The Specialist

The link between dental disease, heart disease and diabetes

Recently, research journals and modern medical professionals have been pointing to a connection between our oral health, hygiene and our cardiovascular risk.

In fact, just last week, a patient visited my office seeking a clean bill of health from their orthopedic surgeon prior to performing a hip replacement surgery. In this case, the main concern is the bacteria that comes from the germs in the mouth and gums and the likelihood of getting into the blood stream. Some of these nasty bugs collect in valves of your heart and prosthetic devices seen in hip and knee replacement procedures.

The Journal of Periodontology reported that inflammatory effects of periodontal disease, which is a chronic bacterial infection of the gums, cause oral bacterial byproducts (poop) to enter the blood stream and trigger the liver to release substances that increase the risk of heart disease. Interestingly, this also happens in patients who have no teeth and are wearing dentures. Did you know that poorly fitting dentures can create an inflammation and infection throughout the mouth that can also trigger a poor systemic effect?

This inflammation can be measured. A substance produced by the body called C-reactive protein (CRP) is suspected to play a role in the link between gum disease and heart disease. This test may be available in some medical labs. The test reveals your likelihood of general inflammation, arterial inflammation and increased risk of blood clots. Optimal health demands that the CRP should be low. Think of the test this way: a high CRP is the “smoke”, and it should put your physician on the search for the “fire”.

Diabetes and how your sugar load can be reduced by improving your periodontal health

The statistics on diabetes is staggering.

There are nearly two million new diagnoses of diabetes each year in the United States (U.S.). However, in The Bahamas, Minister of Health Dr. Duane Sands said in a copy of The Tribune dated October 25, “The prevalence of diabetes in 2005 was 6.7 percent. It has now reached 13.9 percent – and if we include pre-diabetics, we have a staggering prevalence of almost 19 percent. Our death rate from diabetes stands at 37.9 deaths per 100,000 people.”

In essence, the prevalence of diabetes is directly related to our lifestyle choices. Diabetes is now the fifth leading cause of death in The Bahamas.

The health of your gums can influence your diabetic status.

We have known for years that if you are diabetic you have a greater likelihood of periodontitis. If your diabetes is unmanaged, you can lose all of your teeth. The more severe the diabetes, the severity of periodontitis increases.

We have two primary cells involved in bone maintenance: the osteoblast, which is the cell that forms bone; and the osteoclast, which is the cell that removes the old bone. One likely reason for periodontal bone loss in the diabetic, is that high blood glucose itself inhibits the production of osteoblasts. High blood glucose also hinders the ability of the gums and bone to heal. What’s worse is it doesn’t stop there, as there is significant association between periodontitis and your general health.

In diabetics with severe periodontitis, the mortality rate from heart disease was almost three times greater, and from kidney disease over eight times greater, than in the normal population.

However, the reverse appears to be true as well. Good periodontal control may positively influence your general diabetic condition. Several studies of both Type 1 and Type 2 diabetics have shown a 10 percent reduction in HbA1c levels (a test that commonly measures the average amount of glucose in the bloodstream over the previous eight- to 12-week period) by undergoing non-surgical periodontal therapy alone.

What this means to you

It means that everyone, but mostly the diabetic and the heart disease patient, needs a thorough assessment of his or her dental and periodontal condition. This includes periodontal probing, x-rays and an assessment of mobility, bleeding, swelling, fever and other important items in a full periodontal examination.

If periodontitis is diagnosed, the next step is to treat it effectively. In most cases, treatment involves non-surgical scaling and root planing below the gum line. If some areas do not respond to scaling, there are a number of surgical approaches with lasers that can be used to gain access to the pocket and even help to replace some or all of the lost bone support.

Periodontal disease is something that must be acknowledged and treated. Early treatment does not only save your teeth, but may save your life.

Next issue: Are you suffering from chronic halitosis (bad breath)?

• Dr. Kendal V. O. Major is founder and CEO of Center for Specialized Dentistry, a comprehensive family dental practice operating in New Providence and Grand Bahama. He is the first Bahamian specialist in gum diseases and dental implants since 1989. He is also a certified Fastbraces provider. His practice is located at 89 Collins Avenue; he can be reached at telephone (242) 325-5165 or

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