A Healthy Mouth is Essential for a Healthy Heart

 Heart disease is the number one cause of death in the United States. Although there are many contributing factors to the development of cardiovascular disease inflammation is the critical factor. Inflammation drives the progression of atherosclerotic plaque within the arteries and is the critical factor in plaque rupture that leads to clot formation and a heart attack.

Inflammation is The Root Cause of a Heart Attack

Everybody knows that high cholesterol can cause a heart attack, right? Well, no – and yes. It is not that simple. Let’s look at the development of arterial plaque.

 Atherosclerosis begins as fatty streaks on the lining of the endothelium. (Endothelium is the cell layer lining the inside of the artery). Damage occurs to the endothelium of the artery due to conditions such high blood pressure, free radical oxidative stress, bacterial toxins, diabetes and inflammation.

Inflammation causes adhesion molecules to bind to the endothelium lining the inside of the artery making it sticky.

White blood cells become trapped in the damaged and sticky endothelium. The white blood cells then penetrate the endothelium and move inside the blood vessel. LDL cholesterol that floats by gets taken up by the white blood and forms the fatty streaks. Continuous progression of this process leads to larger and larger plaque within the artery.

Without endothelial damage caused by conditions such as insulin resistance, high blood pressure, free radicals, and infections, LDL cholesterol just floats through the artery and doesn’t get deposited to form arterial plaque.

A heart attack occurs when this plaque ruptures and breaks through the endothelium into the lumen of the artery. The subsequent blood clot that forms in response to this plaque rupture and tear in the endothelium is the actual cause of the heart attack.

The plaque ruptures because it is inflamed. These “hot” plaques are the root cause of most all heart attacks. Plaque ruptures cannot occur without inflammation.

 Stable arterial plaque does not cause a heart attack

Contrary to popular belief, most heart attacks don’t occur because the plaque completely blocks the coronary artery. In fact, 68 percent of heart attacks occur when the coronary artery is only 50% blocked.  It is not the complete blockage of the artery by the plaque that causes a heart attack but rather the rupture of the inflamed plaque within the arterial wall, and the subsequent formation of a blood clot that occludes the coronary artery and causes a heart attack.

If high cholesterol were the sole cause of heart disease, then everybody who has had a heart attack should have high cholesterol. That is simply not the case. The truth is that many heart attack patients have perfectly normal cholesterol levels.

I will discuss the other risk factors that cause heart disease in future articles.  For now, let’s focus and the main player in this disease process, and that is inflammation.

Periodontal disease and root canal treated teeth are a primary source of toxins and inflammation

Systemic inflammation increases due to: infection, obesity, lack of exercise, poor diet, smoking, stress, insulin resistance and, low vitamin C levels. One prime source of chronic infection is periodontal disease.

Periodontal disease is a chronic infection of the gums. Over 400 species of bacteria populate the human mouth. Some of these bacteria are pathogenic. These bacteria form colonies in periodontal the sulcus (the space between the gum tissue and the tooth) and cause both inflammation of the gum tissue and eventual destruction of the supporting bone around the teeth.

Periodontal disease causes a rise in inflammatory mediators throughout the entire body including the endothelium of the coronary arteries and the developed plaque already inside the arteries. Unless the periodontal disease is controlled, and the inflammation in the gums reduced or eliminated, this continual assault of inflammatory mediators will fuel the development of arterial plaque as well as make the plaque already in the artery “hot” and prone to rupture, resulting in a heart attack.

The inflammation in the gums also makes the gums permeable to bacteria to enter the blood stream and travel to distant sites in the body.  These pathogenic periodontal bacteria travel from the mouth to the plaque inside the coronary arteries, essentially infecting the plaque. DNA analysis of bacteria found within coronary artery plaque has confirmed this focal infection of dental origin. These bacteria not only increase inflammation, but they contain endotoxins and exotoxins that damage the blood vessel lining making the endothelium “leaky.” This increased permeability of the arterial wall allows more white blood cells and LDL cholesterol inside the artery wall increasing the formation of plaque.

To make matters worse, some strains of oral bacteria make blood more prone to clotting, which is exactly what you don’t want happening inside a coronary artery.

Dentists should be physicians of the mouth.

In spite of all the evidence supporting the oral/systemic link, there are still some dentists that continue to claim that oral infection only shows a correlation to heart disease, not causation. One remark I read recently from a dentist commenting on the link between periodontal disease and heart disease: “people with bad hearts often have bad teeth too, therefore no causative link between the two. I bet they all drink water, take showers and drink coffee…doesn’t mean much.” 

Comments like that are disturbing coming from a health professional. To superficially dismiss the causal mechanism of inflammation and oral bacteria on the progression of atherosclerosis shows a failure of reasoning using first principles. When distilled to the fundamental truths of cardiovascular disease progression, the negative effect of periodontal disease and a sub-set of root canal-treated teeth becomes self –evident and cannot be ignored.

How to put out the inflammation “fire” in the mouth

Optimal oral health is vital to reduce your risk for cardiovascular disease. This means regular visits to your dentist for cleanings to keep the gum tissue healthy as well as early detection and treatment of any developing cavities. Extraction of root canal-treated teeth should also be considered. 

Good oral home care is the key to keep chronic oral infection and inflammation form gingivitis and periodontal disease in check. Of course brushing a minimum of twice per day with a soft brush is a must. I suggest an electric or sonic toothbrush. Brush for a minimum of two minutes, with four minutes being ideal. Angle the brush towards the gum-line so that the bristles work their way under the gum-line where the disease causing bacteria live. If using an electric or sonic toothbrush let the toothbrush do the work. Slowly move the brush around the entire mouth, cleaning both the front and back of the teeth.

Most people hate flossing but it does have benefit. Pulling the floss between the teeth helps clean the contact area between adjacent teeth that a toothbrush cannot get to. This helps to prevent cavities from forming in between the teeth. Rub the floss against the tooth to manually clean the tooth root of sticky tooth plaque that is adhering to it and to also remove debris from the periodontal sulcus.

Everyone should use an oral irrigation device such as a Water Pic

The primary goals of a good home care programs is the disruption of the bacterial colonies under the gum line, removal of any food remnants, and the reduction of the bacterial load. My favorite home care device is water pic with an antimicrobial agent such as hydrogen peroxide or a non- alcohol containing mouthwash added to the water reservoir.  The pulsating stream of water directed under the gum-line is an effective way to accomplish this goal.

Since many of the pathogenic bacteria are anaerobic and cannot live in the presence of a high oxygen content environment, the addition of hydrogen peroxide to the water reservoir is a potent antibacterial, especially to the anaerobic bacteria. The pulsating stream of water breaks up the bacterial colonies and flushes away many of the bacteria along with any remaining food particles.

Fill the reservoir of the water pic with warm water about 3/4 full.  Fill the remaining ¼ of the reservoir with hydrogen peroxide or your favorite non-alcohol containing mouthwash. After thoroughly brushing your teeth, use the water pic by aiming it in between the teeth and under the gum. First time users should set the power to ¼ power. After about a week of use you can increase the power setting to 50 percent.  You will be amazed at what comes out of your mouth even after you have brushed your teeth.

Don’t be alarmed if you see blood in the sink. Blood is an indicator of inflammation and the continued use of the above brushing technique, water pick, and frequent dental cleanings should eliminate any bleeding in a short time. When you no longer see any blood you in the sink when using the water pic that is an indication that the inflammation has been reduced or eliminated. Not only will your teeth and gums be healthier but your heart will thank you as well.

I advise measuring the level of C-reactive protein (CRP) by getting a high sensitivity CRP blood test. CRP is a measure of systemic inflammation and is a major risk factor for heart disease.

Treating active periodontal is beneficial to both dental health and overall systemic health. Periodontal disease raises always systemic inflammation. The decision to have a root canal or extract existing root canal teeth is not as easy. Although all root canal teeth remain infected and release toxins, not all root canal teeth raise systemic inflamation.

I are not saying don’t have a root canal or to extract all existing root canal-treated teeth. What I am saying is that this decision should be made only after becoming informed of all the possible systemic risks.    

Putting out the inflammation fire in the gums, along with the removal of offending root canal-treated teeth, will significantly reduce your risk of cardiovascular disease, and help prevent a heart attack.


The Toxic Tooth

Robert Kulacz, DDS, Thomas E. Levy, MD.  2014

ISBN: 978-0-9837728-2-8

Beat The Heart Attack Gene

 Bradley Bale, MD, Amy Doneen, ARNP, with Lisa Collier. 2014.  ISBN: 978-1-118-45429-9

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Calandrini, CA, Ribeiro, AC, Gonelli AC, Ota-Tsuzuki C, Rangel LP, Saba-Chujfi E, Mayer MP

Oral Dis, 2014 Apr;20(3):e128-34. Doi:  10.1111/odi. 12205

Microbial Diversity Similarities in Periodontal Pockets and Atheromatous Plaques of Cardiovascular Disease Patients

Serra e Silva Filho W, Casarin RC, Nicoleta EL Jr, Passos HM, Sallum, AW, Goncalves RB

PLos One 2014 Oct 16;9(10):e109761. Doi: 10.1371/journal.pone.0109761

Stop America’s #1 Killer!

Proof That the Origin of All Coronary Heart Disease is a Clearly Reversible Arterial Scurvy

Levy, Thomas E.  2006 MedFox Publishing.  ISBN: 0-9779520-1-0

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