Sullivan, Yasner and KazemiDrs Sullivan, Yasner and Kazemi, Specialists in Periodontics Dental Implants1416 Brace Road, Cherry Hill NJ 08034

1416 Brace Road Cherry Hill, NJ 08034-3523 tel 856 795 8020 fax 856 795 9785

Gum Diseases

Periodontal & System Diseases

Cardiovascular Diseases

During the course of practice we frequently consult with physicians, especially cardiologists, regarding the cardiovascular status of our patients undergoing periodontal treatment. Usually we are interested in issues related to antibiotic pre-medication to prevent SBE, interruption of anti-coagulant therapy prior to surgery, and the use of vasoconstrictors in our local anesthetics. The purpose of this article is to make you aware of two additional factors which may have important effects on both the periodontal and cardiovascular health of our patients.

Periodontal Disease as a Risk Factor for Cardiovascular Diseases

Periodontitis is influenced by many of the same risk factors as cardiovascular disease, such as smoking and diabetes. Recent evidence indicates that the presence of periodontitis is itself a risk factor for CVD. Higher levels of morbidity and mortality due to CVD have been seen in patients with periodontitis when compared to control populations. This finding is independent of other risk factors and may be related to bacteremias of periodontal pathogens inducing thromboembolic events. It has been suggested that Streptococcus sanguis may induce platelet aggregation when it enters the bloodstream as part of a bacteremia. The viridans group of streptococci may also have the potential to produce thromboembolic diseases in humans. We are expecting to see additional research efforts to better define the nature and mechanism of this relationship. In the meantime, as Dr. Robert Genco of S.U.N.Y. Buffalo says, "floss or die!"

Nifedipine (Procardia) Induced Gingival Hyperplasia

The increased use of Nifedipine (Procardia) has resulted in a periodontal side effect. Mild to severe overgrowth of the gingiva can occur in patients on Nifedipine and other calcium channel blockers. This reaction is similar to the drug induced gingival enlargement seen in patients taking Phenytoin (Dilantin) and Cyclosporine. This "Nifedipine induced gingival hyperplasia" tends to be more severe when it occurs in the presence of periodontal inflammation and infection (gingivitis and periodontitis). The overgrowth can become disfiguring and have adverse side effects on normal health and function. Appropriate periodontal treatment can usually correct these problems. Occasionally, changes in medications may need to be considered as well.

Close communication and consultation between general dentist, periodontist and physician is essential to management of patients at risk for cardiovascular disease. While we are accustomed to having medical conditions effect the health of our patient's gingiva, here we have yet another example of how our patient's oral health may have an influence on their systemic well being.

References:

Beck JD, Garcia RI, Heiss G, Vokonas PS and Offenbacher S. Periodontal disease and cardiovascular disease. J. Periodontol. 1966; 67 (10, supplement):1123-1137.

DeStefano F, Anda RF, Kahn HS, Williamson DF and Russell CM. Dental disease and risk of coronary heart disease and mortality. Br. Med. J. 1993; 306: 688-691.

Herzberg MC, Meyer MW. Effects of Oral Flora on Platelets - Risks of Cardiovascular Disease. J. Peridontology 1966; 67 (10, supplement):1138-1142.

Nishikawa SJ, Tada H, Hamaski A et al. Nifedipine-induced gingival hyperplasia: a clinical and in vitro study. J.Periodontology 1991; 62: 30-35.

Wynn RL. Update on Calcium Channel Blocker - induced gingival hyperplasion. Periodontal Insights 1996; 3(1): 7-10.