Inflammation and Oral Systemic Connection

Daniel Vinograd


We’re going to get started here in about five minutes, and for those that are early, thank you for being on time.  I’m just going to run through housekeeping items as the group assembles here.

First, a few calendar items.  We’re going to be talking today about really fascinating medical science that has to do with periodontal disease and overall health.  A lot of just fascinating information today.  On the calendar, let me just mention a couple things.  One, the end of this month, September 28 and 29, is the Nomar Hygiene Seminar featuring Tommy Nabors and myself and members of the Tops team.  That will be in Nashville.  In December, we are looking forward to our year-end roundtable, and if you’ve never attended a Tops Crown Council Roundtable event, it is a must-do, and you can get more information about that by calling the toll-free service (877) 399-8677.  So, that is the first Saturday, the end of November to December.  We’re really looking forward to the Crown Council annual event, January 24-26, 2013, in Nashville as well.  This appears to be the biggest annual even ever, and great enthusiasm.  The enrollment is over-the-top.  We’re very excited.  If you have not signed up for that, contact the Crown Council office today because hotel space is very limited now at this point.  There will be never-done-before and maybe never-done-again events at this one.

Of course, everyone is aware we’re going to kick off the annual event Thursday with a big event at the Ryman Theater, home of the country music and the Country Music Hall of Fame. It’s the mother church of country music with an All Star lineup of some of the biggest names in country music.  Celebrate smiles for life, and we’re very excited about that.

Speaking of smiles for life, we just wrapped up the 2012 Smiles for Life campaign.  Total money raised was $1.3, and thanks to everyone who participated and made that really a continuing miracle.  Over the last 13 years, we’ve raised over $31,250,000 dollars for children’s charities.  So, thanks for everything you do every year to make that possible and make a difference in children’s lives.

For those that are anxiously awaiting the checks for your local charity, they are being mailed today.  The check is literally in the mail.  They are being mailed to the doctor.  Just a reminder, the reason why we send the Smiles for Life checks to the doctor in the name of the local charity is so that you can organize a check presentation ceremony where you can make that official, instead of dropping it in the mail.  We hope that you’ll use the check opportunity as a way to get additional publicity for your office and your community.

A few housekeeping items.  For those of you that may not have joined us before on a webinar, we have record attendance today, and we are very excited about that.  There is a high degree of interest in this topic.  So, you are aware, you are in listen only mode.  You can hear us, but cannot hear you so we can have a clear broadcast and everyone can hear our guests today.  There is, in your control panel, on your computer screen, there is a question box.  You’re welcome to submit questions anytime during the presentation.  We will have a question an answer period near the end of the hour, and we will take those questions on a first come, first serve basis.  Again, you’re welcome to submit those at any time, and we will address those on a first come, first serve basis and hopefully get through all of the questions.

With that, let me introduce today’s topic.  I am very excited about this. This webinar today has been long in the making.  I sat down several years ago, here in Dallas, with Dr. Tom Nabors whom everyone knows as dentistry’s expert when it comes to periodontal disease and bacterial testing.  He is the pioneer in the industry in bacterial testing.  If I’m overstating, Tom, I’m sorry, but he has done the whole industry in America a whole lot of good.  He’s with us today, and we’ll be presenting along with Dr. Bradley F. Bale.

Dr. Bale who is an MD, it would take me a half hour to read you his biography of everything he has done in the medical world.  So, I’m going to sum it up with this:  This is a man who is constantly presenting to medicine and health care professionals all over the world.  He is one of the most sought out experts in terms of heart disease and the topic we’re going to talk about today.  He is the only physician that we know of in America who guarantees his patients that they will not have a heart attack if they remain under his care.  We don’t know of anyone else that does that.  He talks about it.  He just shrugs his shoulders, “Of course.  I don’t know why everyone shouldn’t do that.”  When you understand the science of what he talks about today, it really becomes pretty common sense.

So, I’m very excited to have the two of them today to share this joint venture between dentistry and medicine and how the two professions can work better together in helping cure one of the prevalent diseases in chemistry and to be able to screen for one of the most prevalent problems we have in healthcare and medicine.  With that, welcome Dr. Bale, Dr. Nabors.  Thank you for being our guests for today for our Crown Council webinar.

Dr. Bale:              Thanks, Steve.  Dr. Nabors, why do you go ahead and say a few words first.  Then, I’ll take over.

Dr. Nabors:         Sure.  Let me thank Steve and Greg Anderson.  Thank you so much for the good works that you have done in the dental profession.  Let me also thank the Crown Council listeners.  This is a special brew, and we are so proud to be a part of this presentation today, so privileged to be a part of the Crown Council on continuing education. Congratulations on all of the good works that you continue to do.  With that, I’ll turn it over to Dr. Bale.

Dr. Bale:              Okay.  Great.  I appreciate the opportunity, Steve, to address your Council because I know addressing oral medicine individuals who realize the important of maintaining excellent oral in terms of also maintaining cardiovascular health.  It’s always been a pleasure to address and share information with individuals who we can partner with in our efforts to keep people from heart attacks and ischemic strokes.

So, I just want to give you the overall outline of what we’re going to cover today.  The first thing we’re going to do is give you a sense of the overall burden of cardiovascular disease and periodontal disease.  Then, we want to share with you some of the information that links periodontal disease with cardiovascular disease.  We’ll a bit about the recent American Heart Association conclusions about the systemic connection.  Then, we’ll tell you about a course that’s available now in dental economics that I have a pleasure of creating along with Dr. Nabors and my partner, Amy Doneen.  I should mention, Amy knows this subject as well or better than I do.  She’s sorry she can’t be on this webinar, but she’s traveling to San Antonio where I am right now because we’re getting ready to give a two-day course to health care providers.  So, she gives you her best, and hopefully you’ll get to meet her sometime.

Then, we will end with a bit about a course that we’re going to deliver November 2nd in regards to the oral systemic connection.

So, in terms of periodontal disease incidents, we have excellent, very recently published information published online on August 30th.  That’s pretty hot off the press, and it was the best assessment that’s ever been done for the incidents of periodontal disease in the United States.  They actually did full mouth exams that’s never been done before.  They based the definition of periodontal disease on attachment loss and pocket depth.  What they found was shocking to some people, that’s for sure.  I don’t think I was that shocked because Dr. Nabors already informed me how prevalent periodontal disease is in this country.

This study shows that basically half of Americans aged 30 or older have periodontal disease, and about 60% of that periodontal disease was classified as moderate.  About 20% is mild, and about 20% is severe.  Individuals 65 years of age or older, 70% of Americans have periodontal disease.  That’s huge.  I mean it’s got to be ranked up there as the top chronic disease in the United States, and as you know, it’s highly associated with cardiovascular risks as well as type II diabetes.  A lot of individuals with periodontal disease are not aware of it.

In terms of cardiovascular disease, it remains the number 1 killer in this country.  Every 39 seconds, someone dies of cardiovascular disease, and that’s an endpoint nobody can argue with.  In terms of the age for cardiovascular death, about 150,000 in this country die of cardiovascular disease for the age 65, which robs the mat least 13 years of life.

So, the issue is huge with cardiovascular disease as it is with periodontal disease.  A study was published in July looked to see is an adult more likely to have a noncardiovascular death or are they more likely to have a cardiovascular death, fatal or nonfatal?  The study showed that American adults are 2 to 3 times more likely to suffer cardiovascular death, fatal or nonfatal, than to have a fatal noncardiovascular death.

So, we need to enlist the help of all health care providers, certainly the dental community needs to be very involved in the effort to eradicate this unacceptable cardiovascular risk to the American population.

In the year 2009, the American cardiologists along with the American periodontists certainly recognized this issue, and they confirmed the connection between cardiovascular disease and periodontal disease.  They have outlined the known mechanisms by which they are related, and they specified some treatments that could be delivered.  They called for the collaboration of the two fields of health care to work on reducing cardiovascular risk.

In 2010, the European Society of Cardiology basically stated the same thing that oral health does influence cardiovascular health and that we have to start working together in order to reduce the unacceptable risk.

Our method, the Bale/Doneen method in which we do guarantee our results, and I should mention the guarantee may shock you.  Our patients understand it.  It carries no malpractice connotation.  So, we just feel we have evolved to the point where you can, with reasonable assurance, make a guarantee that the patient won’t have a heart attack.  We haven’t had a patient have a heart attack in over 10 years, but if you’re going to do that, you’re going to have a comprehensive approach.  That approach certainly has to include oral health.

We now have Level A evidence showing independent association between periodontal disease and cardiovascular risk.  So, all prevention programs for cardiovascular disease have to include the oral/systemic connection.

So what is the evidence that periodontal disease could impact cardiovascular risk factors?  Well, there are numerous risk factors we know about periodontal disease.  The impacts I’m just going to share with you.  In one study published not long ago, they looked at over 650 healthy subjects who were 35 or older, and they were tested for periodontal bacteria, the four bacteria that are known to carry significant cardiovascular risk.  That’s A.a, Porphyromonas gingivalis, Tannerella forsynthensis, and Trepnoma denticola.

What they found was very interesting:  The individuals who had the highest tertile of burden of these bacteria had significantly higher blood pressure, 9 mmHg for the systole and 5 mmHg for the diastole.  That increase in blood pressure creates very significant increase risk for ischemic stroke and heart attack.  They found the patients in that highest tertile were three times more likely to be hypertensive, and they did make a lot of adjustments before they came up with that figure.

So, the study was interesting in that it was a concentration of bacteria as opposed to the clinical diagnosis of periodontal disease that carried the risk of increased blood pressure.  So, this is certainly evidence that subclinical periodontal disease can have significant cardiovascular impact, and perhaps we need to think of a diagnosis of periodontal disease that includes bacterial burden.

There are lots of other known cardiovascular risk factors periodontal disease is associated with such as the cholesterol issues, the blood sugar involved in type II diabetics, and, in particular, associations with biomarkers that we know indicate arterial inflammation.  If you come to the course we’re going to deliver in November, we’ll be showing the recently published data published in the journal Lancet that actually demonstrates inflammation is causal of cardiovascular disease.  That’s a huge statement.  To show something that’s causal is difficult, but this data indicates that indeed arterial inflammation is involved in the formation of build-up of plaque along the walls of the artery.  It’s involved in the triggering of events, the heart attacks and the ischemic strokes.  We do have evidence that periodontal disease impacts, in an unfavorable way, all of the biomarkers we use in our work to tell if the artery’s hot, if it’s inflamed.  If it’s inflamed, the patient is in peril.

We’re also going to be discussing toll-like receptors in the course, which gets into the nitty-gritty science about how the inflammation is triggered, and we’ll relate that to periodontal disease.  So, there is evidence that periodontal disease is associated with the formation of disease in the wall of the artery.

In 2008, the United States Services Task Force certainly concluded that was the case.  They did a very extensive review of the literature, excellent studies, and concluded that periodontal disease is an independent risk factor for coronary heart disease.  There are lots of other evidence in that regard, and we’ll be presenting a lot of that data in our course in November.  Certainly, it’s fascinating that the data about their demonstrating the presence of these periodontal pathogens within the plaque that’s in the wall of the arteries.  We’ll answer that question, how can it happen, how can it get in there.  We’ll talk about that in our November course.

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One Response to “Inflammation and Oral Systemic Connection”

  1. Ruth Martin says:

    Your webinars sound so informative. Would be interesting to be in on one sometime. My mother has taught us to be natural health oriented.

    Is low blood sugar/pressure something to be concerned about? I have not been diagnosed, but I struggle with being hungry all the time, and if I don’t eat soon enough, I feel faint and/or dizzy/sick.

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Dr. Daniel Vinograd, DDS |
10450 Friars Rd, San Diego, CA 92120 |
Phone: 619-630-7174    •    Dr. Vinograd, DDS, is a Dentist in San Diego, CA, offering services as a periodontist, and providing teeth whitening, dental crowns, invisalign, implants, lumineers, dentures, root canals, holistic, family and cosmetic dentistry.

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