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Abstract
One of the most important risk factors for heart disease occurs in an area of the body that doesnt often be connected with cardiovascular health: the mouth. Yet, numerous studies have shown the correlation between poor oral health and heart disease. Both poor oral health and heart disease are common conditions in America. According to the American Heart Association, 36.3 percent (1 in 2.8) of deaths in 2004 were caused by cardiovascular disease. In elderly populations, poor dental health is also associated with all-cause mortality. Key Words: Oral Health, Acute Myocardial Infarction
Introduction
Both poor oral health and heart disease are common conditions in America. According to the American Heart Association, 36.3 percent (1 in 2.8) of deaths in 2004 were caused by cardiovascular disease.1 In elderly populations, poor dental health is also associated with allcause mortality.2 The National Health and Nutrition Examination Survey (NHANES) 1999-2002 investigated the oral health of the U.S. population. This study found that 41 percent of children aged 2-11, 50 percent of children aged 12 - 15 years, and 68 percent of adolescents aged 16 - 19 years had tooth decay in their primary teeth. Also, the prevalence of decay in adults showed that 87 percent of individuals ages 20-39 and 95 percent ages 40-59 had decay in the coronal surface of the permanent teeth. This study demonstrated another alarming fact: 25 percent of adults over age 60 had lost all of their teeth.3 Due to the prevalence of these conditions, the correlation between oral health and heart disease is significant as oral health may be a possible avenue of intervention to decrease cardiovascular mortality. (1)
including third heart sound (S3) gallop, pulmonary rales, lower extremity edema, and elevated jugular venous pressure.
whom angioplasty fails and in patients who develop mechanical complications such as a VSD, LV, or papillary muscle rupture.
CHAPTER III Association between Acute Myocardial Infarction and Oral Health
The mechanism by which oral health could influence the development of myocardial infarction remains unknown. Occlusive thrombus attached to atherosclerotic plaque caused by dental infection is the most common cause of acute myocardial infarction. Bacterial components affect endothelial integrity, metabolism of plasma lipoprotein, blood coagulation, and the function of platelets and their synthesis of prostaglandin, all of which are factors that influence the progression of atherosclerosis and the processes triggering myocardial infarction and sudden death in subjects with coronary disease. Many of these changes are mediated by the endotoxin associated with certain Gram negative bacteria, but other mechanisms must also play a part. On the other hand, little is known about the long term effects of chronic low grade bacterial infections, such as dental caries or periodontitis, on atherosclerosis and its complications. In the past 20 years researchers have investigated possible links between periodontal and vascular diseases. Although more research is needed to establish cause and effect, findings from numerous studies are compelling. Data from the First National Health and Nutrition Examination Survey (NHANES I) suggest that periodontal disease is a significant risk factor for stroke.(2) Grau and colleagues found that subjects with severe periodontal disease had a risk of stroke 4.3 times greater than that in control subjects.(3) And in a study of more than 4,000 subjects, severe periodontal disease was significantly related to hypertension and myocardial infarction.(4) Other research found a nearly six-fold increase in the risk of coronary heart disease in subjects with severe periodontal disease after controlling for age and smoking.(5) Further, periodontal disease has been shown to increase the risk of death from coronary heart disease. (6) The National Health and Nutrition Examination Survey (NHANES) 1999-2002 investigated the oral health of the U.S. population. This study found that 41 percent of children aged 2-11, 50 percent of children aged 1215 years, and 68 percent of adolescents aged 1619 years had tooth decay in their primary teeth. Also, the prevalence of decay in adults showed that 87 percent of individuals ages 20-39 and 95 percent ages 40-59 had decay in the coronal surface of the permanent teeth. This study demonstrated another alarming fact: 25 percent of adults over age 60 had lost all of their teeth.(7) Due to the prevalence of these conditions, the correlation between oral health and heart disease is
significant as oral health may be a possible avenue of intervention to decrease cardiovascular mortality. Some researchers have suggested that oral infections may produce inflammatory markers, which could contribute to the pathology of coronary heart disease (CHD). Studies indicate that serum inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen levels are significantly higher in individuals with CHD. CHD patients also have showed an increased prevalence of gingivitis and diseased supporting tissue, less natural teeth, and increased loss of all teeth compared to individuals without CHD. A study done in 2009 demonstrated that patients with AMI exhibited an unfavorable dental state of health. After statistical adjustment for age, gender, and smoking, they exhibited a significantly higher number of missing teeth, less teeth with root canal fillings, and a higher number of radiologic apical lesions compared with individuals without myocardial infarction. (8)
Conclusion
Cardiovascular diseases (CVD) are one of the main causes of death in the world, accounting for almost one third of all deaths world-wide. Cardiovascular diseases consist of heterogeneous groups of vascular diseases, with atherosclerotic vascular diseases being the commonest group. Although the risk factors of atherosclerotic vascular diseases include several risk factors such as abnormal lipids, hypertension, smoking and diabetes, a substantial proportion of cardiovascular events cannot be attributed to any of the risk factors. During the past three decades, oral epidemiologists have been actively testing the hypothesis that oral infections may be aetiological factors in atherosclerotic vascular diseases. Different explanatory variables such as periodontal pocket depth, clinical attachment loss or different indices have been used to measure the extent and/or severity of oral infection. Tooth loss, measured by number of teeth, has also been used as an explanatory variable, especially in situations where no other form of data is available. There is a strong connection between oral health and myocardial infarction, as shown by the results of researches above. Relying upon those facts, it is concluded that the prevalence of myocardial infarction can be reduced by paying a lot more attention and care to oral health.
References
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