Oral health and heart disease

Depression and Rural Environment are Associated With Poor Oral Health Among Pregnant Women in Northern Appalachia

Both oral health problems and depression among pregnant women contribute to maternal-infant health outcomes. Little is known, however, about the potential effects of clinically significant depression on the oral health status of pregnant women. The purpose of the present study was to determine the influence of clinically significant depression and rural- or urban-dwelling status on oral health outcomes among pregnant women. Pregnant women (N = 685) in rural (i.e., West Virginia) and urban (i.e., Pittsburgh, PA) areas of northern Appalachia were assessed by calibrated examiners regarding gingivitis, oral hygiene, and DMFT (decayed, missing, and filled teeth), completed the Center for Epidemiologic Studies-Depression Scale (CES-D) and provided demographics. Participants were categorized based on clinically significant depressive symptoms (CES-D ≥ 16) and rural/urban domicile. Women with depression and those living in rural areas had worse oral health on all three indices than their non-depressed and urban counterparts. Depression, particularly among women in rural areas, affects certain oral health indices and represents a modifiable target for intervention. Moreover, treatments designed specifically for rural populations may be of particular utility. Women who are pregnant or planning to become pregnant may benefit from regular depression screenings from their dental and medical health care providers.

Tooth loss in institutionalized coronary heart disease patients of Punjab Institute of Cardiology, Lahore, Pakistan

Objective: To observe frequency and possible association of tooth loss with prevalent coronary heart disease in Pakistani population.

Methodology: Angiographically determined coronary heart disease (CHD) patients of Punjab Institute of Cardiology, Lahore, Pakistan, and healthy individuals were enrolled for status of tooth loss.

Results: Nine hundred and thirty six CHD patients and 595 healthy subjects with mean age of 51.9 ± 8.4 years were examined. Mean (±SD) tooth loss was significantly (P ⩽ 0.001) higher in cardiac patients (9.8 ± 9.2) than healthy subjects (6.8 ± 6.9) with odds ratio (OR) = 1.543 (95%CI = 1.985–2.851). Tooth loss was significantly (P ⩽ 0.001) associated with CHD males and females and cardiac patients with diabetes and smoking. After adjustment of age, gender, diabetes and smoking, subjects with CHD were more likely to have higher tooth loss.

Conclusion: Tooth loss was significantly associated with prevalent CHD independent of classic risk factors of age, gender, smoking and diabetes in this study sample.

Hearts and mouths: perceptions of oral hygiene by at-risk heart surgery patients

OBJECTIVE

To assess and use the attitudes of patients who are placed at risk after valvular heart surgery due to the connection between poor oral hygiene, valvular heart disease/surgery and the risk of developing infective endocarditis.

DESIGN

A qualitative (focus group) design based study carried out on subjects three months post heart surgery.

METHOD

There were five focus groups of five participants each convened by an experienced moderator.

RESULTS

These portrayed an apparent pressing desire by most patients to talk about their experiences. However, patients did not accept the link between their oral health and their general health. Oral hygiene practices were not necessarily oral health related.

CONCLUSIONS

The importance of the study in understanding the reasons for a patient's behaviour is evident when there is a clear need to modify the behaviour patterns of the patients effectively. Clinical trials can now be developed based on these results.

The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks

Oral epidemiological research into the social determinants of oral health has been limited by the absence of a theoretical framework which reflects the complexity of real life social processes and the network of causal pathways between social structure and oral health and disease. In the absence of such a framework, social determinants are treated as isolated risk factors, attributable to the individual, having a direct impact on oral health. There is little sense of how such factors interrelate over time and place and the pathways between the factors and oral health. Features of social life which impact on individuals' oral health but are not reducible to the individual remain under-researched. A conceptual framework informing mainstream epidemiological research into the social determinants of health is applied to oral epidemiology. The framework suggests complex causal pathways between social structure and health via interlinking material, psychosocial and behavioural pathways. Methodological implications for oral epidemiological research informed by the framework, such as the use of multilevel modelling, path analysis and structural equation modelling, combining qualitative and quantitative research methods, and collaborative research, are discussed.

Inflammatory response to acute coronary syndrome in patients with coexistent periodontal disease

BACKGROUND

The inflammatory process that occurs in atherosclerotic plaque situated in the coronary vessel often leads to its destabilization, which in turn results in clot formation and the occurrence of acute coronary syndrome. Acute coronary syndromes (unstable angina, myocardial infarction) are among the leading causes of death in the human population. An inflammatory factor which leads to this process may be bacterial pathogens originating in the periodontal tissues. The aim of the study was to evaluate the influence of periodontal disease on the intensity and dynamics of the inflammatory response in patients with acute coronary syndrome and coexistent periodontal diseases.

METHODS

The study involved a group of 50 consecutive patients (nine females; 41 males) < or = 60 years of age (37 to 60; mean 51) with coronary pain and with an initial diagnosis of acute coronary syndrome admitted to the Coronary Care Unit of the Department of Cardiology. Dental examinations were carried out during the first 24 hours of hospitalization. Blood samples were taken at admission (examination 1), after 10 to 12 days of hospitalization (examination 2), 3 months after the acute coronary syndrome (examination 3), and, in some patients, 6 months after the acute episode (examination 4). This information was used to estimate the mean serum levels of interleukin-1 (IL-1) and tumor necrosis factor (TNF-alpha).

RESULTS

Chronic periodontitis was found in all patients. The patients were divided into two groups on the basis of periodontal disease and clinical attachment loss (CAL). The study showed raised mean values for TNF-alpha in examinations 2, 3, and 4 in patients with more advanced periodontal disease. There was also an increase in IL-1 concentration in the acute phase and in long-term observation (examination 3) in these patients. The patients with more advanced CAL had more pronounced periodontal disease and higher bleeding index values. All patients were characterized by high mean values of plaque index (46%) and bleeding index (80%).

CONCLUSIONS

The periodontal health of patients admitted to the Coronary Care Unit due to acute coronary syndrome is unacceptable. The mean values for CAL and probing depth, as well as extensive bleeding on probing sites indicate the presence of active periodontal disease, which may affect the incidence of cardiovascular disease. Although there were no significant differences in serum TNF-alpha or IL-1 levels in acute coronary disease patients with advanced periodontal disease compared to those with less advanced periodontal disease, we observed that patients with acute coronary syndrome and with more advanced periodontal disease tend to be characterized by higher mean values of serum concentrations of IL-1 in the acute phase of acute coronary syndrome, as well as in the long term, and of TNF-alpha in the long-term observation. Patients with less advanced periodontal disease were characterized by a faster diminution of the inflammatory response in comparison to the groups with more advanced periodontal disease.

Recovery of periodontopathogenic bacteria from embalmed human cadavers

There is recent interest in recovery of periodontopathogenic bacteria from arterial and bronchial tissues to identify a link between periodontal and cardiovascular or pulmonary diseases. This interest could provide a useful clinical correlation exercise for gross anatomy. Our objective was to perform a feasibility study to determine whether these bacteria could be recovered from two sites within eight (4 dentate, 4 edentulous) human embalmed cadavers from an anatomical dissection laboratory. Bacterial samples were collected from the right coronary artery and the right superior secondary bronchus and assayed for the presence and concentrations of the DNA of A. actinomycetemcomitans, E. corrodens, C. rectus, P. intermedia, P. gingivalis, B. forsythus, T. denticola, and F. nucleatum. Frequencies were compared using a Kruskal-Wallis H-test. Correlations between the presence of teeth, bacterial species, and site were determined by a Spearman's rho correlation test. A. actinomycetemcomitans and B. forsythus frequencies were different between the sites in edentulous subjects (P <0.05); the frequency of B. forsythus was different in dentate and edentulous subjects at the bronchus site (P <0.05). Numerous significant correlations were identified between strains of bacteria, site, and presence of teeth. Thus, it is possible for the DNA of periodontopathogenic bacteria to be recovered from human embalmed cadavers. Collection and identification of these bacteria from these cadavers could be a useful clinical correlation exercise for dental students in a gross anatomy class.

Dentistry and the medically compromised patient

Certain medical conditions and their accompanying drug treatment do have an impact upon oral structures and the delivery of dental care. Recent evidence suggests that oral health could be a significant risk factor for coronary artery disease. Many medical conditions can affect dental care are often over-stated and lack an evidence base. Examples include the need for antibiotic cover in patients at risk from infective endocarditis and the necessity to provide supplementary corticosteroids for those patients on longterm steroid therapy. By contrast, certain systematic drug treatments can have a profound affect on the oral tissue. The most obvious is drug-induced gingival overgrowth. Drugs frequently implicated in this unwanted effect include phenytoin, ciclosporin and the calcium channel blockers. Several risk factors for drug-induced overgrowth have been identified and include age, sex, peridontal variables and a range of drug pharmacokinetic variables. The relationship between oral health and coronary artery disease opens up a potentially new vista for the delivery of oral care. Although the association is convincing, casualty has not been established. If casualty for this relationship can be confirmed then the delivery of dental care and the promotion of oral health will receive a significant impetus.