Hello, welcome everybody, this doctor Bolad, board certified physician in cardiology,
interventional cardiology and internal medicine. If you are new to this channel,
then definitely consider hitting the subscribe button below and switch on the notification bell
so you don’t miss any new videos that I post. Gum disease, also referred to as periodontal disease,
occurs when either the gum on its own, or the gum and the supportive connective tissue become
inflamed. When only the gum is involved, the disease is referred to as Gingivitis,
and it is an inflammatory process characterized by gum redness, swelling, and bleeding that is
provoked by routine brushing or flossing. Healthy gums are pink, stippled and firm.
Non Inflamed gums should not bleed during routine flossing and brushing. When the gum disease is
accompanied by the loss of supportive connective tissues including the periodontal ligaments
and alveolar bone, the disease is referred to as Periodontitis. Clinical findings include
gingival bleeding on probing and increased tooth mobility. Bone loss is seen on X-ray. Progression
of periodontitis will cause accelerated tooth mobility and eventual tooth loss.
People with chronic gum disease and periodontitis have two to three times the risk of having a heart
attack, stroke and other cardiovascular diseases. However, not everyone with gum disease develops
heart disease, and also, many people who have heart disease have healthy gums. It was previously
postulated that shared risk factors like poor diet and smoking might explain the association.
However, there is growing evidence that gum disease is an independent risk factor for heart
disease. The link is thought to be through chronic inflammation as periodontal disease
increases the body’s burden to inflammation. Acute inflammation leads to stimulation of the immune
cells that attack the infection, whether that is bacterial or viral infection or otherwise.
Chronic inflammation is a long-term inflammatory process, and leads to many health problems,
including heart disease and heart attacks. In a study published in the journal Circulation,
the association between clinical and X-Ray measures of periodontitis
and the incidence of coronary heart disease in the form of angina, heart attacks and
fatal coronary disease was studied. In the VA Normative Aging and Dental Longitudinal Study,12
hundred men were followed with triennial comprehensive medical and dental examinations for
up to 35 years. A significant dose-dependent association between periodontitis and coronary
heart disease was found in men less than 60 years of age independent of body mass index,
smoking, alcohol intake, diabetes mellitus, fasting glucose, cholesterol, and high blood
pressure. In another study published in the Journal of General Internal Medicine,
a meta-analysis was performed on seven cohort studies that looked into the association between
periodontal disease and heart disease. The studies were conducted in North America and Finland
and represented cohorts of 170,000 men and women with follow-up ranging from 5–21 years. The study
found that periodontal disease was a risk factor or a marker for coronary heart disease that was
independent of traditional coronary heart disease risk factors, including socioeconomic status.
In a third study, published in the Journal of Public Health Dentistry, a meta analysis
was performed on two large studies, the Health Professional Follow-up Study and the Nurses Health
Study. Participants included about 41 thousand men and 58 thousand women free of any cardiovascular
diseases at baseline. There were 16 thousand incidents of coronary heart disease events
among men during a 12-year follow up period, and there were over 500 events among women
during 6-years of follow-up. The study showed a significant association
between number of teeth at baseline and risk of coronary heart disease, with participants
with fewer teeth at baseline having a higher incidence of coronary heart disease on follow-up.
The mechanisms by which chronic periodontitis predisposes to coronary heart disease
are not well understood, but an adverse effect of systemic inflammation on endothelial function may
play a role. In addition to local infection, other factors may contribute to systemic inflammation
including intermittent bacteria in the blood and release of bacterial endotoxins of
oral origin into the bloodstream, an effect that can be induced by gentle chewing.
The Question that then lends itself is whether treatment of periodontal disease improves heart
health and reduces the risk of coronary heart disease. In a study published in the Journal
of Clinical Periodontology, male participants with known coronary artery disease and elevated
blood inflammatory markers and oxidized low density lipoprotein cholesterol
were studied. Participants underwent non-surgical periodontal treatment. There was significant
improvement in periodontal health at 3 months and all systemic inflammatory indices decreased
in addition to a significant decrease on oxidized low density lipoprotein cholesterol,
suggesting that improvement in periodontal health improved systemic inflammation and would
likely improve coronary health. In a second study published in the New England Journal of Medicine,
Endothelial Function, which is a marker for development of coronary artery disease,
has improved in 6 months, following treatment of individuals with severe periodontal disease.
There are also other associations between gum disease and health. Individuals with
periodontal disease have been shown to have increased risk of Diabetes,
Cancers including lung, bladder, oropharyngeal, esophageal, kidney, stomach and liver cancers,
Dementia, and Spontaneous Preterm Birth My message to you regarding gum disease,
is that whether there is a direct or indirect link with the development of coronary disease,
is that a healthy mouth, teeth and gums will help you keep your teeth
and reduce your risk in the development of coronary artery disease and heart attacks.
Daily tooth brushing and flossing can prevent and even reverse an early stage of gum disease.
Many people don't spend enough time or care when brushing, the recommended duration is two
minutes. Flossing sweeps away the sticky film between teeth that leads to plaque
buildup. Twice-yearly cleanings by a dentist or a dental hygienist are highly advisable.
If you have any questions about what I presented to you today, or any medical question in general,
then subscribe to my channel and share your question in the comments section below
and I will reply to you. If you have a question that you would not like to share in public, then
subscribe to this channel, follow me on twitter @DoctorBolad, and then send me a private twitter
Direct Message and I will reply to you. Please like and share this video with family and friends.
This is Doctor Bolad, helping you with your heart health, thanks for watching, and talk to you soon.