Brush to Prevent Heart Disease?

The American Academy of Periodontology
Patient Information Pages
July 2009

Gum disease and cardiovascular disease are both major public health issues that impact a large number of Americans every day. While these two diseases impact separate areas of the body, research indicates that periodontal disease and cardiovascular disease are connected; having one disease may actually increase your risk of developing the other.

Inflammation’s Role
Periodontal disease and cardiovascular disease are both considered chronic inflammatory conditions. Inflammation is the body’s instinctive reaction to fight off infection. Inflammation is initially good for your body because it helps in the healing process. However, chronic and prolonged inflammation can lead to severe health complications. Researchers believe that inflammation provides the basis for the connection between gum disease and heart disease1. And now, periodontists and those who treat cardiovascular disease are working together to provide the best care to patients.

The Perio-Cardio Connection
In July 2009, a consensus paper2 was published in both the Journal of Periodontology and The American Journal of Cardiology. The paper was jointly developed by periodontists and cardiologists. Periodontists are dentists with advanced training in the treatment and prevention of periodontal disease, and cardiologists are doctors who specialize in treating disease of the heart. The paper summarized the evidence that links periodontal disease and cardiovascular disease and provides clinical recommendations for periodontists and cardiologists to use in managing their patients living with, or at risk for, either disease.

What Does This Mean For You?
You might be surprised when your periodontist now asks even more questions about your medical history, especially questions about your family history of heart disease and any behaviors that may affect your heart health such as smoking. Your cardiologist may start to ask you about your dental history and might even look in your mouth to evaluate your teeth and gums! These new recommendations are intended to help periodontist and cardiologist better manage your risk factors for future disease progression, and ensure your well-being. Hopefully by working together with your periodontist to ensure healthy teeth and gums, you will also ensure a healthy heart throughout your entire life.

1Journal of Periodontology. August 2008, Vol.
79, No. 8s, Pages 1501-1614.
2 V Friedewald, K Kornman, J Beck, et al.
Editors' Consensus: Periodontitis and
Atherosclerotic Cardiovascular Disease.
Journal of Periodontology. July 2009, Vol. 80,
No. 7, Pages 1021-1032.

You can learn more about the Perio-Cardio Connection by visiting the AAP website at http://www.perio.org/ . To learn about this connection in the Philadelphia, PA, Camden, NJ, Montgomery County area, call Dr. Stephen Brown at (215) 735-3660 or visit The Perio Group on the web at http://www.theperiogroup.com/.

Study Shows Scientific Support for Laser Procedure in Treating Moderate to Severe Periodontal Pockets

A story published in the March 2008 issue of Inside Dentistry (Volume 4-Number3) highlighted the results of a peer-reviewed manuscript demonstrating histologic success in the treatment of moderate to severe periodontal pockets using the patented Laser Assisted New Attachment Procedure (LANAP) developed by Millennium Dental Technologies. New connective tissue attachment and regeneration of cementum was achieved in 100% of the cases in the study. These results suggest the FDA-approved and patented LANAP is a viable alternative for treating gum disease with traditional cut and suture blade surgery.

The study was led by Dr. Raymond Yukna, director of Advanced Periodontal Therapies, University of Colorado, School of Dental Medicine, and showed repeatedly positive responses in LANAP-treated patients. Twelve single-rooted teeth that had chronically shown moderate to severe periodontal infection participated in this split-mouth designed study. While six teeth received the laser LANAP therapy, the other six teeth were treated with scaling and root planing only.

Following three months of observation, 100% of the teeth treated with LANAP showed not only new cementum but also new connective tissue attachment. Under the same observation, the control teeth which had received only scaling and root planing showed no evidence of either new attachment or regeneration. No evidence of any adverse changes was recorded around any of the LANAP-treated teeth. The study was the fourth largest prospective comparative histology project in the entire peer-reviewed, periodontal literature.

Study leader, Dr. Yukna was "quite pleased and encouraged by the results of this study" and remarked, "Recent years have seen major advancements in periodontal technology, and this study is a successful demonstration of using a free-runnning pulsed Nd:YAG laser applying the specific LANAP protocol."

Philadelphia Periodontist, Dr. I. Stephen Brown has been extensively trained in this newest technology available for periodontal patient care. If you are interested in a no cut, no sew, no fear laser alternative for the treatment of gum disease Philadelphia, contact The Perio Group at 215.735.3660 or on the web at www.theperiogroup.com.

Inflammation and Periodontal Disease

Inflammation and Periodontal Disease
December 2008 Patient Page
from the American Academy of Periodontology

Most people know that maintaining healthy teeth and gums is a necessary step in achieving overall wellbeing. In fact, now not only dentists encourage brushing and flossing, but many physicians also promote oral hygiene as a way to help keep the rest of the body healthy. Several research studies have suggested that gum disease may be associated with other health issues, including heart disease, stroke and diabetes. And with more and more research reinforcing the connection between periodontal and systemic health, scientists are beginning to understand why these connections exist. One theory points to chronic inflammation as the culprit.

Inflammation is the body’s natural response to harm, such as an injury or infection. For many years, dentists believed that gum disease developed as a result of a bacterial infection caused by the build-up of plaque between the teeth and under the gums. While plaque build-up is still a factor in the development and progression of gum disease, researchers now suspect that the more severe symptoms, namely swollen, bleeding gums; recession around the gum line, and loss of the bone that holds the teeth in place, may actually be caused by the chronic inflammatory response to the bacterial infection, rather than the bacteria itself. Scientists hypothesize that the chronic inflammatory response mechanism may be the reason behind the periodontal-systemic health link.

Many of the diseases associated with periodontal disease are also considered to be systemic inflammatory disorders, including cardiovascular disease, diabetes, rheumatoid arthritis, kidney disease and even certain forms of cancer, suggesting that chronic inflammation itself may be the
basis for the connection. More research is needed to pinpoint the precise biological mechanisms responsible for the relationship between gum disease and other disease states. However, since previous findings have indicated that gum disease sufferers are at a higher risk for other diseases, it is critical to maintain periodontal health in an effort to achieve overall health.

Dentists recommend daily oral care, including regular brushing and flossing, and routine visits to the dentist to avoid gum disease. If gum disease develops, consultation with a dental professional such as a periodontist can lead to effective treatment. A periodontist is a dentist with three years of additional specialized training in the prevention, diagnosis and treatment of gum disease.

For more information on the role of inflammation in oral health, tips on how to prevent or treat gum disease, to find out if you are at risk or to schedule a gum disease evaluation in the Philadelphia, PA area visit Dr. I. Stephen Brown at http://www.theperiogroup.com/ or call 215.735.3660. To see more patient pages like this one, visit http://www.perio.org/.

Talking With Patients About Systemic Diseases and Dental Treatment

Today, more than any time in history, dental patients are hearing about and researching the "oral-systemic" link. Oral disease and it's recently publicized link to other systemic infections, has become a popular topic among dental patients. Physicians and Dentist alike have known for years that this connection exists, however, only recently has ample evidence existed to back up what these practitioners have long been aware of.

Dental treatment for the management of periodontal disease and other oral afflictions is now being recognized as part of a full-body wellness plan. The challenge for dentists to to be able to talk to their patients about the importance of good oral health and how that relates to the overall well-being. What is the best way for these practitioners to broach this topic in such a way that patients feel compelled to get the treatment they really need? Luckily for these practitioners, patients today are more educated about how their bodies work and are more apt to do the research themselves before their dental visit. Patient communication and education is key.

The Connection is the Inflammation

Most people understand the concept of infection and the ways in which the body can become infected. A relatively high number of the population understands also the basics of inflammation. Talking to patients about the link between inflammation/infection, oral diseases, and their overall health status can be a critical element in their understanding about why dental care is needed. Patients should be reminded that studies have shown that bacterial infection and tissue inflammation are important causative factors in periodontal disease. Bacterial by-products and inflammation in the body can also be major contributors in the development of diseases such as diabetes, heart disease, stroke, and other serious problems. Most importantly then, inflammation appears to be a significant link between systemic and oral disease.

Literature defines inflammation as the body's first response of the immune system to injury, infection, or irritation. Your body sets off a series of automatic reactions which are designed to protect the entire body during an infection, and redness and heat occur around the site of the infection due to the dilation of the blood vessels. Blood vessels may also constrict further away from the infection site causing swelling, pressure and pain. White blood cells move to the affected area in response to the amount of blood vessel activity happening. Once in position, the white blood cells surround the bacteria to prevent spreading. As a result, the purpose of inflammation can be described as a method of isolating and eliminating infection.

The inflammatory process has the ability to affect the entire body, which can leave a patient with symptoms such as fever, body aches and fatigue. However, patients may be surprised to know that an infection can exist in his/her body and the process of inflammation can be occurring while the patient isn't experiencing any symptoms at all. If the cause of the inflammation goes away, the inflammatory response may stop and the situation may resolve itself. However, that doesn't always happen. If the cause of the inflammation fails to go away or becomes worse; organs, blood vessels, the heart, and even joints and nerves can suffer significant damage. Therefore, since gum disease has the ability to trigger a body-wide inflammatory response, the body can suffer damage if the periodontal disease remains uncontrolled.

Reference:

Systemic Diseases and Dental Treatment: Talking With Your Patient

Carol Tekavec, CDA, RDH

Dentistry Today - June 2009

If you are a dentist who is interested in reading more information about how to talk to your patients about the oral-systemic connection or if you are a patient who is interested in learning more about the topic yourself, the full story is available at http://www.dentistrytoday.com/.

Dr. I. Stephen Brown is a gum disease Philadelphia dentist and Montgomery County Dental Implant specialist who can answer your questions about this topic and other related topics. Submit your questions online by visiting him on the web at http://www.theperiogroup.com/ and filling out one of the online question submission forms.