To save his heart he lost his teeth

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To save his heart he lost his teeth
Feb. 21, 2008
By Sarah Vos
Kentucky.com

Ricky Ray woke the night of Sept. 22 gasping for breath. At the emergency room in Middlesboro, doctors identified the problem: His heart was failing, overworked from a birth defect Ray didn't know he had.

Ray, 42, needed a new aortic valve or, doctors said, he would die from heart failure.

But surgeons couldn't perform the operation. The problem was Ray's teeth: He had cavities so deep they had infected the bone. Periodontal disease tore into his gums, rotting his teeth from below.

All the bacteria in Ray's mouth presented a hazard, not only to his teeth, but to his life. Before Ray's valve could be replaced, all 32 teeth would have to be pulled.

Dentists have long extolled the value of taking care of one's teeth -- brushing, flossing and regular cleanings -- as a way to preserve a pretty smile. But a growing body of research is showing that a healthy mouth is important for more than smiling and eating. Studies have shown close relationships between periodontal disease, an advanced form of gum disease, and strokes, heart disease, pre-term births, kidney disease, diabetes and osteoporosis.

Whether those relationships are coincidental or causal is still up for debate. Either way, the implication is not good for Kentucky. The state has some of the worst oral health in the nation.

Only West Virginia has more older adults with no teeth, a condition that is usually the result of severe periodontal disease. A 2001 survey found that half of all 2- to 4-year-olds in Kentucky had a large number of cavities and almost one-third of third to sixth-graders had visible, untreated tooth decay.

Kentucky's heart health also is bad. The state has the seventh-highest death rate in the nation from cardiovascular disease, according to the American Heart Association. That is one of the top three causes of death for Kentuckians 25 and older, according to the Kentucky Department for Public Health. Only residents of West Virginia and Alabama report having had more heart attacks. Only West Virginia residents report more diagnoses of coronary heart disease.

The realization that oral health is tied to overall health is slowly trickling into everyday practice. Physicians are beginning to check their patients' mouths for problems, and dentists extol the added health benefits of having good teeth. Nationally, some health insurers have added dental benefits, because providing dental care saves them money on other health problems.

In Kentucky, Medicaid now pays to treat periodontal disease in pregnant women. (For other adults, it pays for only one general cleaning a year). Several pilot programs at the University of Kentucky are exploring the relationship between oral health and overall health. One focuses on pregnant women, another on diabetes.

Dr. John Novak, associate director of the Center for Oral Health Research at the University of Kentucky, has proposed a project to improve the heart health of one Kentucky community. Part of that project would include dental care.

In Kentucky, poor oral health is a cultural issue. Some people think that losing adult teeth is a normal part of life, said Dr. Fred Howard, a dentist in Harlan and president of the Kentucky Dental Association.

"A lot of people have this misconception that your teeth just last so long and then you have them out," Howard said. "Teeth should last a lifetime."

Linking teeth, hearts

Studies have shown that patients with periodontal disease are more likely to have heart attacks and strokes. But researchers are still uncovering why that is. Similar factors contribute to periodontal disease and heart disease, factors such as smoking, poor eating habits, lack of exercise and socioeconomic status. Some researchers say that explains the link between the two.

"If a patient is likely to have all their meals at McDonald's and not take care of themselves, they're not likely to take care of their teeth," said Novak.

Other researchers theorize that severe periodontal disease leads to bad eating habits, causing heart disease.

"If you lose your teeth, you're not able to eat fresh fruits and vegetables," said Kaumudi Joshipura, a professor at Harvard University's schools of Public Health and Dental Medicine.

Denis Kinane, director of the oral health and systemic disease research group at the University of Louisville, says the relationship is one of cause and effect -- but not because of tooth loss.

"With periodontal disease, the bacteria in the gum can get into the blood and can cause problems elsewhere," Kinane said.

When gums become infected, small ulcers form, allowing bacteria -- nourished by the warm, moist environment of the mouth -- to get into the blood. Deep cavities can also send bacteria into the blood.

Once the gums become infected, simple activities such as eating and brushing teeth can dislodge bacteria. One theory is that bacteria from the mouth harm blood vessel walls, encouraging plaques, the gummy deposits of heart disease, to build up. Eventually, these plaques can block the vessel and cause a heart attack.

Kinane's theory is that the regular onslaught of bacteria from the mouth causes a chronic inflammation of the body. An immune reaction then leads to the thickening of arterial walls and heart problems.

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