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Antibiotics and your heart
Journal of American Dental Association, Vol. 138, June 2007.
The American Heart Association has revised its recommendation for patients with certain heart conditions to take antibiotics shortly before dental treatment.
For decades administering preventive antibiotics before dental procedures was done with the belief that antibiotics would prevent infective endocarditis. Infective endocarditis is an infection of the heart’s inner lining of valves, which results when bacteria enter the bloodstream and travel to the heart. However, a growing body of scientific research evidence shows that the risks of taking preventative antibiotics outweigh the benefits for most patients.
"The risks include adverse reactions to antibiotics that range from mild to potentially severe cases, and inappropriate use of antibiotics, which can lead to the development of drug-resistant bacteria".
The new guidelines say "patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with mitral valve prolapse, rheumatic heart disease, bicuspid valve disease, calcified aortic stenosis, or congenital heard conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy".
The new guidelines target patients "who have the greatest danger of a bad outcome if they developed a heart infection". Patients that should take preventative antibiotics prior to their dental treatment include those who have artificial heart valves, a history of infective endocarditis, certain specific, serious congential heart conditions
(see full article for details), and a cardiac transplantation that develops a problem in a heart valve.
In addition to this revision, the American Heart Association guidelines also emphasize that "maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of Infective endocarditis than is taking preventative antibiotics before dental visits".
To access to the full article please click on the link below:
Journal of American Dental Association, Antibiotics and your heart, Vol. 138, June 2007
When Gums Speak Volumes
A summary taken from an article in the Los Angeles Times Health section
Until recently it had been thought that Dentistry and Medicine were two separate fields. In other words, "what happens in the mouth stays in the mouth." However, over the past few years researchers have been discovering that there is a strong correlation between the wellbeing of the mouth and the health of the rest of the body.
"Research compiled over the last five years suggests that gum disease - especially if the condition has persisted for a long time without treatment - can contribute to diabetes, cardiovascular disease and stroke, pregnancy complications, and perhaps even Alzheimer's disease, osteoporosis and some types of cancers".
While inflammation of the gums is usually a positive side effect of the mouth fighting off bacteria, if left unchecked, inflammation allows bacteria to become transient and enter the blood stream. Two studies by the Journal of Periodontology found, "periodontal bacteria (bugs normally found in inflamed gums) in the arteries of people with heart disease and in the placentas of pregnant women with high blood pressure". While this is likely a negative outcome of periodontal disease, there have been studies showing the positive effects of gum treatment. The New England Journal of Medicine found that, "treating severe gum disease can improve the function of blood vessel walls, improving heart health".
These studies are important because persistent inflammation of the gums is estimated to be a problem effecting 40% of Americans. Furthermore, 10% of these individuals suffer from advanced cases that damage the structures (ligaments and bone) that support the tooth.
Unfortunately, gum disease is often asymptomatic, other than periodic bleeding, until it is too late. "Well before the gums or teeth start to hurt, the dual forces of infection and inflammation in the mouth appear to hitch a ride in the bloodstream and travel to other parts of the body, wreaking havoc once there". It has been found that gum inflammation and periodontal disease can affect health in the following ways:
- Studies surveying large groups show that people with severe gum disease have significantly higher rates of cardiovascular disease. Besides influencing the function of blood vessel walls, byproducts from the bacterial infection can enter the bloodstream and trigger the liver's release of a substance called C-reactive protein, studies have suggested. C-reactive protein is thought to inflame arteries and promote blood clot formation.
- Bacteria in plaque release toxins that cause the immune system to produce chemicals called cytokines. In excess, cytokines can increase inflammation and damage tissues throughout the body.
- Diabetics tend to have more severe gum disease and have it at an earlier age than people without diabetes. Furthermore, research shows having gum disease increases the amount of time a diabetic's blood sugar remains high.
- Doctors at USC have connected a common virus, cytomegalovirus, to gum disease and complications in kidney transplantation. About 20% of all failed kidney transplants are related to cytomegalovirus infection. One of the most well established links between gum disease and secondary infection is among people with mitral valve heart defects. In fact, doctors have long warned valve patients to take antibiotics before teeth cleanings so that the bacterial disruption in the mouth will not travel through the bloodstream to infect the valve.
In light of this information, the sensible thing to do is to make sure to have periodic dental check ups and have your dentist check the depth of your periodontal "pockets". This will allow the dentist to prescribe the proper treatment to combat any periodontal disease and assist in your overall well being.
Reference:
Los Angeles Times, When Gums Speak Volumes, April 16, 2007
