Healthy Gums for Healthy Heart
 Heart and gum diseases (Gingivitis or Periodontitis) are commonly seen diseases that impact people’s health and quality of life. Both cardiovascular disease (CVD) and periodontitis are non-communicable diseases (NCD) – i.e. diseases that are not transmissible directly from one person to another. This article focuses on the relationship between Cardiovascular and gum diseases.

The era of Non-communicable diseases
21st century has major public health challenges. The rise in non-communicable diseases (NCD) is a major cause of concern worldwide. As per a report by Ministry of Health and Family Welfare (MOHFW), Government of India (GOI), it is noted that there is increase in the contribution of NCDs from 30% of the total disease burden- ‘disability-adjusted life years’ (DALYs) in 1990 to 55% in 2016 and also an increase in proportion of deaths due to NCDs (among all deaths) from 37% in 1990 to 61% in 2016. These figures are alarming and show a rapid epidemiological transition with a shift in disease burden to NCDs. The greatest global NCD burden arises due to cardiovascular disease (CVD), responsible for 17.9 million deaths (a third of total mortality), and 45% of NCD‐induced mortality.

Gum diseases – The overlooked NCD
Periodontitis is also a NCD with a high prevalence of 45%–50% overall, with the most severe form affecting 11.2% of the world’s population, being the sixth most common human disease. Evidences from the literature shows independent associations between severe periodontitis and several NCDs including diabetes, cardiovascular diseases, chronic kidney disease and even pulmonary diseases.

Gum diseases and cardiovascular diseases
Gum disease like Periodontitis and cardiovascular diseases are common, widely spread, chronic non-communicable diseases. Their prevalence increases with age. The available scientific evidence shows periodontitis is associated with an increased risk of acute myocardial infarction, heart failure, and stroke.

Evidence based associations
The possible mechanism given is that periodontitis can cause bacteremia that can lead to triggering of inflammation by virulent bacteria which can affect the cardiovascular system. Also it can cause promotion of atheroma and acceleration of atherosclerosis.

Periodontal pathogens generate antibodies (anticardiolipin antibodies) that might eventually cross-react with the cardiovascular system of the patient, possibly contributing to the onset of CVD.

Patients with periodontitis present with following findings when compared to healthy individuals:

– Increased level of cytokines and inflammatory mediators, which have been associated with a higher incidence of CVD.

– A higher level of fibrinogen (thrombotic factors).

– Higher levels of traditional CVD risk factors such as cholesterol, LDL, triglycerides, VLDL, oxidised LDL, etc.

Genetic links ?

Periodontitis and CVD share the same genetic factors. There is a specific area on chromosome 9 – in which multiple expressions have been noted – that also links to Type-2 diabetes and Alzheimer’s Disease.

Common Risk factors that aggravate gum disease and cardiovascular disease
Smoking
Stress
Obesity
Diabetes
Unhealthy diet
Sedentary lifestyle
Importance of treating/ preventing gum diseases
Gum diseases like gingivitis or periodontitis affect 80% of people over 35. If left untreated, periodontitis causes tooth loss and can cause difficulty in eating, speech problems, and a lower quality of life. Gum disease is a chronic condition that may make it harder to prevent CVD and it may even aggravate CVD in patients who already have the disease. The evidence suggests that periodontal treatment and good oral hygiene help prevent CVD. It is reported that, patients who brush their teeth twice a day and have a good oral-health routine may have less risk of acute CVD events.

Role of general public in prevention of gum diseases and CVD
One should look out of signs of gum disease such as swollen gums, bleeding gums, longer-looking teeth, or loose teeth. If any of these signs are present, you should visit your dentist as soon as possible.
Those with existing CVD should inform your dentist about the outcome of your visits to your doctor/cardiologist and provide updates on your CVD history and any changes in your medications.
One should also inform the dentist if the individual is taking anti-coagulant medication. While periodontal treatment in CVD patients is appropriate and safe, if patients are receiving anticoagulant or anti-platelet therapy, then certain measures to avoid excessive bleeding need to be taken first.
Gum disease may also be present and get worse with no apparent signs (especially if you smoke). So, one should receive regular dental check-ups (at least once a year) as part of managing CVD.
Brush at least twice a day, for at least two minutes, using a manual or an electric toothbrush.
Clean between teeth using interdental brushes and dental floss if the gaps are too small for brushes.
Use specific toothpastes and/or mouth rinses if your dentist or dental hygienist recommends them.
Role of Healthcare professionals in prevention of gum diseases and CVD
Cardiologists, doctors, and other healthcare professionals should advise patients with CVD that periodontitis may worsen their disease and increase the risk of CVD events.
Inform and educate patients that periodontal therapy may have a positive impact on their cardiovascular health.
Ask patients with CVD about signs and symptoms of periodontitis (such as bleeding gums and loose teeth) and, where appropriate, recommended a periodontal evaluation.
If patients have been diagnosed with periodontitis, doctors should investigate if appropriate periodontal care and maintenance are being provided.
Patients with newly diagnosed CVD should be referred for a periodontal examination.
Furthermore, doctors should closely liaise with dental surgeons in the periodontitis management of CVD patients on anti-coagulant or anti-platelet therapy before any oral intervention or periodontal surgery, as it is very important to avoid excessive bleeding or the risk of ischaemic events.
Role of Dental professionals in prevention of gum diseases and CVD
The early diagnosis, prevention, and co-management (by dentists and physicians) of both CVD and periodontitis is of the utmost importance.

Detailed patient histories to assess CVD risk factors
Inform the patient of any CVD risk, and tell them to consult their doctors if any of these factors is not controlled.
Inform patients with periodontitis of their higher risk of suffering CVD, provide them with a tailored oral-hygiene regime, and encourage them to address lifestyle factors that increase the risk of both diseases.
Patients with CVD should be given a thorough oral examination and placed on a preventive care regime if no periodontitis is diagnosed or a treatment regime if periodontitis is found.
Dental professionals should tell patients with both periodontal disease and CVD to follow recommended dental regimes (prevention, therapy, and maintenance) and they should provide non-surgical treatment as needed.
Surgical treatment, including implant therapy, may be provided but clinicians should first consult with patients’ doctors and/or cardiologists.
5 Sutras for Healthy Gum and Healthy Heart:

Visit your doctor and dentist regularly
Clean your teeth twice a day
Stay active, exercise
Eat healthy foods, watch your weight
Do not smoke
Final note
The available evidences show the possible relations and risk factors of CVD and gum diseases. As periodontitis is preventable with appropriate oral care by dental professionals and the patients, regular oral care would be beneficial to the patients in terms of cardiovascular health.