Flu-related complications potentially more likely in perio patients

The Set-Up

“With the emergence of new clinical data, health care professionals are becoming increasingly aware of the interrelationship of oral and systemic disease. In this article, Dr. Kelly Blodgett considers the possible connection of different inflammatory diseases,” Dr. Peter O. Cabrera, Team Lead

Given all the talk in the media about the H1N1 virus, chances are your patients are even more concerned than usual about coming down with the flu. But it’s your patients who have periodontal disease who really should be aware of their risk for contracting the flu and the possible complications they might experience if they do.

People with chronic periodontitis may be more prone to developing complications such as heart attack, pneumonia and stroke after having a major viral illness, such as the seasonal flu or H1N1^7-10. That’s why it’s so important for oral health professionals, who are on the “front lines” of fighting chronic infections, to place a heavy emphasis on managing periodontal disease to minimize other systemic health issues.

The purpose of this article is two-fold: First, to review the relationship between periodontal disease and cardiovascular disease. Secondly, to consider the pathophysiology of an influenza A infection as it relates to the cardiovascular system. Perhaps this will motivate us to help our patients seek appropriate treatment for their chronic oral infections.

Periodontal disease and stroke

There are studies that point to a relationship between periodontal disease and stroke. In one study that looked at the causal relationship of oral infection as a risk factor for stroke, people diagnosed with acute cerebrovascular ischemia were found more likely to have an oral infection when compared with those in the control group³.

Heart disease and perio

Within our profession, we now accept that there is a relationship between periodontal disease and the prevalence of cardiovascular disease. The oral cavityis an easy place for bacteremia to enter an otherwise sterile cardiovascular system. The incidence of bacteremia following oral health procedures such as tooth extraction, endodontic treatment, periodontal surgery and scaling and root planing is well documented¹. It takes less than one minute after an oral procedure for microorganisms from the infected site to reach the heart, lungs and peripheral capillary systems².

Different theories exist to explain the link between periodontal disease and heart disease. One theory is bacteria from the oral cavity can affect the heart when they enter the blood stream, attaching to fatty plaques in the coronary arteries and contributing to clot formation. These blood clots can obstruct normal blood flow, restricting the amount of nutrients and oxygen required for the heart to function properly. This may lead to heart attacks³.

Another possibility is that inflammation caused by periodontal disease increases intravascular plaque build up, which may contribute to artery swelling. Researchers have found people with periodontal disease are almost twice as likely to suffer from coronary artery disease as those without periodontal disease.

The take home message here is patients who have chronic periodontitis (particularly when it is untreated) may have a higher risk of developing heart disease than those who don’t have gum disease.