Teething troubles for the heart

There is a direct link between dental hygiene and cardiac health. Ignoring health could not just lead to bad breath but also could result in serious health complications for the heart and even compromise the functioning of the coronary arteries. Dentists and cardiologists warn that bad oral hygiene can not only damage your teeth and gums but can also cause a bacterial infection called infective endocarditis which leads to inflamed arteries and infection of the heart valve which if left untreated could have health complications. Experts opine that oral hygiene is as important as a healthy diet and workouts when it comes to matters of the heart.

Dr Neeraj Bhalla, senior director, cardiology, BLK-Max Super Specialty Hospital, New Delhi, reckons there is an association between bad oral hygiene and an increased incidence of cardiac conditions such as heart attack or acute cardiac syndrome (when the blood flow to the heart reduces suddenly).

What is infective endocarditis

A research article published in the science journal, Circulation, examines a large, prospective study which demonstrates a strong association between some indexes of oral hygiene and gingival disease and the incidence of bacteremia from Infective Endocarditis-related (IE) species. IE is a bacterial infection of the heart valve lining. It says that poor oral hygiene results in gingivitis, which often leads to periodontitis, and it is likely that these two periodontal diseases are associated with community-acquired IE. Current evidence suggests that poor oral hygiene and periodontal diseases and not dental office procedure (protective dental procedures and protocols) are likely to be responsible for the vast majority of cases of IE that originate in the mouth.

Dr Divya Marina Fernandes, consultant, heart failure specialist and interventional cardiologist, Aster RV Hospital, throws light on infective endocarditis. “It occurs when bacteria or other germs enter the bloodstream and travel to a person’s heart. These germs then stick to the damaged heart valves or tissues and cause infection and inflammation,” she explains.

A study published in StarPearls says that infectious endocarditis is the inflammation of the endocardium and is primarily a disease caused by bacteria and has a wide array of manifestations. Without early identification and treatment, a myriad of intracardiac and far-reaching extracardiac complications can develop. Therefore, careful evaluation, including a thorough history and physical exam, can help diagnose cases and guide management, limiting mortality and morbidity.

“Poor oral hygiene, minor gum injury caused by tooth brushing and sometimes dental procedures, are some of the main causes leading to infectious endocarditis,” says Fernandes. Experts suggest that one should be alert and consult a physician if he/she is experiencing pain in chewing and swallowing, has swollen or bleeding gums and are also experiencing symptoms like fever, pain in the cheekbone, chills, sore throat, nasal congestion, headache and muscle pain.

Dr Bhalla adds that IE may be due to chronic or acute inflammation in the oral cavity due to conditions such as pyorrhoea, gingivitis or poor gum health leading to a chronic inflammatory state which affects atherosclerotic processes (when arteries thicken and harden because of plaque) and can cause inflammation in the arteries leading to a heart attack.

Another problem is poor oral health in patients who have deformed or prosthetic cardiac valves (artificial cardiac valves). “Especially if any instrumentation such as any extraction or any surgery is done of the teeth, this causes bacteremia, in which a flood of bacteria enter the bloodstream and circulate because of the injury caused by the instrumentation,” explains Dr Bhalla.

Dr Neetu Kamra, head dental and maxillofacial surgery, BLK-Max Super Specialty Hospital, New Delhi, explains that periodontitis is a serious gum infection that not only damages gums but can destroy the jawbone as well.

A word of caution

Dr Bhalla says that prior to undergoing valve surgery, people are always advised to visit a dentist and extract any rotting teeth to pre-empt or prevent the occurrence of infective endocarditis. “Those patients who have an infective heart valve are always advised to take a shot of antibiotics before they undergo any dental procedure or any other procedure which has the potential to let loose a stream of bacteria in the blood,” explains Dr Bhalla.

This means that any infected area that is being operated on is given a prior dose of antibiotics. A couple of doses of antibiotics are also given after the procedure to prevent any infection from settling on these valves.

People at risk

According to Dr Karma, almost everyone with poor oral hygiene is at risk of getting heart problems, however, diabetic and immunocompromised patients are at higher risk apart from people with periodontitis (gum disease).

Dr Bhalla says once infective endocarditis occurs it is a serious and life-threatening condition, especially in those people who have mechanical or artificial cardiac parts.

Infective endocarditis treatment

According to Dr Fernandes, the treatment includes several weeks of antibiotics or other medicine and sometimes surgery. “With quick, aggressive treatment, many people survive. Without treatment, endocarditis can be fatal,” cautions Dr Fernandes.

The dental treatment according to Dr Kamra includes professionally cleaning the pockets around teeth to prevent damage to the surrounding bone. “Advanced cases may require flap surgery (a reconstructive dental surgery),” explains Dr Kamra.

Dr Bhalla believes that the condition can be prevented and pre-empted with good oral health and timely visits to the dentist. “Knowing what precautions are to be taken in case you have a predisposing condition is important,” he explains.

Infective endocarditis symptoms

Dr Fernandes says a doctor should be consulted if a person has a persistent oral infection, inflammation and fever above 100°F, apart from pain and redness. “Sometimes you may experience that the sores aren’t healing and there might be white patches in your mouth or tongue while some people might experience nausea, vomiting or diarrhoea apart from shortness of breath and poor appetite followed by weight loss,” she says.

Some other symptoms to watch out for are:

• Muscle and joint aches
• Skin rash
• Internal bleeding
• Sore throat or pain when swallowing
• Headache and nasal congestion
• Persistent cough

According to Dr Kamra, a person with symptoms of oral infection may experience bad breath or bad taste that won’t go away. “Some people may experience pain in chewing and the gums may turn red or swollen or could be bleeding. For some, the teeth may experience sensitivity or could become loose because the infected gums can’t secure them,” she says. Also, the gums may pull away from the teeth, causing gum recession.