Oxidative Stress - The Link Between Dentistry and Medicine

Oral Health and Your Heart

World renowned cardiovascular expert Amy Doneen, DNP, shares the key to understanding the link between cardiovascular disease and periodontal disease. 

Understanding Cardiovascular Disease and Periodontal Disease 

Cardiovascular disease (CVD) remains the leading cause of death and disability for both women and men worldwide. Chronic periodontal disease (PD) affects upwards of 70% of adults in the U.S. and is the sixth most prevalent chronic disease.¹ PD is a bacterial infection. These high-risk bacteria are causal of plaque growth in the arteries (atherosclerosis). It is important to ask your dental team to check your saliva for these dangerous bacteria.  Treating the infection can dramatically reduce heart attack and stroke risk.²  

Oxidative Stress and Health: What You Need to Know  

Oxidative Stress (OS) provides the key to understanding the causative link between cardiovascular disease and periodontal disease. OS occurs when reactive oxygen species (ROS) are abundant relative to antioxidants.  Simply stated; the body is breaking down at a faster rate than it is being repaired. When oxidative stress is chronic, it leads to arterial disease development which can cause heart attacks and strokes. Systemic conditions that drive OS and arterial disease include cholesterol imbalance, high blood pressure, insulin resistance (pre-diabetes) and Type 2 diabetes, psychosocial health (stress, depression, anxiety, PTSD), gut inflammation, obesity, lack of exercise, periodontal disease, sleep disturbances, low vitamin D, nicotine, autoimmune diseases, and others.³  

Importance of Interdisciplinary Collaboration 

This established oxidative stress link between oral health and CVD demands that medicine and dentistry work together. While the link is certainly complex, there are certain disease states that can readily be identified in the dental office as well as the medical office that require special focus on oral health in both settings. When poorly managed, insulin resistance (IR) and metabolic syndrome often lead to the end stage disease of type 2 diabetes (T2DM). Likewise, when PD is poorly managed, it leads to bone loss and tooth loss. People with moderate to severe PD are twice as likely to have metabolic syndrome.⁴

Shared Risk Factors and Management Strategies 

Both conditions are chronic and inflammatory, promoting oxidative stress for years. There is a bidirectional relationship between IR and PD. Both conditions share common risk factors such as high blood pressure, obesity, sleep apnea, gut dysbiosis and chronic inflammation. These factors can be easily identified in both clinical settings and should be mutually addressed. In the dental setting, this vulnerable group should receive routine pathogen testing, undergo 3D cone-beam evaluation for endodontic lesions, have more frequent hygiene visits and maintain optimal home oral healthcare, along with formal sleep evaluations. Likewise, the medical community must enforce the importance of oral health and airway management, ensure routine inflammatory biomarker testing, treat to optimal blood pressures, set weight goals with genetically guided nutritional counseling, and provide optimal medical management of all conditions. 

Most importantly, medicine and dentistry must work in partnership for the health of the individual patient with the goal to mitigate the number one cause of death and disability which is cardiovascular disease.

Meet Amy Doneen

Amy Doneen, DNP, is a world-renowned cardiovascular specialist and co-founder, along with Bradley F. Bale, MD, of the BaleDoneen Method. They teach this model for understanding and preventing heart disease to healthcare providers in their American Academy of Family Medicine-accredited preceptorship program. Dr. Doneen is Medical Director, Owner of The Prevention Center for Heart & Brain Health. Learn more valuable information about heart health in her two books—Healthy Heart, Healthy Brain and Beat The Heart Attack Gene.  

Sources

1. Aizenbud I, Wilensky A, Almoznino G. Periodontal Disease and Its Association with Metabolic Syndrome-A Comprehensive Review. Int J Mol Sci. 2023 Aug 21;24(16):13011).
2. Bale BF, Doneen AL, Vigerust DJ. High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J. 2017 Apr;93(1098):215-220.
3. Bale BF, Doneen AL, Leimgruber PP, Vigerust DJ. The critical issue linking lipids and inflammation: Clinical utility of stopping oxidative stress. Front Cardiovasc Med. 2022 Nov 9;9:1042729.
4. Gomes-Filho, I.S.; Balinha, I.d.S.C.E.; da Cruz, S.S.; Trindade, S.C.; Cerqueira, E.d.M.M.; Passos-Soares, J.d.S.; Coelho, J.M.F.; Ladeia, A.M.T.; Vianna, M.I.P.; Hintz, A.M.; et al. Moderate and severe periodontitis are positively associated with metabolic syndrome. Clin. Oral Investig. 2020, 25, 3719–3727.