Dedicated to Dental Department at the Cuban Hospital in Qatar.
After several years studying the subject of cardiovascular disease early in life and with some papers published recently about it (1-5) I can say that nowadays, as health care providers, we are facing several cardiovascular disease contributing risk factors (hypertension, obesity, smoking, unhealthy diet, etc.) which prompts a large burden on our shoulders as they keep leading to a long-lasting and quite steady worldwide prevalence of heart conditions, stroke, kidney failure, premature death and disability for the last 20 years. (6)
Even, children and adolescents are not spared from this. For instance, according to the latest European (7) and North American Guidelines about the subject (8), the prevalence of high blood pressure in children and adolescents ranges between 3 to 11 % and rises up to 40 % when obesity is in place as well.
The above mentioned is a known fact that unfortunately is ongoing with some ups and downs but continue to be a pending endeavor yet to be solved by the medical community. Thus, I do not want to dwell on it on this post.
At the moment, I am more interested on reflecting how these spotlighted main risk factors might be blindfolding us from seeing “little facts” that are having also an impact on the complex setting related with the development of cardiovascular disease and sadly are often overlooked.
In this light, there is one fact which is not as publicized as the main risk factors mentioned above which is critical my opinion. I am referring to the buccal hygiene and its links to cardiovascular disease.
To get started, it is worth mentioning that the surfaces of the human body are heavily colonized by a varied microbial ecosystem called the microbiota, in other words, this is a mixed community of microorganisms composed of bacteria, viruses, archaea, and eukaryotic microbes that coinhabit in our body . The gathering of those microbes and their genes is named the human microbiome and each person has a unique microbiome which varies along with our genetic background, age and life style (9)
As per the aim of this paper, I will point out at the oral microbiome, which is considered one of the most highly dynamic ecosystems in the human body.
According to the latest investigations, the estimated number of bacteria in the mouth is up to 100 billion and comprised nearly 700 identified bacterial species being the most prevalent Firmicutes and Proteobacteria, along with Bacteroidetes, Actinobacteria, and Fusobacteria (10)
Though, the oral microbiome is dynamic in terms of functioning, as ecosystem must be stable in its composition and structure. Any disruption in it leads to a state called dysbiosis.
Recently, multiple animal and human studies have examined the relationship between the oral microbiome disruption (dysbiosis) and blood pressure and have reported important insights explaining such links.
The most important proposed links to hypertension would be the following:
- Increasing sympathetic nervous system activity.
- Inflammation and endothelial dysfunction with vascular remodeling (11)
The above links, in turn are known triggering factors for high blood pressure through complex mechanisms beyond the scope of this article.
Now, I will lay out a question: How many time have you been asked by a doctor (no a dentist) in a clinic when feeling some cardiac-like symptoms about your buccal hygiene habits?
The response to this question will come later…
When one looks into it, it is remarkable how deeply has dug the investigations on this subject. While it is true that some years back several scientific papers had found associations between periodontal disease due to an increased subgingival colonization by A. actinomycetemcomitans, P. gingivalis, T. forsythia and T. denticola and hypertension (12)
Now we know that more than associations there are proven links when going deeper into the oral microbiome, where apart from microbes we are studying genes (microbiome). Keep in mind that associations and causation are different concepts.
In this line, the investigation are aiming at seeking the attenuation of the microbiome system when dysregulated of disrupted.
The aim is wider now. It is not any longer to advice only about obesity, smoking, etc. It is also about to explore on unhealthy habits when it comes to buccal hygiene.
Now we know that these “little and usually forgotten things” as to caution a patient about his or her oral hygiene or how many times he or she has gone lately to a dentist may make a difference and contribute to a more comprehensive care.
We must never forget that the principal cause of coronary artery disease and all its variants (acute myocardial infarction, unstable angina, sudden death, etc.) is arterial hypertension.
I will recap by responding the previous question I set above:
How many time have you been asked by a doctor (no a dentist) in a clinic when feeling some cardiac-like symptoms about your buccal hygiene habits?
This is my personal, honest and first-hand opinion: Doctors dealing with patient being hypertensive or with others cardiac conditions barely or never ask about it.
Then, when you travel into the complexity of cardiovascular disease, one simple question and the timely step to be taken can make the difference.
Those who have eyes see it, those who have brains think over it.
Note. This is an excerpt of a scientific paper I just sent to a scientific journal that has been modified to fit the posting writing.
To be continued…..
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1- Pérez Fernández GA. Hipertensión arterial en la adolescencia. Riesgo, daño y predicción. Publicia: ISBN 978-3-639-55244-7; 2013. (Available at https://www.editorial-publicia.com/catalog/details//store/es/book/978-3-639-55244-7/hipertensi%C3%B3n-arterial-en-la-adolescencia-riesgo,-da%C3%B1o-y-predicci%C3%B3n
2- Perez Fernandez GA. Interacciones novedosas entre factores de riesgo cardiovasculares. Resultados del estudio PESESCAD-HTA. Rev Chil Pediatr. 2017;88(3) Noviembre – Diciembre (Available as ahead on line at: http://www.revistachilenadepediatria.cl/index.php/rchped/issue/view/8)
3- Perez Fernandez GA. Prediction of cardiovascular disease from the early stages of life: A forgotten issue? Qatar Medical Journal 2016; 1(6). DOI: 10.5339/qmj.2016.6. (available at: http://www.qscience.com/doi/full/10.5339/qmj.2016.6)
4- Pérez Fernández GA, Grau-Abalo R. From the prehypertensive adolescent to the hypertensive adult. Is possible to predict the conversion?. Arch Cardiol Mex. 2012 Apr-Jun;82(2):112-9. Spanish. PubMed PMID: 22735651.
5- Perez Fernandez GA. Hypertensive heart disease in adolescence. preliminary results of the PESESCAD-HTA study. Hipertens Riesgo Vasc. 2012; 29:75-85.
6- Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the United States: National Health and Nutrition Examination Survey, 2011–2012. NCHS Data Brief(2013) 133:1–8.
7- Flynn JT et al.Clinical practice guideline for screening and management of high blood pressure in children and adolescents. Pediatrics 2017 Aug 21; [e-pub]. (http://dx.doi.org/10.1542/peds.2017-1904)
8- Lurbe E, Agabiti-Rosei E, Cruickshank J, Dominiczak A, Erdine S, Hirth A, et al. 2016 European Society of Hypertension guidelines for the management of high blood pressure in children and adolescents. J Hypertens. 2016 vol: 34 (10) pp: 1887-1920.
9- Yang T, Santisteban MM, Rodriguez V, Li E, Ahmari N, Carvajal JM, et al. Gut dysbiosis is linked to hypertension. Hypertension(2015) 65(6):1331–40.
10- Desvarieux M, Demmer RT, Jacobs DR Jr, Rundek T, Boden-Albala B, Sacco RL, Papapanou PN. Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens. 2010 Jul;28(7):1413-21.
11- Odamaki T, Kato K, Sugahara H, Hashikura N, Takahashi S, Xiao JZ, et al. Age-related changes in gut microbiota composition from newborn to centenarian: a cross-sectional study. BMC Microbiol 2016.16:90.10.1186/s12866-016-0708-5.
12- Desvarieux M, Demmer RT, Jacobs DR Jr, Rundek T, Boden-Albala B, Sacco RL, Papapanou PN.Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens. 2010 Jul;28(7):1413-21.