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Flossing and Heart Disease

A global protocol followed among all dentists and oral care providers is the association between oral health and systemic diseases. Comprehensive screening with thorough assessment of oral hygiene can create a good prophylaxis and also determine the relationship between oral health and systemic diseases. Research has proven that the link between oral health and systemic inflammatory diseases can be evaluated to assess the deteriorating effects on the organ systems.


Inflammatory response

The inflammatory response patterns that manifest in the body are redness, swelling, pain and loss of function. The process of inflammation predominantly affects the periodontium. The biofilm formed may contain bacteria of different types mainly gram positive and gram negative in origin. The microorganisms colonize in the regions of interproximal spaces and gingiva releasing exotoxins, cytotoxins and also protein toxins respectively. In the process of infection the visible changes appear which include bleeding gums, redness etc. This phenomenon is called periodontitis. Prolonged cased of periodontitis can eventually cause coronary diseases such as atherosclerosis.

These conditions occur because of the proliferation of soluble compounds and the release of interleukins and tumor necrosis factors and prostaglandins. The local inflammation thus formed begins to sustain by chemical mediators leading to the development of atherosclerotic lesion. The lesion progresses and the action of extra cellular proteolytic enzymes may cause rupture. This may lead to the formation of thromboses facilitating the blood flow into the heart causing infarction. The identification of inflammatory markers may help in effective diagnosis.


Oral conditions causing heart disease


  • Poor oral health and improper assessment of oral hygiene associated disease can progress to cardiovascular disease.
  • Patients with a history of gum disease are at a risk of developing a heart disease.
  • Patients with fewer teeth due to tooth decay are susceptible to coronary conditions.
  • Alcohol, smoking, diabetes can also lead to deterioration of oral hygiene which may result in coronary conditions.

Development of coronary condition due to poor oral hygiene is mainly associated with the type of inflammatory response generated due to infection in the oral cavity. The research on periodontitis associated heart disease is still underway and the plausible theory of oral hygiene and systemic diseases is slowly being ruled out by extensive study carried out in the respective area.

Flossing

Since the development of heart disease is related to oral hygiene, one of the effective methods to avoid inflammatory conditions suggested by dental care experts is through flossing. Flossing regularly can prevent the onset of periodontitis which occurs due to plaque and tooth decay. The type of floss recommended may be multi filament nylon or monofilament PTFE in origin. The floss is generally coated with waxy layer to avoid the damage or tearing of gums. The method of flossing has to be carefully followed as it may sometimes erode or lead to bleeding of the gums which may also be associated with the travel of formed blood clots in to the heart. Preexisting heart conditions may also lead to the development of bacterial endocarditis due to poor oral hygiene. Other conditions associated are myocardial infarction, congenital heart valve defects and also hypertrophic cardiomyopathy.


  • Inform your doctor about medications that you are taking for any health problem or underlying history of heart disease.
  • In case of the use of blood thinning medications, the dentists and cardiologists have to be notified.
  • Good oral hygiene such as brushing and flossing is suggested to the patients.

Gingivitis

Gingivitis involves inflammation of the gums surrounding the teeth. Due to this, the gums become soft and swollen and usually red instead of a healthy pink. The inflammation of the gums is a defense mechanism put up by the body's immune system to prevent the growth of bacteria which along with the remnant food particles and plaque form tartar. This cannot be removed by simple brushing or flossing.


What Causes Gingivitis Disease?

The primary cause of gum disease is plaque. However, there are various other reasons why gingivitis disease develops.


  • Gums become sensitive when there are hormonal changes in the body, such as during puberty, pregnancy, menopause and menstruation. During pregnancy, hormonal changes and tartar induce excessive growth of gum tissues resulting in the formation of lumps commonly referred to as pregnancy tumors. These tumors prevent bacteria from being removed effectively during brushing, thus resulting in gingivitis disease.

  • In post-menopausal women, a painful condition called desquamative gingivitis may develop, for reasons yet unknown. In this condition, the outer layers of the gums come away from the teeth and lose their solidity, resulting in the exposure of nerve-endings which causes acute pain.

  • Long-term use of contraceptive pills can also result in gingivitis.

  • Diseases that affect the immune system such as HIV or cancer may also affect the gums. Diabetes when uncontrolled, can affect the gums. On the other hand, gingivitis disease may also be a pointer to systemic disorders.

  • Some medications can also cause gum disease as they restrict production of saliva which prevent the formation of tartar. Some medications used in the treatment of angina and seizures can cause abnormal growth of the tissues in the gums.

  • Habits, such as smoking, do not facilitate the easy self-repair of the gums. A severe form of gingivitis, known as Trench mouth or ANUG (Acute necrotizing ulcerative gingivitis) is mostly found in the case of smokers. ANUG is also reported in the case of incapacitated persons under severe stress. Acute pain, swelling, bleeding and bad breath develop very quickly in this condition and also the gums turn grey.

  • If gingivitis runs in the family, then there is a greater chance of a person getting it. Poor oral hygiene is a major contributor to gingivitis.

  • Dental appliances not properly fitted or improper alignment of teeth may also cause gingivitis.

  • Dietary imbalances, vitamin deficiencies, and drug reactions can also result in gingivitis.

  • Gingivitis disease is also often caused by fungal and viral infections.


Symptoms of gingivitis

There is usually no pain associated with mild form of gingivitis. Hence it may go unnoticed. However, there are certain symptoms that warn that treatment for gingivitis is needed:


  • When the gums are swollen, soft, or red.

  • When gums bleed during, or after brushing.

  • When bad breath or bad taste in the mouth persists even after brushing and flossing.

  • When the gums recede.

  • Deep pockets are formed between teeth and gums.

  • Visible deposits of tartar.



If the dentist finds that someone is particularly prone to formation of plaque, he may recommend use of special implements to remove plaque, such as toothpicks, electric toothbrushes etc. This treatment for gingivitis would suffice when the gingivitis disease is in the early stages.

For reducing the pocket depth between teeth and gums, which can also cause gingivitis, dentists undertake root-planing and scaling. In addition dentists may also administer minocycline microspheres. For women who have desquamatic gingivitis, hormone replacement therapy could be beneficial. However, adverse effects of the therapy could prevent their recommendation. Instead, corticosteroid rinses and pastes which can be directly applied on gums may be more commonly recommended.

Pericoronitis is acute, painful inflammation of the gingival tissue over a partly erupted tooth (as in the case of a wisdom tooth). The treatment for this would include removal of the debris beneath the gingival flap and irrigation with saline. This may be followed up with extraction, particularly when there is recurrence of the episode.


Prophylaxis

Prophylaxis involves preventive care from injuries and diseases. This is contrary to curative or palliative care that is taken after a disease is contracted. Prophylaxis also encompasses inoculations, vaccinations and procedures followed to prevent disease, such as flossing teeth to prevent plaque. These preventive methods can be taken at individual or public health level.

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Bibliography / Reference

Collection of Pages - Last revised Date: September 22, 2019