Generations of Smiles | Issue 13

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issue feb ‘24

Generations of Smiles Oral Health Means Better Health <3 Your Heart & Your Smile

Quality care from sea to shining sea.

The Mouth-Body Connection® Takes Flight If you’ve ever been on a plane, you’ve probably heard the following announcement: “Please return your seat backs and tray tables to their full upright position. Stow loose items overhead or beneath the seat in front of you. And don’t forget to see your dentist.”

OK. That last line isn’t something flight attendants typically say. But I wish they would.

Just as air travel can increase a person’s risk of stroke and pulmonary embolism, so, too, does periodontitis, or gum disease.1 That is why many doctors now recommend that people at high risk of stroke and cardiovascular disease stay up-to-date on their oral health.2 In a 2023 study, researchers discovered that the risk of stroke was 2.5 times higher in people with periodontitis.3 And a separate study found gum disease increased a person’s risk of cardiovascular disease by 1.2 times.4 Treating cavities, receiving regular dental cleanings and maintaining healthy teeth and gums can go a long way to protecting yourself against blood clots and disease. Unfortunately, the CDC reports that 26% of U.S. adults have untreated dental cavities.5 It is time for the Mouth-Body Connection® to take flight.

So, if it has been a while since you’ve traveled to your dentist, book your next visit. Maintaining your oral health can keep your smile beautiful – and your heart health soaring.

Until next time,

Dr. Carolyn Ghazal, DDS

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Contents If You <3 Your Heart, Tell Your Dentist About It Research shows that people with blood clots are more likely to have gum disease? Tell me more.

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Deep Vein Thrombosis: A Rare Complication of Oral Surgery It’s rare but still good to know about this potential oral surgery complication.

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Oxidative Stress - The Link Between Dentistry and Medicine World renowned cardiovascular expert Amy Doneen, DNP, shares the key to understanding the link between cardiovascular disease and periodontal disease.

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Meet Amy Doneen, DNP A name worth knowing for anyone interested in understanding heart health.

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Smile Stories This heartwarming video features our partership with Special Olympics.

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If You Your Heart, tell your dentist about it When singers croon about having the kind of smile to take a person’s breath away, they’re probably not referencing the relationship between periodontal disease and venous thromboembolism (VTE).

But that’s the tune Lulu Tang, D.M.D., practice owner of Sahara Modern Dentistry in Las Vegas, Nevada, has been singing to her patients – particularly to those who are at increased risk of vascular disease.

“One of our goals as dentists is to help people make the connection between their oral health and their systemic health,” Dr. Tang said. “You can look in the mirror and say, ‘I brush my teeth, I floss, I’m fine,’ but you need regular checkups to see below the surface.”

This is particularly true for people at risk of cardiovascular conditions, like VTE. VTE blocks the flow of blood and oxygen to tissues and organs and 6

can even lead to pulmonary embolism, a potentially fatal block of oxygen to the lungs. VTE also includes deep vein thrombosis (DVT), a clot in a vein deep in the body, which kills about 100,000 Americans each year according to the Centers for Disease Control and Prevention.1 What does oral health have to do with these potentially fatal conditions?

Research shows that the association between periodontal disease and VTE comes down to inflammation.2 Inflamed gums release certain proteins into the body that are associated with heart disease, pulmonary embolism and stroke.3 In fact, the inflammatory bacteria released by periodontitis, or gum disease, can increase a person’s risk of VTE by 30%.4

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“When I meet patients for the first time, we talk deeper about their medical history and their family history, and we discuss how bacteria in the mouth don’t stay in the mouth,” Dr. Tang said.

“They travel through the body, where they can cause a lot of damage.”

Helping patients understand that connection empowers them to take their health into their own hands.

"While there are several risk factors associated with VTE, preventing and treating gum disease can go a long way to protecting yourself against this potentially fatal condition," said Dr. Tang.

“When they have multiple medical appointments already, they’re exhausted. They look at their dental appointments and think they just don’t have the energy or time for them,” she said.

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“What we are hoping to do is connect the dots for them: periodontal disease is a chronic condition that requires regular treatment. And preventing periodontal disease requires regular visits, just like preventing heart disease or anything else.”And like other chronic conditions, prevention is the key to overall health.5 “We have had some patients who were able to get off of some of their heart medications just by being consistent with their dental appointments,” Dr. Tang said. “It’s rewarding for us as dentists, and empowering for the patients.” As an added bonus, maintaining your oral health is a fairly low-cost and easy thing to do.

No scales, fad diets or medications involved. “Just like you go to the cardiologist to check your heart health, go to the dentist to check on your periodontal health,” Dr. Tang said.

So, the next time you want to show your heart a little love, make an appointment with your dentist. You could end up with a smile to make hearts melt … and make your own heart a little healthier.

Deep Vein Thrombosis:

A Rare Complication of Oral Surgery Deep Vein Thrombosis (DVT) is a potential but rare complication of oral surgery. The risk in oral surgeries is less than 1 percent compared to 10-40 percent for hospital surgeries.1 DVT occurs when a blood clot forms in veins that are either injured or the blood flowing through them is too slow after surgery.2 In most cases, DVT affects veins in the legs, but can also occur in other parts of the body.

Symptoms can include leg swelling and pain, tenderness, cramping or soreness originating in the calf, skin color changes (red or purple), and warmth in the affected area. Sometimes, there are no symptoms.3

When DVT happens, it can be dangerous and even deadly.

If a piece of the clot breaks away and travels through the veins into the lungs, it can cause blockage called a pulmonary embolism.3 The initial treatment for DVT is a category of medications commonly known as blood thinners.4 9

Oxidative Stress The Link Between Dentistry and Medicine Dr. A my Doneen , DNP

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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

Chronic periodontal disease affects upwards of 70% of adults in the U.S. 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 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 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

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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 get routine pathogen testing, 3D conebeam evaluation for endodontic lesions, more frequent hygiene visits and optimal home oral healthcare and formal sleep evaluations.

Likewise, the medical community must enforce the importance of oral health and airway health, get routine inflammatory biomarker testing, and treat to optimal blood pressures and weight goals with genetically guided nutritional counseling and 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.

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Amy Doneen, DNP Medical Director, Owner of The Prevention Center for Heart & Brain Health Clinical Associate Professor Washington State University College of Medicine Adjunct Professor Texas Tech Health Sciences, School of Nursing Assistant Professor University of Kentucky College of Dentistry

Meet Amy Doneen Amy Doneen, DNP, is a world-renowned cardiovascular specialist and co-founder, along with Bradley F. Bale, MD, of the Bale/Doneen 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.

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Increasing Access to Care Smile Generation partners with Special Olympics International to support athletes in their journey to finding great dental care and understanding the importance of good oral hygiene. Together we are bridging the gap that patients with intellectual disabilities have in receiving comprehensive oral healthcare.

Join us in signing Special Olympics’ Inclusion Pledge.

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Healthie Happ Generations of Smiles A Smile Generation Magazine

LET'S DO THIS AGAIN! The Smile Generation exists to connect you with trusted dentists in your area and to offer education on the critical link between oral and overall health. We’d love to know what you think of our magazine.

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Sources The Mouth-Body Connection® Takes Flight 1. American Academy of Nureology 2. AHA Journals 3. BioMed Central 4. CDC -Heart Disease

If You <3 Your Heart, Tell Your Dentist About It 1. AHA Journals 2. National Library of Medicine Periodontal Disease 3. National Library of Medicine Systemic Markers 4. Wiley Online Libary 5. Heart.org

Deep Vein Thrombosis: A Rare Complication of Oral Surgery 1. PubMed Central 2. Cleveland Clinic 3. Mayo Clinic 4. Harvard Health

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Oxidative Stress – The Link Between Dentistry and Medicine 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.

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