Open up? Periodontal disease: A growing cardiovascular concern

Maybe it’s time for a little cross marketing……….between the dentist’s office and the cardiology exam room that is.

When earlier studies linked gingivitis to cardiovascular disease, we as cardiologists began to agree over small talk in doctors’ lounges or medical meetings that the finding was remotely “interesting”.  I’ve even gone so far as to tell a modest number of patients staring at me from behind toothless grins that poor dental habits could be associated with heart disease.   Now with the recent publication from the University of Kiel, Germany suggesting a genetic link between periodontal ills and atherosclerosis, it’s apparent that I should do more than just mention it in casual conversation. 

There is one huge obstacle however.  I don’t think cardiologists know much  about the oropharynx.   About the only time I ever look in someone’s mouth is when I’m forced to fill out that ridiculous ASA criteria prior to a cath (I know just enough to be able to check the box if I can see the Uvula).  Occasionally, I inspect the soft palate for petechia in a patient with a FUO. Other than that, I’m content to listen to the carotids, check for facial asymmetry or JVD, note the thyroid and call it an HEENT exam.   So, I’ve taken a little time to ask folks who are “in the know” about periodontal disease and what exactly we as cardiologists should look for. 

Dr. Phillip Whiteside DMD, graduate of the University of Louisville School of Dentistry in private practice in Glasgow Kentucky (and my personal dentist)  told me that from a dental  perspective “the  gums are inspected for color and texture and a digital exam is performed to check for loose teeth”, a tell tale sign that periodontal disease may be present.  He recommends we ask the patient if “bleeding with flossing” occurs and recommends regular teeth cleaning.  He also explains that “dentists utilize a periodontal probe that measures pocket depth to evaluate for destruction of the periodontal ligament”.  I know I’ll leave the probing to qualified folks like him, but at least I can ask a few questions and make a few recommendations that might motivate the patient toward a formal exam with their dentist.   Dr. Whiteside added “this is not new news for us.  We’ve been telling patients about this link for a long time.  Though we aren’t in the business of practicing medicine, the two areas (of dentistry and medicine) are coming closer together all the time”. 

 Dr. Alan Carr DMD, Department of Dental Specialties and Professor of Dentistry at the Mayo Clinic, Rochester believes the real question is "whether or not a cost effective assay can identify patients with this propensity" and "if we can guide the patient to seek counseling for environmental risk reduction and more frequent surveillance for early disease".  He then added that "the critical need for further study would be toward identifying if the expression of one disase that is untreated makes the other more refractory to treatment".  When I asked his opinion about whether cardiologists should educate patients  regarding dental issues and vice versa he said "yes".  He then added " especially if the above mentioned assay could be developed as a saliva test".  He then stated that "the broader issue here with genetic 'identifiers' is the opporunity to develop cost effective and practical assays that can be used before disease expression" occurrs. This allows a focused approach to patient management.........which can reduce costs of care by treating early stage rather than late stage disease". 

As for the cross marketing approach mentioned above, maybe dentists should place information packets on their waiting room tables informing their patients of the risk factors for coronary disease.  Maybe we should approach our respective national associations about taking a more aggressive stance on campaigns for better periodontal health. It seems imperative that we join together to drive a change in our culture that would cause us to view poor dentition as not something shameful but potentially deadly. No doubt, our current economic downturn in America and the lack of universal coverage for dental insurance will continue to take its toll. Universal coverage for dental health would be another lofty goal.

 From the cardiologist’s perspective, it’s time we tuck something more than just Viagra (or Lipitor) into those much coveted give-away-bags that sometimes  takes so much courage to obtain. Maybe we should surprise our patients with something really practical……….. like a toothbrush, dental  floss and toothpaste as well.       

7 comments7 commentaires | Post a comment |

Share this post:

Permalink