INTRODUCTION:
Coronary heart disease.
Coronary
heart disease is
also known as ischemic heart disease[1]. Atherosclerotic
heart disease[2]. It
is the
common type seen and which falls within the group of cardiovascular disease.[3]
Coronary heart
disease is a disease in which a waxy substance known as plaque builds up inside
the coronary arteries ie, the arteries which supply the heart. These arteries
supply oxygen rich blood to the heart muscles. The plaque get builder up over
many years and when the plaque which gets formed in the arteries, the condition
is called atherosclerosis. In a period of time these plaque gets harden and
they narrows the coronary arteries, causing reduced flow of oxygen rich blood
to the heart. If the plaque gets ruptured
A blood clot can
get form in the systemic circulation. If the blood clot becomes larger in size
it can mostly or completely block the blood flow through the coronary artery.
Limitation of blood flow to the
heart causes ischemiaof
the myocardial cells. Myocardial cells may die from lack of oxygen and this is called a myocardial
infarction which
is known as the heart attack commonly. It leads to heart muscle damage, heart muscle death and later myocardial
scarring without heart muscle regrowth. Chronic high-grade
stenosis of the coronary arteries can induce transientischemiawhich leads to the induction of
a ventricular arrhythmia which may terminate into ventricular fibrillation leading to death. A common
symptom is chest pain or
discomfort which may travel into the shoulder, arm, back, neck, or jaw.[4]
Stable angina is
termed for chest pain that is seen usually after eating and is associated with
narrowing of the arteries that supplies the heart. If there is an increase in
the intensity or frequency or character then it is termed as unstable angina.
Unstable angina may lead to myocardial infarction. Patients reporting emergency
in the hospital with an unclear cause of pain, about 30% have pain due to
coronary heart disease.[5]
Usually symptoms occur with
exercise or emotional stress and it lasts maybe for few minutes.[4]
High blood
pressure, high blood cholesterol, obesity and lack of exercise, diabetes,
smoking, high alcohol consumption, depression are the major risk factors
causing the coronary heart disease.[6][7][8]
Serum LDL
concentrations, HDL concentrations has a protective effect over development of
coronary artery Disease.[9] High blood triglycerids also plays a role in this disease.[10] High levels of lipoprotein a[11]-[13]
a compound
formed when LDL cholesterol combines with a protein known as apoprotein a.
Dietary cholesterol does not appear to have a significant effect on blood
cholesterol and thus recommendations about its consumption may not be needed.[14] Coronary angiogram
and electrocardiogram can be used for the diagnosis of the disease.[15]
Oral hygiene:
Oral hygiene
differs in relation with the corresponding systemic diseases. Patients who are
Suffering from cardiac problems often are affected by dental diseases. Especially
they are affected by the periodontal diseases. Many adults in the U.S. currently have
some form of the disease. Periodontal diseases range from simple gum
inflammation to serious disease that results in major damage to the soft tissue
and bone that support the teeth. In the worst cases, teeth are lost. Periodontal
pathology is a
science or a study of periodontal diseases. Periodontal diseases can affect one
or more of the periodontal tissues. The periodontal tissues include periodontal
ligament, alveolar bone, cementum and gingiva. While there are many different periodontal
diseases that can affect these tooth-supporting tissues, by far the most common
ones are plaque induced
inflammatory conditions,[16] such as gingivitis and periodontitis.[17] Often the term periodontal disease orgum disease is used as a synonym for
periodontitis, specifically chronic periodontitis. While in some sites or individuals,
gingivitis never progresses to periodontitis,[18] studies show that periodontitis is always preceded by
gingivitis.[16] Plaque
gets deposited on the tooth. The longer plaque and tartar are on teeth, the more harmful they
become. The bacteria cause inflammation of the gums that is called
“gingivitis.” In gingivitis, the gums become red, swollen and can bleed easily.
Gingivitis is a mild form of gum disease that can usually be reversed with
daily brushing and flossing, and regular cleaning by a dentist or dental
hygienist. This form of gum disease does not include any loss of bone and
tissue that hold teeth in place. When gingivitis is not treated, it can advance
to “periodontitis”. The term Periodontitis refers to the inflammation around
the tooth. In periodontitis, gums pull away from the teeth and form spaces that
become infected. The spaces formed are clinically termed as periodontal
pockets. The
body’s immune system fights the bacteria as the plaque spreads and grows below
the gum line. Bacterial toxins and the body’s natural response to infection
start to break down the bone and connective tissue that hold teeth in place. If
not treated, the bones, gums, and tissue that support the teeth are destroyed.
The teeth may eventually become loose and have to be removed. Smoking, hormonal
changes, genetic factor, diabetes, other systemic illness and medications are
some of the risk factors for the susceptibility of the periodontal disease. A dental hygienist procedure
called scaling
and root planning is
the common first step in addressing periodontal problems, which seeks to remove
calculus by mechanically scraping it from tooth surfaces.
DISCUSSION:
Studies report
that people with periodontal disease or with few or no teeth experience an
elevated risk of cardiovascular disease. Chronic infection with inflammation
and change in diet are the proposed pathways linking tooth loss and
cardiovascular disease.[19] Using an index based on the severity of
caries, periodontitis, periapical lesion and pericoronitis they found that
patient admitted to hospital for acute
myocardial infarction had high scores on the dental index than matched matched
controls of the population. Adults in United States have an average of 10-17
decayed, missing or filled teeth and most of them have experienced periodontal
disease.[20] Periodontal pathogensas, for example Bacteroides forsythus
(Tannerellaforsythensis), Porphyromonas gingivalis,
and Prevotellaintermedia, have been identified in atherosclerotic plaques as well
as in human aortic and coronary endothelium.[21] Infectious agents
relevant in oral health such as Streptococcus
sanguis and actinobacillus, actinomycetemc omitans have also been shown to
have possible direct effects contributing to the pathogenesis of
atherosclerosis and thrombosis. Oral hygiene index seemed to have an stronger
association, indicating that oral health indices may be general indicators
personal health behaviour Instead of being casually related to coronary heart
disease.[22] Research studies continue
to investigate the possible relationship between periodontal disease and
cardiovascular disease. Some studies have shown that bacteria in the mouth that
are involved in the development of periodontal disease can move into the blood stream
and cause an elevation in C-reactive protein, a marker for inflammation in the
blood vessels. These changes can, in turn, increase the risk of heart disease
and stroke. It has been suggested that periodontal disease-associated bacteria can
penetrate gingival tissues and enter the blood stream. Periodontal disease
associated bacteria could enter the blood stream and play a direct or or indirect
trole in the Progress ionofstenotic coronary artery plaque lesions.[23] Periodontal
disease cause by the gram negative bacteria found in the oral flora is common
among the adults. Over time the bacterial endotoxins in the mouth may enter the
systemic circulation through gingival connective tissue causing vascular
injury.[24] Hitherto, studies on a possible connection between
periodontal disease and atherosclerosis have focused on the prevalence of over tatherosclerotic
disease or clinical cardiovascular events in patients affected by this disease.
There sultsofthese studies strongly suggest that thereis an association between
periodontal disease and increased incidence of coronary artery disease,
myocardial infarction and cerebro vascular events.[21]
Both dental and
cardiac disease have several risk factors in common like diabetes and smoking.[25]
The cause of coronary heart disease is due to several risk factors such
as high serum cholesterol concentration, low serum high density lipoprotein
cholesterol concentration, diabetes, hypertension, smoking.[26]
The higher
concentration of total cholesterol, apart from being atherosclerotic risk factor,
may be the result of periodontitis related alteration in lipid metabolism.[21]
Role of smoking acts as a risk factor for both periodontal disease and
heart disease.[27] Cardiovascular disease in children complicates
the dental care by making them more susceptible to infective endocarditis ,
increase the risk associated with general anaesthesia and for those children
who are taking warfarin there is the risk of prolonged bleeding. About one baby
in hundred is born with a cardiac defect.[28] Acute myocardial
infarction patients had worse dental health. There lation between dental health
and acute myocardial infarction, however, remained significant even after adjustment
for age, social class, hypertension, serum lipid and lipoprotein
concentrations, smoking, presenceof diabetes and serum C peptide concentration.
A link between dental caries and ischemic heart disease may also be derived
from diet.[26] In men, high numbers of carious teeth and retained
roots, indicating poor oral health care, were associated with the risk of Coronary heart disease.[22]
Patients with high
alveolar bone loss at the baseline had a significant increased risk of
developing heart disease. There is also an approximate two fold increased risk
of fatal coronary heart disease and three fold Increased risk of stroke.[24]
Studies show that there is a positive independent relation between
carotid intima Media thickness and the cumulative periodontal bacterial burden.[29]
Analyses reveal that the prevalence of carotid plaque increases substantially
and peaks among individuals missing 10 to 19 teeth compared with those missing 0
to 9 teeth. When one loses teeth previously affected by periodontal disease, the
evidence of the cumulative effect of period ontitisisremoved while the systemic
damage may partly persist.[30]
There is also a
significant relationship between HDL levels and number of gingival pockets and
gingival inflammation. Periodontal disease influences the blood lipid
concentration and thereby the risk of coronary heart disease.[25]
CONCLUSION:
Both, the coronary
heart disease and the oral diseases especially the periodontal disease have
positive relationship. As they both maintain a positive relationship and also
other systemic disease maintain the same relation with the periodontal disease,
proper care and control should be taken for the coronary heart disease and
other systemic disease which may help us to maintain a proper oral hygiene. The
rate of incidence of the periodontal disease is equal in both males and
females.
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