Periodontitis And Myocardial Infarction: A Shared Genetic Pr

ORAL-BODY INFLAMMATORY CONNECTION
The connection between dental disease and cardiac disease has been recently documented. In 2005, after studying the relationship between periodontal bacteria and atherosclerosis (narrowing of the carotid arteries), Desvarieux et al² reported that periodontal disease can contribute to cardiovascular disease (CVD) and can be a major risk for death. He also showed that chronic periodontal disease may be a possible cause of CVD.
A paper published in 2010 in the British Medical Journal³ correlated tooth brushing, inflammation, and the risk of CVD from a Scottish Health Survey. Close to 12,000 participants, both men and women, with a mean age of 50 years, were studied. Oral hygiene was assessed from the self-reported frequency of tooth brushing. The reported poor oral hygiene was associated with a higher risk of low-grade inflammation and higher levels of CVD.
Because of the oral-body inflammatory connection (OBIC), clinical treatment studies have been performed to evaluate the effect that treatment of periodontal disease has on the degree of heart disease present. In April 2009, Piconi et al⁴ published a study showing that the treatment of periodontal disease reduced the narrowing of the carotid artery and resulted in an improvement in the atherosclerosis.
Slepian and Gottehrer5 in 2009 described the OBIC and discussed many of the inflammatory enzymes as being involved in patients with CVD. This has finally led to an understanding of how periodontal disease develops and progresses, leading to technology which now allows the disease to be stabilized and controlled. The following year, they authored a guide entitled Evaluation and Management of the Oral Body Inflammatory Connection Resource Guide. (This guide was published as a courtesy for all the practicing dentists in the United States by Chase Health Advance Financing Options.) It describes in detail both this critical connection and the effective, nonsurgical management of periodontal disease.
In September 2010, the US Centers for Disease Control and Prevention, Division of Oral Health completed a National Health and Nutritional Examination Survey (NHANES) published in the Journal of Dental Research,⁶ which found gum disease to be a significant health concern. NHANES has historically been the main source for determining the status of periodontal disease in the US adult population. Comprehensive periodontal exams were conducted on more than 450 adult patients over the age of 35 years. The prevalence rates were compared against previous NHANES studies, which only used a partial mouth periodontal exam. The previous studies had shown prevalence of both gingivitis and periodontitis as high as 56% in adults. The present study found that the original methodology may have understated the disease prevalence by up to 50%. These figures could easily be interpreted to represent periodontal disease as the most common disease present in the body today.

 A recent study in 2010⁷ has discovered how bacteria in the mouth that results in tooth decay can also cause blood clots. While the study was conducted in small lab animals, it was hypothesized that poor dental hygiene conditions could lead to bleeding gums, providing the bacteria, even in gingivitis, an escape route into the blood stream. It can initiate blood clots resulting in heart disease. Streptococcus bacteria, normally present in the oral biofilm, can result in both gum disease and tooth decay. Upon entering the bloodstream through bleeding gums, they produce a protein that brings together platelets from the blood to form a clot which results in thrombosis.

 IMPACT OF SYSTEMIC DRUG MANAGEMENT ON PERIODONTAL HEALTH 

In March 2011, Payne et al¹⁶ completed a 2-year study using SDD to reduce systemic biomarkers including serum inflammatory MMP and high sensitivity C-reactive protein (hsCRP). There was also a statistically significant increase in high-density lipoprotein (good) cholesterol in women more than 5 years postmenopausal. Alveolar bone density loss was reduced. Clinical attachment levels were stabilized. SDD and periodontal maintenance decreases the odds of more progressive periodontitis by 19% relative to placebo.
Ridker et al¹⁷ did significant research to identify hsCRP as a systemic inflammatory biomarker, reporting it to be more predictive of cardiovascular events than elevated low-density lipoprotein cholesterol levels.

LOCAL DELIVERY OF SITE-SPECIFIC ANTIMICROBIAL DRUGS 
The local delivery of antimicrobials, such as Arestin (Orapharma), offer the dentist a statistical and significant system for the treatment of periodontitis.18 The Agency for Health Care Research and Quality (the federal agency assigned to improve quality, safety, efficiency, and effectiveness of healthcare) evaluated literature on these antimicrobials in 2004.¹⁹ They concluded that scaling/root planing, when accompanied by the placement of an antimicrobial agent (Arestin) as a supplement or adjunct treatment, resulted in an improved clinical outcome in adults with chronic periodontitis. (This was compared to scaling/root planing that was done alone.) Systemic and locally placed antimicrobial drugs are therefore suggested for use when active disease is detected. They have clearly shown in the studies mentioned to be of significant help in resolving the diseased condition and restore periodontal health as quickly as possible. 
Patients usually understand medical treatment with medication. It is a natural addition to periodontal treatment, following the medical model. These drugs can be used on a routine basis as a standard of care, in successfully managing periodontal disease.