“Patients with newly diagnosed cardiovascular disease should be referred to the dentist”

Pablo Malo Segura
Currently, there is a great lack of knowledge about the impact periodontal diseases have on a systemic level. This is said in an interview with Common sense THE Dr. Vanessa Blanc, head of translational research at Dentaid. “The doctor should think that all his patients with newly diagnosed cardiovascular disease they should be referred to the dentistGiven that periodontal examination should be part of the ongoing management of this type of pathology”, Explain. In this sense, he addresses The relationship between oral and cardiovascular healththe risk factors they share, the role the dentist should play in promoting cardiovascular health and initiatives Promosalud which runs the SEPA Foundation to promote and improve the oral health of the people Dentaid has joined.

What is the relationship between oral health and cardiovascular health and how has the data evolved in recent years?
Humans can suffer from a variety of chronic immune-mediated inflammatory conditions, collectively termed chronic inflammatory diseases, whose developmental processes are interrelated. This group includes cardiovascular diseases and gum diseases.

Specifically, numerous scientific studies have investigated the relationship between the inflammatory process initiated by a chronic dental infection and cardiovascular pathologies. Currently, strong evidence from epidemiological studies demonstrates the relationship between periodontitis and some cardiovascular pathologies, such as coronary or cerebrovascular diseases.

“Strong evidence shows the association between periodontitis and certain cardiovascular pathologies, such as coronary or cerebrovascular diseases”

The positivity of preventive and control interventions for periodontitis in reducing the risk of occurrence or worsening of many systemic diseases, such as cardiovascular events, diabetes or certain complications of pregnancy, has also been described.

At Dentaid we know that overall good health starts with a healthy mouth and it is important to raise awareness of this to generate a positive impact on people’s lives, their health and well-being.

“Good overall health starts with a healthy mouth”

Is there sufficient awareness among healthcare professionals of this connection?
In general, there is a great lack of knowledge about the impact periodontal diseases have on a systemic level. Periodontitis is the severe form of gum disease and affects about 20% of the country’s adult population. However, most of the population does not know the connection between oral health and general health and how the lack of oral health can negatively affect other pathologies that people suffer from.

It has been shown that, in patients with periodontitis, peri-implantitis or poor plaque control, microulcerations can occur in the gums that facilitate bacteremic events. This extravasation occurs from biofilms that have high pathogen loads. But the distribution is not only of the bacteria, but their secreted products, toxins and inflammatory mediators created by the surrounding tissues also reach the bloodstream.

Therefore, periodontitis is associated with the occurrence, aggravation and pathogenesis of a number of systemic inflammatory diseases. In some of them the link has been clearly demonstrated, such as respiratory infections, adverse births, diabetes and metabolic diseases or the aforementioned cardiovascular events. And in this regard, researchers, dentists and hygienists have a great challenge before us: to know how to explain to the medical community, in its various specialties, as well as to the entire population, how important it is and the clinical benefit that can have. bring, maintain patients in periodontal health.

“Periodontitis is associated with the appearance, worsening and pathogenesis of a number of systemic inflammatory diseases”

What risk factors do periodontitis and cardiovascular disease share?
Periodontitis is a chronic inflammatory disease that exhibits immune deregulation at its base (improper immune function) and that involves multiple causative components interacting at the same time. The same is described for cardiovascular diseases, where multiple causal components play a role simultaneously and interact with each other, often in unpredictable ways. These factors of causal interaction are common to these two inflammatory pathologies.

It has been proven that aging, dietary factors, systemic conditions such as obesity, diabetes, osteoporosis and depression, environmental factors such as pollution, certain medications, as well as modifiable risk and lifestyle factors such as smoking, psychological stress, alcohol consumption and elements of other psychosocial factors have the ability to induce epigenetic changes that cause both pathologies.

“The same genetic variants are associated with cardiovascular disease and periodontitis”

Furthermore, the same genetic variants have been observed to be associated with both cardiovascular disease and periodontitis. To date, four genetic loci are shared between coronary artery disease and periodontitis. This common genetic background suggests that periodontitis is not related due to atherosclerotic diseases, but rather that both pathologies are a consequence of equally aberrant responses during inflammatory processes.

Consistent with this concept is the aforementioned recognition of dysbiosis of the oral microbiome, which can trigger a hyperinflammatory immune response at various body sites in susceptible individuals. The presence of oral pathogens, confirmed by the detection of DNA and RNA in vascular biopsies of coronary and carotid thrombi and cerebral aneurysms, is thought to activate excessive production of cytokines that initiate and/or accelerate the progression of atherosclerosis.

“The presence of oral pathogens is thought to activate excessive production of cytokines that initiate and/or accelerate the progression of atherosclerosis”

What role should the dentist play in promoting cardiovascular health?
The dental office is visited by 55% of the population, at least once a year. Patient education and information work by dental professionals is essential so that their patients recognize and appreciate the intra- and extra-oral consequences of poor oral health. Ideally, patients diagnosed with periodontitis should be informed that there is a higher risk of developing cardiovascular disease as well as suffering subsequent complications if they present any of these pathologies. It seems important to actively encourage them to control the risk factors that can cause these cardiovascular events.

At the same time, oral health education should be offered to all patients with periodontitis, encouraging them to regularly adhere to recommended therapeutic, maintenance and preventive regimens. It may also be appropriate to establish a personalized oral hygiene protocol, including twice-daily brushing, interdental brushing, and, in some cases, the use of supplemental chemical plaque control.

“Oral health education should be provided to all patients with periodontitis, encouraging them to regularly adhere to recommended therapeutic, maintenance and preventive regimens.”

Patients with diagnosed cardiovascular disease should undergo a preventive regimen of oral care and be monitored periodically (at least annually) to detect changes in periodontal status. In people with cardiovascular disease, if periodontitis is diagnosed, they should be treated as soon as their cardiovascular status allows.

49% of the Spanish population does not know well what periodontitis is and, therefore, it should be expected that they will have considerable difficulty in identifying its symptoms. Regarding cardiovascular events, if we focus on high blood pressure, and despite the fact that, although it is easy to diagnose and relatively easy to treat with low-cost drugs, a study conducted by a network global doctors and researchers during the period. 1990-2019 revealed significant gaps in diagnosis and treatment.

Globally, about 580 million people with hypertension (41% of women and 51% of men) were unaware of their condition because they were never diagnosed. The Spanish Heart Foundation reveals that in our country one third of people with hypertension do not know they are hypertensive. Based on this reality, the SEPA Foundation leads the Promosalud project, whose objective is to position the dental clinic as an allied health center to improve the general health condition of citizens. Dentaid has joined this initiative because it is in line with the company’s goal to promote and improve people’s oral health and, above all, because we believe that this action is essential to increase the population’s awareness that oral care directly affects health systemic.

“Patients with diagnosed cardiovascular disease should undergo a preventive regimen of oral care and be monitored periodically”

What benefit would a joint approach to periodontal and cardiovascular disease provide?
Observational evidence suggests that oral health intervention, including patient-performed oral hygiene habits, dental prophylaxis, increased dental visits, and periodontal treatment may favor a reduction in the incidence of cardiovascular events. The doctor should keep in mind that all his patients with newly diagnosed cardiovascular disease should be referred to the dentist, since the periodontal examination should be part of the ongoing management of this type of pathology. In fact, the progression of cardiovascular pathologies can be influenced by successful periodontal treatment, regardless of the traditional management of risk factors for these diseases.

In this regard, coordination and communication between the doctor and dentist, as well as patient education, are key to mitigating both oral and cardiovascular risks. At Dentaid we collaborate with dentists, dental hygienists, pharmacists and general health professionals to promote and improve people’s oral health from a holistic approach to health.