DENTAL INFECTIONS: YOUR RISKS
INCREASED cardiovascular risks
premature babies
ALZEIHMER, DIABETES, MIGRAINE
Your teeth and your health: an intimate relationship
Your health depends on the health of your teeth
a complex INFECTIOUS synergy
THE SYSTEMIC RISK TO YOUR OVERALL HEALTH FROM PERIODONTAL INFECTIONS
Periodontal infections increase all cardiovascular risks, premature babies and even Alzheimer and migraine
Recent clinical and epidemiological studies have shown that there is a complex synergy between our teeth and our health. Indeed, periodontal diseases and systemic diseases can be linked and influence each other in an asymmetric reciprocity.
The health professions, aware of the evolution of the new medical paradigms, are taking into account the health check-ups of the patients in the protocols of dental medicine.
Our teams at Smile Designer of medical doctors and dentists work together to identify dental infections, especially periodontal or periapical infections, as early as possible.
These should be brought to the attention of patients to warn them of the increased risk of cardiovascular events, worsening of diabetes, Alzheimer’s disease, migraines and premature babies for pregnant women.
PREVENTION OF CONTINGENCIES IN ORAL HEALING
A patient who smokes increases the risk of problems during the healing of periodontal surgeries, gingival or bone grafts, dental implants and in general all the protocols of reconstruction of the jaws. This increase in risk due to tobacco use must be offset by smoking cessation at least one month prior to oral surgery.
The American Academy of Periodontology uses the integration of smoking cessation into any periodontal surgical plan, and into the plans for reconstructions of the maxilla through implantology and pre-implant grafts.
It is also important to note that the incidence of periodontal disease is higher in patients who are smokers and former smokers. The risk increases dramatically above ten cigarettes per day. Indeed, tobacco plays a major role in periodontal infections. It amplifies the process of tissue destruction by generating an insufficient immune response through oxidative stress.
The changes that smoking induces in the oral environment are due to the increase in oral temperature, and to the components that enter the patient’s oral sphere (smoke, tars and nicotine, for example).
All these elements have consequences for the teeth and gums:
- Vasoconstriction of the gingival and bone microcirculation;
- Alteration of fibroblasts and collagen synthesis;
- Decrease of salivary secretion by the action of nicotine on the nicotinic receptors of the parotid glands.
In addition, the patient’s oral mucosa is weakened by regular tobacco consumption. As a result, they become more fragile and susceptible to irritation (whether mechanical or chemical) and infection.
Paradoxically, this same patient will be more resistant to superficial gum inflammation. Hypoxic gums have less bleeding when compared to the usual symptoms of gingivitis. These symptoms are masked by nicotinic vasoconstriction (Kinane, 2001).
This paradox can delay the awareness of dental problems, and therefore delay the consultation with a dental surgeon. The patient may need to consult once the periodontal infections have progressed, a factor that compromises the success of oral treatments.
Smoking presents another problem for the periodontal patient: it reduces the positive effects of dental treatment. In fact, regular smoking will slow down and disturb the healing of the tissues. Slow healing is observed in the case of surgery, but also in the case of root planing. The case has also been observed for maxillary reconstructions with bone grafts.
Optimizing difficult healing in smokers and weaned patients
New solutions are possible to increase the regenerative potential of tissues in recently weaned patients: PRP – Platelet Rich Plasma – and FRP – Fibrin Rich Plasma – injection protocols show convincing results in optimizing difficult wound healing. These injections are performed pre-operatively, during surgery, and post-operatively. Patients who have recently quit smoking can thus be operated on with minimal risk of random scarring.
Smoking causes 90% of refractory periodontal disease, as well as treatment failure.
Patients with oral diseases are twice as likely to have a fatal heart attack as people without periodontal problems.
A serious cardiovascular disease: Osler’s endocarditis
The endothelium is a cell layer of the heart valve that protects the heart from bacterial attack. In the case of valve disease, or with age, the endothelium is affected. This terrain is conducive to the development of endocarditis. Bacteria in the bloodstream can then start to colonize the valve, since the cell layer can no longer perform its protective role.
The passage of bacteria into the bloodstream, called bacteremia, is common after certain dental operations, when brushing the teeth, but also when chewing. Some patients are carriers of large infectious foci: periodontal diseases or periapical cysts. These patients are at high risk for cardiovascular disease when not screened.
Screening by 3D Cone Beam scanner allows for a comprehensive exploration of the oral and ENT sphere. 2D examinations such as the dental panoramic may miss an important infection because it is hidden behind an anatomical element that is opaque to the radiograph.
DENTAL INFECTIONS INCREASE CARDIOVASCULAR DISEASE
Studies show that there is a link between periodontal or cystic infections and cardiovascular or respiratory diseases.
Cardiovascular diseases
Undiagnosed periodontal disease can lead to the risk of cardiovascular disease or its aggravation. It is therefore essential for health to treat periodontal infections.
Bacteria causing periodontal disease are bound to cause clots of clotted and infected blood. This clump, called an embolus, is released into the bloodstream and can cause a septic embolism. This embolism may cause a blockage of an artery, which in turn causes ischemia.
Different arteries can end up being clogged:
- The pulmonary artery, causing a pulmonary embolism;
- A cerebral artery, resulting in a stroke;
- A peripheral artery, generating an infarction of the limb containing the artery;
- A myocardial artery, leading to a myocardial infarction.
Patients with atherosclerosis are particularly at risk. Indeed, atherosclerosis causes the thickening of the arterial wall, called atheroma, which leads more easily to the obstruction of an artery.
Atheroma is a major cause of cardiovascular disease:
- First cause of death in westernized countries by coronary insufficiency, and cerebral diseases;
- Main cause of coronary heart disease;
- Major cause of disability and morbidity: heart failure, stroke sequelae, transient ischemic attack, aortic aneurysms, obliterative arterial disease of the legs, renal failure and mesenteric infarction.
This frequency is similar to that of periodontal diseases. Patients are therefore encouraged to react accordingly, and to follow strict preventive behaviors.
PREGNANCY AND PREMATURE BABIES IN CONNECTION WITH DENTAL INFECTIONS
A positive correlation exists between periodontal infections and deliveries leading to preterm infants. Indeed, undiagnosed periodontal disease is a risk factor for the mother to have a preterm birth.
Dr. Steven Offenbacher et al. (1995) proposes an explanation for this phenomenon: untreated periodontal disease is one of the possible causes of labor at less than 36 weeks of gestation. The infected periodontium retains many bacteria and inflammatory mediators, such as cytokines, as well as the bacterial endotoxin called lipopolysaccharide. These elements participate in the stimulation of prostaglandins. The latter are crucial in the workings of early childbirth.
In Anglo-Saxon countries, 30% of premature deliveries are associated with this infection process.
In a statistical study reported by Dr. Patrice Phaneuf and Dr. Catherine Parent of Laval University in Canada, 7.3% of premature births are related to untreated periodontal disease.
According to a study by Offenbacher in the United States, periodontal infection is responsible for 18% of premature births every year.
DIABETES AND PERIODONTAL DISEASE
Medical hypotheses point to a link between untreated periodontal and oral infections and blood glucose control. Periodontal disease could indeed exacerbate diabetes.
In 2000, the U.S. General’s report estimated that uncontrolled diabetes is a significant risk factor for undiagnosed oral infections. Indeed, when not controlled, diabetes increases the risk of suffering from gum inflammation, or any other periodontal disease. In addition, diabetic patients are at risk of developing periodontal abscesses and degeneration of periodontal fibers.
Conversely, oral infections increase the patient’s resistance to insulin, making it more difficult to control blood sugar.
To remedy this situation, simple treatments such as scaling and root planing can significantly improve blood sugar control.
While it is faster to treat one periodontal problem area at a time, recent studies have shown that a comprehensive treatment of the oral sphere is more effective. In addition, it puts less stress on the body, which allows for better control of bacteremia.
Dental surgery under sedation in the operating room is particularly indicated in this case to clean all areas in the same procedure.
VITAMIN D OPTIMIZES BONE AND IMPLANT HEALING
Vitamin D is an essential vitamin for the proper functioning of the body. This hormone is ingested through food, but it is mainly synthesized by the human body under the action of UVB radiation from the sun.
Vitamin D is essential, since it participates in the proper assimilation of calcium and phosphorus by the intestines and in their absorption in the kidneys (thus reducing calciuria). It intervenes in the mineralization of bones and joints by helping to fix calcium on the skeleton, and allows to keep a good tonicity of muscles. Its effects do not stop there: vitamin D influences more than 200 genes and is believed to play an important role in DNA repair.
Its absorption allows to avoid rickets during the early childhood, and also to avoid osteomalacia in adults. In addition, it plays a role in reducing the risk of osteoporosis, and has a beneficial role for patients with diabetes, certain cancers, and dementia.
Recommended intake of vitamin D
The nutritional intake recommended daily by the Academy of Medicine 30 µg per day, or 1200 IU per day for an adult.
For dark-skinned patients, the Academy of Medicine strongly advises doubling the recommended dose if sun exposure is low.
Tolerable Upper Intake Levels for vitamin D
The Tolerable Upper Intake Level (UL) for vitamin D is the highest daily amount of a vitamin that can be ingested over a long period of time without risk of developing adverse effects. Various researchers believe that this maximum intake is lower than it actually is and based on a misinterpretation of the available data. Some researchers, based on clinical trials, suggest a UL of 10,000 IU instead.
Contraindications
Hypercalcemia, or too much calcium in the blood, is a contraindication to taking vitamin D.
If the patient has renal calcifications and sarcoidosis, it is important to consult a physician before taking vitamin D.
Vitamin D has beneficial effects on a number of pathologies:
- Hypoparathyroidism: this condition can be caused by the removal of the thyroid glands, resulting in hypocalcemia. Taking vitamin D will help reduce hypocalcemia.
- Psoriasis: a vitamin D analogue is prescribed for the treatment of mild to moderate psoriasis.
- Rickets: this disease is due to a vitamin D deficiency in children. The prescription of vitamin D is therefore essential in the treatment of this pathology.
- Caries: several studies have shown an association between vitamin D intake and the prevention of dental caries.
- Prevention of falls: clinical trials show that vitamin D is effective in preventing falls, especially in the elderly.
- Osteoporosis: taking vitamin D in combination with calcium is recommended for people suffering from osteoporosis. Its prescription is also recommended for the prevention of osteoporosis following endocrine pathologies or in the case of a deficient diet.
- Epilepsy: vitamin D combined with calcium supplementation would be beneficial for the well-being of patients with epilepsy.
- Cancer prevention: in vitro studies have shown that vitamin D in its hormonally active form, calcitriol, has preventive effects against cancer and reduces the development of cancerous tumors. In addition, studies show that populations living in high latitudes have an increased risk of several cancers. Some case-control studies have analyzed the association between blood levels of vitamin D and the risk of developing colorectal cancer, breast cancer, and prostate cancer. However, even if the results are encouraging, no study allows us to affirm with certainty that vitamin D supplementation has a definite effectiveness on these diseases.
- Prevention of type 1 diabetes: numerous case control studies have shown that vitamin D intake during pregnancy and infancy is associated with a lower risk of developing type 1 diabetes. In addition, a recent clinical trial shows that a daily supplementation of 4,000 IU of vitamin D has a beneficial effect on blood sugar control in patients with type 1 diabetes.
- Prevention of type 2 diabetes: Doctors believe that vitamin D deficiency plays a major role in the development of this disease, as it influences insulin secretion and resistance, as well as inflammation. Epidemiological and clinical data are varied, but not yet conclusive. Indeed, according to a 2010 systematic review, these trials did not have enough subjects or trials by themselves that tested the effect of vitamin D in this case.
- Prevention of certain autoimmune diseases: according to some epidemiological data, the active form of vitamin D has an immunomodulatory action. It would therefore be able to play a key role in certain autoimmune diseases, such as multiple sclerosis, rheumatoid arthritis or inflammatory bowel diseases.
- Prevention of cardiovascular disorders: vitamin D plays several important roles in this area. It reduces inflammation, calcification of the vessels, and blood pressure. Various syntheses of epidemiological data conclude that there is a relationship between low levels of vitamin D in the blood and an increased risk of developing cardiovascular pathologies.
- Stimulation of immunity Various placebo-controlled clinical trials from 2010 and 2011 show that vitamin D supplementation decreased the incidence of seasonal influenza in subjects aged 6 to 15 years, slightly reduced the incidence of respiratory infections in young men, increased the immune response of recently vaccinated individuals against tetanus, and reduced the number of pneumonia relapses in young subjects aged 1 to 36 months.
- Cognitive decline: various epidemiological studies have indicated a relationship between low blood levels of vitamin D and an increased risk of cognitive decline in the elderly.
- Asthma: Researchers have found links between low blood levels of vitamin D and the development of asthma in children.
If vitamin D is essential for the prevention of these diseases, it is also essential for oral health.
