Dr. Mark J. Weingarden

Newly released clinical recommendations encourage cardiologists to examine the    mouth and periodontists to ask questions about heart health.

 CHICAGO – June 1, 2009 – Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day.  Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other. 

A consensus paper on the relationship between heart disease and gum disease was recently published concurrently in the online versions of two leading publications, the American Journal of Cardiology (AJC), a publication circulated to 30,000 cardiologists, and the Journal of Periodontology (JOP), the official publication of the American Academy of Periodontology (AAP).  Developed in concert by cardiologist, the physicians specializing in treating diseases of the heart, and periodontists, the dentists with advanced training in the treatment and prevention of periodontal disease, the paper contains clinical recommendations for both medical and dental professionals to use in managing patients living with, or who are at risk for, either disease.  As a result of the paper, cardiologists may now examine a patient’s mouth, and periodontists may begin asking questions about heart health and family history of heart disease. 

The clinical recommendations were developed at a meeting held earlier this year of top opinion-leaders in both cardiology and periodontology.  I addition to the clinical recommendations, the consensus paper summarized the scientific evidence that links periodontal disease and cardiovascular disease and explains the underlying biologic and inflammatory mechanisms that may be the basis for the connection. 

According to Kenneth Kornman, DDS, PhD, Editor of the Journal of Periodontology and a co-author of the consensus report, the cooperation between the cardiology and periodontal communities is an important first step in helping patients reduce their risk of these associated diseases.  “Inflammation is a major risk factor for heart disease, and periodontal may increase the inflammation level throughout the body.  Since several studies have shown that patients with periodontal disease have an increased risk for cardiovascular disease, we felt it was important to develop clinical recommendations for our respective specialties.  Therefore, you will now see cardiologists and periodontists joining forces to help our patient.” 

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist.  The clinical recommendations outlined in the consensus paper advise that periodontists not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk. 

To find out if you are at risk for periodontal disease, visit our website at www.pittsburghimplantsandperio.com.   Look under the Services tab and check out the section entitled, “Maintaining Your Periodontal Health”.   Or call Dr. Weingarden’s office at 412-487-8288.

Presently, the perception is that osteonecrosis has a very low incidence associated with oral bisphosphonates.  However, most of the information that I find available includes relatively limited term usage of these drugs – approximately three years.

However, I frequently see patients who have taken bisphosphonates for five, ten, twelve or more years!  To my knowledge, we are in uncharted territory regarding the risk of increased incidence of osteonecrosis for these patients.  What we do know is that these drugs accumulate with a perhaps undefined or unknown half-life, and the percentage of vital bone likely diminishes with usage over time.   

Unfortunately, the incidence of very significant, untreated, periodontal disease is on the rise.  I am seeing on a very regular basis, (as are periodontists across the country), patients presenting with increasingly advanced periodontal conditions.  This dramatic increase in disease severity, along with the extended usage of bisphosphonate drugs, can be potentially dangerous. 

It is also important to note that even advanced periodontal disease is most often completely without symptoms, and that fewer than 50% of general dentists today examine their patients for periodontal disease. Therefore, I am strongly encouraging physicians to refer their patients to a periodontist for dental clearance, prior to initiating bisphosphonate therapy.  With this minimal effort, we could greatly reduce the risk of osteocrenosis for our patients.

 I welcome your input or questions regarding this subject.

 Sincerely,

Mark J. Weingarden, D.M.D.

markjerome@msn.com

www.pittsburghimplantsandperio.com

By Jane Brody, Published November 16, 2009 

If I have one serious regret about my age, it is that my permanent teeth developed before New York, my hometown, got fluoridated water.  I first lost a permanent molar to decay in my early 20’s, and the resulting bridge has had to be replaced several times in subsequent decades, ultimately as a four-part apparatus. 

Now that has to go as well.  Because I could not floss and clean properly under the bridge and between the supporting crowns, I developed a severe periodontal infection. 

Dr. Michael Zidele, the young periodontist I consulted, took one look at my mouth and said: “This is not how we do restorations nowadays. A bridge is not a permanent solution and makes it too hard for most people to keep their gums and underlying bone healthy.  Now we do implants and individual crowns where needed.” 

More out of curiosity than distrust – and before I invested thousands of dollars and countless hours on new teeth – I did my own homework and got a second opinion.  Dr. Zidile, I learned, is correct.  In an overwhelming majority of cases, implants to replace lost teeth are by far the best long-term solution for maintaining a healthy mouth.  Also, because they rarely need to be replaced, in the long run they are more economical than bridges. 

Implants for replacing lost teeth have come a long way in the 25 years since I last wrote about them in this column.  Better materials, procedures and professional experience result in far fewer problems than occurred in the early years of implants.

Critical to their success, however, is proper selection of both patients and practitioners – and, after the implants, a commitment to good oral hygiene.  Dental implants must be treated like natural teeth: kept clean and free of plaque through proper brushing, flossing and periodic professional cleanings. 

“Bridges are not the standard of care anymore,” Dr. Lawrence J. Kessler, a periodontist and associate professor of surgery at the University of Miami School of Medicine, told me in an interview. “For most people who lose teeth, implants are the treatment of choice”.