For the past century, scientific articles have continued to pour in showing that there are very many risk factors for heart disease, like elevated cholesterol, high blood pressure, diabetes, and so on. There is no question that such risk factors are clearly associated with heart disease, and, when uncontrolled, appear to accelerate its development. But, there IS a missing link that we must discuss right now.
‘Preventative cardiology’ is becoming the new medicine for heart patients.
In recent years, cardiology now appears to have collectively realized and accepted that coronary atherosclerosis (arterial narrowing and blockages) never develop in the absence of inflammation in the coronary arterial wall, initially in the endothelium, its innermost layer. As doctors despise treating anything they feel they do not understand, this revelation has helped many of my cardiologist colleagues to feel comfortable that they are no longer treating just ‘unlucky’ individuals, and that they are no longer limited to just taking care of their patients after the heart attack has already occurred.
Instead, the thought process is akin to: “Your coronary arteries are chronically inflamed, and we need to minimize that inflammation as best we can.”
Yet, while the focus has now shifted to coronary artery inflammation, the conclusion is still that a heart attack victim is more unfortunate than anything else, but that there is now a name for that ‘misfortune’: inflammation. Nobody, it seems, is yet ready to ask why the elephant named inflammation is in the room to begin with.
Every cardiologist needs to understand the significance of gum disease.
For some years now, the cardiology and dental literature has shown that chronic periodontal disease (infected gums) is clearly “associated” with increased coronary artery disease. While this is true, it is finally becoming clear that this “association” is really cause-and-effect. That is to say, the oral pathogens directly cause the atherosclerosis. Multiple studies now reveal that the blood vessel walls and the atherosclerotic plaques contain the same array of pathogens that are found in the infected gums. In addition, a much higher concentration of these pathogens has been found to be present in the blood clots that acutely and completely block off the coronary artery and cause the heart attack. Yet the literature continues to assert only an “association” between these pathogens and coronary artery pathology.
Sometimes simple logic just gets tossed out the window.
How could a heart attack-causing blood clot accumulate a high concentration of organisms from blood that is supposed to be completely sterile when cultured? Of course, no researcher is going to resolve gum disease, document the disappearance of coronary inflammation, and then re-infect the gums to show the return of the inflammation.
Without the use of clear-headed logic, the oral pathogen-coronary inflammation connection remains forever a mere “link or association,” and clinicians need not feel compelled to make oral examination and treatment a mandatory part of the treatment of any patient with suspected or documented coronary heart disease.
A ‘take home’ message for every heart disease patient.
The point is that all coronary heart disease patients are not being correctly and completely treated if their mouths have not even been examined or considered in the evaluation and treatment of their condition.
In point of fact, such patients are having the most important reasons for their heart disease being ignored or otherwise neglected. Oral pathogens are the reason for well over 90% of heart attacks, and probably less than 5% of cardiologists and other physicians even know to look for this causative factor.
Bottom line, partnering with an Oral Systemic Health Specialist is the best way to ensure you are getting the right information, the right dental care, and the right tools to address the ever present elephant in the room – YOUR MOUTH and it’s microbes.
About the author: Thomas E. Levy, MD, JD is a board-certified internist and cardiologist. He is also bar-certified for the practice of law. He has written extensively on the importance of eliminating toxins while bolstering antioxidant defenses in the body, with particular focus on vitamin C.
Haraszthy et al. (2000) Identification of periodontal pathogens in atheromatous plaques. Journal of Periodontology 71:1554-1560. PMID: 11063387
Mattila et al. (2005) Dental infections and cardiovascular disease: a review. Journal of Periodontology 76:2085-2088. PMID: 16277580
Caplan et al. (2006) Lesions of endodontic origin and risk of coronary artery disease. Journal of Dental Research 85:996-1000. PMID: 17062738
Caplan et al. (2009) The relationship between self-reported history of endodontic therapy and coronary artery disease in the Atherosclerosis Risk in Communities Study. Journal of the American Dental Association 140:1004-1012. PMID:19654253
Willershausen et al. (2014) Association between chronic periodontal and apical inflammation and acute myocardial infarction. Odontology 102:297-302. PMID: 23604464
Ott et al. (2006) Detection of diverse bacterial signatures in atherosclerotic lesions of patients with coronary artery disease. Circulation 113:929-937. PMID: 16490835
Pessi et al. (2013) Bacterial signatures in thrombus aspirates of patients with myocardial infarction. Circulation 127:1219-1228. PMID: 23418311