

diseases ranging from cavities andgum disease to oral cancers causepain and disability for millions ofAmericans. Unfortunately, theimpact of oral disease does not stopat the mouth and teeth. Researchhas shown that oral health, particu-larly gum disease, is related to several chronic and life-threateningdiseases, including diabetes, heartdisease, and cancer.1234 In preg-nant women, poor oral health hasalso been associated with prema-ture births and low birth weight.5

In Part I of this series, therelationship of diabetes and gumdisease, called periodontal dis-ease, was addressed. People withdiabetes or who are overweighthave more periodontal diseaseand a higher risk of heart diseaseand stroke. Chronic gum diseasecan make blood sugar controlworse in diabetics, and treatinggum disease can help regulateblood sugar levels and reducesystemic inflammation. Profes-sional dental cleanings can significantly reduce a diabetic’srisk for a heart attack.

In recent years, not onlyhave we realized that gum disease increases the risk of having diabetes by 50%6 butresearch also implicates gum disease with increasing the risk of certain cancers by 30–50%.7 We will addressperiodontal disease and cancer in Part III of this series.

A Mouthful of EvidenceThe relationship between heart disease and oral

health is nothing new. It was just over 20 years ago that aFinnish cardiologist and his team reported findings thattheir patients with myocardial infarction (heart attack)

had poorer oral health, including gum disease and toothdecay.8 This landmark paper in 1989 stimulated a tidalwave of interest in the associations between oral healthand various systemic diseases over the last two decades.

In 1993, one of the first studies on the association of periodontal disease and heart disease recognized peri-odontal disease to increase the risk of heart disease by76%,9 and the evidence continues to grow each year. Asearly as 1998, the American Academy of Periodontology

(AAP) issued a strong warn-ing that gum infectionsrepresent a “far moreserious threat” to thehealth of millions ofAmericans than previous-ly realized. Over 2800referenced citations onperiodontal disease andcardiovascular diseasecan be found on PubMed.Nearly half of these arti-cles have been publishedin the past 10 years, andone-third in just the last5 years.

Long in the ToothPeriodontal disease is a

chronic infectious inflammatorydisease that affects the gum tis-sue and bone supporting theteeth. Is it estimated that nearly85% of the U.S. adult popula-tion is afflicted with periodontaldisease at some time in theirlives.

One out of every twoAmerican adults aged 30 andover currently has periodontaldisease, according to recentfindings from the Centers forDisease Control and Prevention(CDC). A 2012 study in theJournal of Dental Research

estimates that nearly half (65 million) American adultshave mild, moderate or severe periodontitis, the moreadvanced form of the disease. In adults 65 and older,prevalence rates increase to 70%.10

Periodontal disease is higher in men than women(56% vs. 38%) and is highest in Mexican-Americans(67%) compared to other races. Other segments withhigh prevalence rates include: current smokers (64%);

The Mouth-Body Connection

It is impossible to haveoptimal health without

having good oral health…studies have demonstratedan association between periodontal disease and diabetes, cardiovascular disease, stroke and adversepregnancy outcomes.”

—Dr. Donna Shalayla, M.D.,Former U.S. Surgeon General

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17January–February 2013

those living below the federal pover-ty level (65%); and those with lessthan a high school education (67%).

Staggering StatisticsHeart disease, also called

cardiovascular disease (CVD), killsan estimated 630,000 Americanseach year, and it’s the leading causeof death for both men and women inthe US.11 The CDC estimates that935,000 heart attacks and 795,000stokes occur each year.12 Heart dis-ease and stroke are the first andthird of all deaths in the UnitedStates. The American HeartAssociation estimates more the 83million Americans currently livewith one of more types of CVD, creating estimated health care costsnearing $450 billion each year.Sadly, epidemiological data showthat as many as 50–70% of CVDevents occur in low-risk populationswithout easily identifiable causes.13

Both gum disease and heart disease are chronic inflammatoryconditions that can take decades todevelop and they can exist subclini-cally for years before any symptomsbecome noticeable to the patient.CVD can be a killer by heart attackor stroke. 90% of coronary arterydisease is asymptomatic. In fact, 50%of the time the very first symptom of heart disease is cardiac arrest.Every year, over 400,000 people inthe US—nearly half of the peoplewho have heart attacks annually—die from sudden cardiac arrest inhospital emergency rooms or beforethey can receive medical attention.

There is strong proof that peoplewith gum disease are at greater riskfor heart disease—including heartattacks, stroke and atherosclerosis—than people with healthy gums. Thelink between gum disease and heartdisease exists separately from otherrisk factors for heart disease, such as smoking, diabetes, obesity, orhigh blood pressure. The researchdocumenting the relationshipbetween gum disease and heart disease indicates people with themost serious gum infections havethe greatest risk.

Got Plaque?Complications from gum disease

are the number-one cause of toothloss in adults according to the AAP,but that isn’t the only consequence.Periodontal disease starts whensticky bacterial biofilms, called dental plaque, build up on teethand root surfaces. These bacteria andother microorganisms cause acuteinflammation and bleeding gums. If gum infection becomes chronic,turning gingivitis (the earliest stageof gum disease—9 out of 10 adultshave it and don’t know it!) into peri-odontitis, the risk for irreversiblebone loss around the teeth dramati-cally increases, and with it so doesthe amount of bacteria spilling intothe bloodstream and spreading infec-tion throughout the rest of the body.

As bacteria, endotoxins (poisonsreleased from dead bacteria) andinflammatory compounds seed fromthe mouth into the circulation, thebody produces antibodies against

these common oral bacteria to keepthem in check. Usually these bacte-ria are killed, but as gum diseasebecomes more chronic and inflam-mation progresses, a hyperimmunereaction develops and the antibodiesend up attacking the tissue wherethe blood meets the artery alongwith the invading bacteria. With afoothold in the walls of arteries,called the endothelium, these oralbacteria cause the lining to becomeinflamed, increasing blood clottingand promoting the formation ofarterial plaques.

The body attempts to wall offthis inflammation by depositing cholesterol, which promotes thebuildup of plaques in the blood vessels, narrowing the vessels fromthe inside. The coronary arteries andheart valves are especially suscepti-ble as are the carotid arteries thatfeed the brain. As the buildup ofplaque increases the arteries becomeatherosclerotic or hardened leadingto hypertension, and if the plaquebecomes unstable and ruptures itcan have three potentially deadlyoutcomes: acute heart attack, cardiac arrhythmia, and stroke.

The Cholesterol MythIn their book, Reverse Heart

Disease Now, co-authors and inte-grative cardiologists Stephen Sinatra,MD, and James Roberts, MD, addressthe role of repeated cardiovascularinjury caused by chronic inflamma-tion and the role of infectious oralbacteria. They simply remind us, “To help put out the fire in your

Healthy GingivitisEarly

PeriodontitisModerate

PeriodontitisAdvanced

Periodontitis

Pale pink gumsPlaque Tartar

Bad breath

Inflammation Pronouncedbleeding

Looseteeth

Gumdamage

Infection

PocketsBleeding gums

Swollen &red gums

Progression of gingivitis to periodontal disease, which can be a key factor in heart disease.

arteries, you need to put out the firein your mouth.”

Medicine’s traditional finger-pointing at cholesterol as the badguy has recently shifted to acknowl-edging inflammation as the mostimportant factor in plaque formationand arterial disease. “Both periodon-tal disease and cardiovascular disease are inflammatory diseases,and inflammation is the commonmechanism that connects them,”says Dr. David Cochran, DDS, PhD,past president of the AAP and Chairof the Department of Periodontics atthe University of Texas HealthScience Center at San Antonio.

The oral bacteria found in periodontal disease have beenidentified in atherosclerotic plaqueof patients with coronary artery dis-ease. Periodontal disease is associated with elevated levels of C-Reactive Protein (CRP), a keyinflammatory marker. In 2000,a Harvard study put CRP onthe map as the best predictorfor identifying people at risk forheart disease, not bad choles-terol. CRP actually interfereswith the process that inhibitsblood clots, which can predis-pose a person to a sudden heartattack or stroke. The presenceof the highest levels of CRPindicates five times the risk ofdeveloping CVD, and fourtimes the risk of heart attackand stroke. If cholesterol wereto blame, then everyone withCVD would have high choles-terol, when in fact, half of allheart attacks occur in people withnormal cholesterol levels.

It seems bacteria must have helpto do harm, and other factors, suchas smoking, toxic chemical andheavy metals, oxidative stress, bad fats, poor diet, food allergies,elevated insulin, high blood pres-sure, excess stress, and other inflam-matory diseases can set the stage forinfection. In rheumatoid arthritis for example, researchers have discovered that a woman’s risk for heart attack is doubled.

Garbage InSo, cholesterol isn’t the problem

after all—it’s chronic inflammation—caused by bacteria, environmentaltoxins, and diet. Overloading thebody with highly processed carbohy-drates (sugar, flour and all the products made from them) andomega-6 vegetable oils, like soybean,

corn, canola and sunflower that arefound in many processed foods, are some of the biggest culprits of inflammation. The cholesteroltheory led to the promotion of theStandard American Diet (SAD) thatis low in saturated fats and high inpolyunsaturated fats (omega-6 vegetable oils) and carbohydrates.The high levels of omega-6 fattyacids compared to omega-3 fattyacids in this type of diet is believedto contribute to autoimmune andinflammatory diseases as well as

cancer and cardiovascular disease.14 15

A number of studies haveshown that the heart is especiallysensitive to heavy metal toxicity andthey indicate hypertension or highblood pressure may be related toaccumulative heavy metal overload.The cardiovascular, immune andnervous systems are all extraordinar-ily sensitive to heavy metals like

cadmium, lead and mercury.Several European studies

have shown significantlyhigher incidences of

coronary atherosclero-sis, congestive heartfailure, cardiacmyopathy, and cardiac arrest inpatients with elevat-ed mercury levels.

Drs. Sinatra, Roberts,and others feel these

toxic metals, especiallymercury from fish,

“silver” mercury-amalgamdental fillings, and vaccines, playan active role in inflammation, mitochondrial dysfunction andplaque formation.

Are You at Risk?Despite the fact that 15–20

million people in the US take expensive (and controversial) statinmedications like Lipitor®, Crestor®,and Zocor®, and apart from the medical advances in emergency and interventional cardiology, more Americans will die this year of heart disease than ever before.

The latest analysis of lifetimerisk of CVD for the average adultwas recently published in theNovember 2012 issue Journal of the American Medical Association.16

The results are alarming. In fact, 3 out of 5 men without heart disease or identifiable risk factors at age 45 will develop a CVD (whichincludes coronary artery disease,stroke, and congestive heart failure)over time. Men are at higher riskthan women for all ages. The greaternumber of lifetime risk factors, suchas smoking, diabetes, periodontal

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Medicine’s traditionalfinger-pointing at

cholesterol as the badguy has recently shiftedto acknowledginginflammation as themost important factor in plaque formation and arterial disease.

Artery narrowedby atherosclerosis

PlaqueBloodflow

Normalartery

Narrowed arteries indicate the presence of coronary artery disease, which can lead to a heart attack.

disease, obesity, and high blood pressure, the higher the likelihood ofeventually developing heart disease.The message is clear—even peoplewith relatively low risk may sufferfrom heart problems down the road.

Realizing that traditional pre-ventive medicine is failing to keepup with the increasing prevalence of CVD is a bitter pill to swallow.The evidence supporting that inflam-mation in the artery wall is the realcause of heart disease and not badcholesterol is slowly leading to aradical paradigm shift in how heart disease is being treated. NewCardiology, as endorsed by Drs.Sinatra, Roberts and others, utilizesintegrative care—medication, nutri-tional supplements and lifestylechanges—to help stabilize these dan-gerous arterial plaques and reversethem before a life-threatening eventcan occur or surgery is needed.17

Saving Lives—One Smile at a Time

American Heart Associationspokesman Dr. Richard Stein, MD,past director of preventive cardi-ology at Beth Israel Medical Centerin New York City and a spokesmanfor the American Heart Association,says that he: “regularly counselspatients worried about their risk forheart attack or stroke to incorporategood periodontal care in their pre-ventive strategies, just as they wouldinclude exercise, healthy diets andappropriate medications.”

Fortunately, unlike CVD, signsof periodontal disease occur earlyand are easily detectable. One of theeasiest ways and most comprehen-sive screening is from your dentist.As a Center for Dental Medicine werecommend that all adults shouldreceive a Periodontal HealthAssessment. In our office we canassess your risk for gum disease by

examining your:

• Health history• Family health history• Nutrition and diet• Plaque, bleeding and gum-

pocket scores• Gums, bone and soft tissue• Existing dental work• Bite and TMJ health• Saliva pH testing • Bacterial levels• Genetic susceptibility• CRP and HbA1c levels

The American Heart Association(AHA) has dedicated February

as American Heart Month.Remember the old saying, “An ounceof prevention is worth a pound ofcure!” Here is how you can reduceyour risk for gum disease and heartdisease:

1. Eat a healthy, whole-foods, non-processed, and anti-inflammatory diet.

How old are you?<45 (5)40-65 (10)>65 (15) ___________

Do you use tobacco?No (5)Yes (15) ___________

Have you seen a dentist in the past two years?

No (10)Yes (5) ___________

How often do you floss?Daily (5)Weekly (10)Seldom (15) ___________

Do you have any of the following health conditions: Heart disease, osteoporosis, diabetes, or high stress?

No (5)Yes (25) ___________

Do you have chronic bad breath or a persistent metallic taste in your mouth?

No (5)Yes (15) ___________

How many dental fillings, crowns orimplants do you have?

None (5)1–3 (10)4+ (15) ___________

Do your gums bleed after brushingand/of flossing?

No (5)Yes (55) ___________

Do you have any loose teeth?No (5)

Yes (55) ___________

Do you have receding gums?No (5)Yes (55) ___________

Have you had any adult teeth extracted?No (5)Yes (55) ___________

Do you have any root canalled teeth?No (5)Yes (55) ___________

MY TOTAL: ___________

PERIODONTAL DISEASE RISK SCORE

LOW RISK: 75 OR LESS POINTS

MEDIUM RISK: 80–105 POINTS

HIGH RISK: 110 OR MORE POINTS

If you scored 110 or more points, your riskof having periodontal disease is high and

the higher your score, the greater is yourrisk for tooth loss, diabetes, cancer andheart disease. Even with a high score, yourrisk can be significantly reduced with prop-er oral hygiene, professional periodontalcare and an anti-inflammatory diet. �

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ Periodontal Disease Quiz ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

Do you have periodontal disease? Many people are unaware that they have gum disease. The absence ofpain, obvious inflammation, or tooth decay is no guarantee you are free from periodontal disease. To test

your risk, answer each of the following questions as truthfully as possible. Keep track of your to total points(shown in the brackets) and evaluate your score at the end of the test.

~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~

19January–February 2013

20 www.naturallifenews.com • Natural Life News & Directory

Are you ready for a healthy change?

Oral SedationMercury-Free DentistryVeneers & CrownsSleep Apnea & Snoring

Experience the difference ofhealth-centered dentistry today.

Holistic Dental CareDental ImplantsTMJ, Headaches & Jaw PainOrthodontics & Clear Aligners

TODD A. KINNEY, DDS

AMY C. MADDEN KINNEY, DDS

406-582-8500 • 3502 Laramie Drive • Bozeman • www.drskinney.com

Over 15 years experience in General Dentistry

2. Brush and floss daily to removeplaque.

3. See your dentist and dentalhygienist for regular gum diseaseexaminations, even before yousee the first signs of bleedinggums or tartar buildup. It couldsave your life!

4. Live a physically active, emo-tionally healthy and spirituallyprofound lifestyle.

5. Listen to your doctor—and don’tsmoke!

Periodontal disease and heartdisease are entirely preventable andboth can be treated and reversed ifdetected early. Regardless of geneticpredisposition or other factors, youcan live a longer, happier, healthierlife with an investment of just a fewminutes every day. �

Drs. Todd and Amy Kinneyhave provided integrative den-tal care in Bozeman since1997. Their health-centeredpractice was recognized as aCenter for Dental Medicine in2010—one of less than 100dental practices dedicated topreventive dental medicine.

NOTES

1. Bensley L., VanEenwyk J., Ossiander E.M.Associations of self-reported periodontal diseasewith metabolic syndrome and number of self-reported chronic conditions. Prev. Chronic Dis.2011;8(3):A50

2. J. Am. Dent. Assoc. 2006;137(suppl 2).

3. Barnett M.L. The oral-systemic disease connection.J. Am. Dent. Assoc. 2006;137(suppl 2):5S–6S.

4. Division of Oral Health, Centers for Disease Controland Prevention. Public Health Implications ofChronic Periodontal Infections in Adults. Atlanta,GA: 2005.

5. Office of the Surgeon General, U.S. Department ofHealth and Human Services. Periodontal diseaseand adverse pregnancy outcomes. Oral Health inAmerica: A Report of the Surgeon General.Washington, D.C.: 2000.

6. Annual meeting American Diabetes Association.June 2008. Dr. George W. Taylor, Univ. of Michigan.

7. Michaud, D.S. Periodontal disease, tooth loss andcancer risk in male health professionals: a prospec-tive cohort study. Lancet Oncol. 2008; 9: 550-58.

8. Mattila K.J., Nieminen M.S., Valtonen V.V., et. al.Association between dental health and acutemyocardial infarction. BMJ. 1989;298:779–781.

9. DeStefano F., Anda R..F, Kahn H.S., et. al. Dental disease and risk of coronary heart disease andmortality. BMJ. 1993;306(6879):688-691.

10. P.I. Eke , B.A. Dye , L. Wei, G.O. Thornton-Evans , andR.J. Genco . Prevalence of Periodontitis in Adultsin the United States: 2009 and 2010. J DENT RES0022034512457373, first published on August 30,2012 as doi:10.1177/0022034512457373

11. American Heart Association, 2012.

12. Centers for Disease Control and Prevention. Heartdisease and stroke prevention; addressing thenation’s leading killers: at a glance 2011. Availableat: www.cdc.gov/chronicdisease/resources/publi-cations/AAG/dhdsp.htm.

13. Jackson R., Marshall R., Kerr A., Riddell T., Wells S.QRISK or Framingham for predicting cardiovascu-lar risk? BMJ. 2009;339:b2673.

14. Simopoulos, Artemis P. (2008). “The Importance ofthe Omega-6/Omega-3 Fatty Acid Ratio inCardiovascular Disease and Other ChronicDiseases.” Experimental Biology and Medicine 233(6): 674–88. doi:10.3181/0711-MR-311. PMID18408140.

15. Astrup, Arne; Dyerberg, Jørn; Elwood, Peter;Hermansen, Kjeld; Hu, Frank B.; Jakobsen,Marianne Uhre; Kok, Frans J.; Krauss, Ronald M., et.al. (2011). “The role of reducing intakes of saturat-ed fat in the prevention of cardiovascular disease:Where does the evidence stand in 2010?”American Journal of Clinical Nutrition 93 (4): 684–8. doi:10.3945/ajcn.110.004622. PMC3138219. PMID 21270379.

16. Wilkins, J.T. Lifetime Risk and Years Lived Free ofTotal Cardiovascular Disease JAMA. 2012;308(17):1795-1801. doi:10.1001/jama.2012.14312

17. Sinatra, S., 2007. Reverse Heart Disease Now: StopDeadly Cardiovascular Plaque Before It’s Too Late.(Stephen Sinatra and James Roberts; with MartinZucker.) New Jersey. John Wiley & Sons, Inc.