Healthy Mouth, Healthy Heart

What do strokes have to do with good mouth hygiene?


You’ve probably heard that periodontal disease can be sign of heart disease. But it can also put you at risk for stroke as well. We spoke with Dr. Rob Bradley, owner of First Choice Dental Group, to learn how poor oral hygiene may increase the chances of having a stroke.

Madison Magazine: Tell us about the correlation between dental health and the likelihood of strokes.
Dr. Rob Bradley: This is something that is a little newer. There has been research done showing the correlation between periodontal disease and the risks with pregnancy, low birth weights, diabetes and heart disease.

Dr. Rob BradleyMoise Desvarieux, MD and PhD who works at Colombia University, published an article in Circulation, the journal of the American Heart Association. He found that people who had active periodontal disease are more likely to have atherosclerosis. [Atherosclerosis] is the clogging of the arteries, which leads to strokes.

When you move from gingivitis to periodontal disease, you get tooth loss and tissue loss; the presence of the bacteria sets it all in motion. If that bacteria gets into the bloodstream, that can stimulate clotting factors. That and other effects associated with bacteria can damage blood vessels and increase clotting, which increases the risk of stroke in individuals.

A stroke by definition is either bleeding in the brain because of a ruptured vessel or an impaired vessel that is blocking blood flow. Studies are not necessarily conclusive but there is a high correlation between periodontal disease and a high risk of stroke.

MM: What can a patient’s dental health tell you about their overall heath?
RB: A lot of times you can get an overall snapshot of their general health if the [patient’s] periodontal situation is severe. They probably have some heart issues, lung problems and many have diabetes.

We had a patient who had periodontal disease and was doing well, but after six months, he had a huge relapse. We suggested he see his doctor and the next day, they put a couple of stints in his blood vessels because he could have had a heart attack.

MM: What procedures do you perform when patients come in for a checkup?
RB: The hygienist does a full periodontal screening and measures pocket depth between the tooth and the gum. Four to five millimeters or deeper with the presence of bleeding is periodontal disease, but two to three millimeters is considered healthy. We clean the pockets out and flush out bacteria with oxygenated water. We perform X-rays to make sure bone levels are okay. We do a full oral and tooth exam every time a patient comes in.

MM: Why is oral health and its connection to heart disease subject to so much attention now?
RB: Research brings [these issues] to the forefront; there is a big push right now to live healthier. Your oral health is just as important as anything else. No one ever thought that oral health would tie into any other factors of health.

MM: What is your best health advice for patients to prevent strokes?
RB: On a long-term basis it is important to keep regular cleaning appointments. On a short-term basis, if you have bleeding gums, get to the dentist and get that treated. Periodontal disease is one of the most under-diagnosed diseases. A lot of dentists that are not up on research are basically keeping an eye on bleeding, but that is like supervised negligence.

The American Dental Association says sixty percent or more of the population has periodontal disease. The good news is that it is a treatable disease. Bone doesn’t grow back but you can arrest the disease and keep on top of it so it doesn’t get worse. You can prevent relapses of periodontal disease with professional intervention. Once you know that you have periodontal disease, treat it and stay on top of your regular visits.

MM: What are ways that you educate your patients about this disconcerting trend?
RB: Based on the screening, if you are healthy we don’t talk about anything other than good homecare and maintenance.
If you have periodontal disease or pockets, we get brochures out. We educate [patients] about the corollary trends of periodontal disease. If [periodontal disease] is left untreated, it can lead to eventual tooth loss. It can be a life changing experience [for some patients].

MM: What do you see in the future as the next big highlight in dental health in terms of overall health or disease prevention?
RB: Other than antibiotics, I can see dentists using possible laser treatments that could kill bacteria. Bottom line is patients need to come to the dentist and get things taken care of.

— Dena Goldstein

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