Oral bacteria and cardiovascular health: Difference between revisions

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==Section 3==
==Cardiovascular Disease==
Include some current research, with at least one figure showing data.<br>
As mentioned, there are several categories of heart disease. Cardiovascular disease is classified as any disease pertaining to the cardiovascular system outlined above. This includes disease of the coronary arteries, carotid artery, or peripheral arteries. Causes of heart disease can be environmental or genetic. Certain lifestyle choices can be beneficial to preventing heart disease such as increased exercise, reduced salt or fatty food intake, and not smoking.<ref name=uu>Wakim, S., & Grewal, M. (2021, September 4). Cardiovascular Disease. Butte College. https://bio.libretexts.org/@go/page/17137</ref>
Specifically looking at atherosclerosis, a disease of the arteries that is due to a buildup of plaque and fatty material, there is a clear increase in incidence with patients that also have chronic inflammatory diseases such as periodontitis.<ref name= hh/><ref name= uu/> Plaque consists of white blood cells (which are launched as an immune response), fatty substances, and cholesterol.<ref name=uu/>
There are certain biomarkers (a measure of what is happening within a cell at a certain time) that indicate heart disease. <ref name=qq/><ref name=rr>Biomarkers. National Institute of Environmental Health Sciences. (2022). Retrieved 16 April 2022, from Biomarkers(short%20for%20biological,warning%20systems%20for%20your%20health.</ref> These biomarkers include low-density lipoprotein (LDL) and C-reactive proteins (CRP). The presence of these biomarkers indicates the activation of pathways that indicate an infection.<ref name=qq/> Lipoproteins transport cholesterol which is a fatty substance in the blood. <ref name=ss> Lipoprotein(a): What it is, test results, and what they mean. Medicalnewstoday.com. (2022). Retrieved 16 April 2022, from https://www.medicalnewstoday.com/articles/lipoprotein-a-what-it-is-test-results-and-what-they-mean. </ref> There are two types of lipoproteins: high density lipoprotein (HDL) and low density lipoproteins (LDL). HDL is often referred to as good cholesterol and LDL bad cholesterol. <ref name=ss/> High levels of LDL is a major indicator of atherosclerosis. <ref name= tt> Grundy, S. (2002). Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy. Circulation, 106(20), 2526-2529. https://doi.org/10.1161/01.cir.0000038419.53000.d6 </ref> The ingestion of LDL causes lipid oxidation resulting in the formation of and accumulation of lipid products in the arterial vascular wall. High CRPs can be a predictor of future strokes or systemic arterial hypertension. They indicate that there is an infection or increased inflammation. They also play a role in endothelial cell dysfunction which as previously mentioned are essential for regulating the heart.<ref name=hh/> <ref name=jj/>
Another type of cardiovascular disease is infective endocarditis (IE). Infective endocarditis is the result of a bacterial infection on the endocardial surface of the heart <ref name= vv>Holland, T. L., Baddour, L. M., Bayer, A. S., Hoen, B., Miro, J. M., & Fowler, V. G., Jr (2016). Infective endocarditis. Nature reviews. Disease primers, 2, 16059. https://doi.org/10.1038/nrdp.2016.59</ref> The endocardium is a smooth and thin tissue that lines the chambers and valves of the heart.<ref name=ww>Gurarie, M. (2022). What to Know About the Endocardium. Verywell Health. Retrieved 16 April 2022, from https://www.verywellhealth.com/endocardium-definition-5088789#:~:text=The%20endocardium%20is%20a%20thin,and%20contains%20necessary%20blood%20vessels.</ref> There is an interaction between bacteraemia and the endocardium. Bacteraemia is an infection of the bloodstream (usually due to the presence of bacteria).<ref name=ww/> Invasive or pathogenic microorganisms and host immune system interaction with bacteraemia sometimes results in infection, affecting the endocardial tissue composition. Typically, the valvular endothelium resists bacterial colonization. However, with IE, the tissue is modified which produces a site for bacterial attachment and subsequently bacterial colonization.<ref name=ww/> <br>
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Revision as of 19:38, 16 April 2022

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Introduction

The photo credit for this image belongs to Linda Adair, who is a writer for Complete Dental [1][2].


Oral disease and Cardiovascular disease (CVD) are two incredibly prominent health issues in America. Oral disease and Cardiovascular disease (CVD) are two incredibly prominent health issues in America. Oral diseases or periodontal diseases are caused by infections or inflammation of the gums.[1] Periodontitis is an inflammatory disease of the tissues (gums). Gingivitis is an inflammation of the gingival sulcus which is the space between a tooth and gingival tissue. Lastly, dental caries include tooth decay, cavities, or general breakdown of teeth due to bacteria.[2] According to the CDC, 47.2% of adults who are 30 years or older and 70.1% of adults 65 years and older report having periodontal disease. Additionally, 56.4% of men report periodontal disease whereas 38.4% of women report it.[1]


Cardiovascular diseases are one of the leading causes of death for both men and women within the United States.[3] There are several types of heart disease including valvular heart disease, arrhythmias, hypertension, and atherosclerotic disease.[4] An estimated 560,000 people die due to CVD each year.[5] Other types of CVD include peripheral artery disease, congestive heart failure and stroke.[2]


Research in recent decades draws several connections between increased periodontal disease to increased risk of CVD.[4][6][7] There are several connecting factors such as systemic inflammation, bacteremia, and overlapping risk factors (i.e. smoking, diabetes, etc.).[8] Other studies done demonstrate reduction of certain markers of atherosclerotic cardiovascular disease. Over the course of 6 months of periodontal therapy resulted in the lowering of c reactive proteins, improvement of endothelial function, and a lowering of carotid intima thickness.[4] C reactive proteins (CRP) are produced by the liver and found in blood plasma. Rising CRP levels indicate increasing inflammation or the beginning of an infection.[9] The endothelium is a very thin membrane that lines the inside of the heart and blood vessels. Endothelial cells are critical to heart function because they release substances that control the heart beat (contraction and relaxation) and enzymes that regulate blood clotting, immune function and platelet adhesion. Platelets or thrombocytes are blood cells that form bone marrow and play a major role in blood clotting. The ability to clot is critical to controlling any type of bleeding. Any dysfunction of endothelial cells can be an indicator of heart disease, more specifically is a precursor to atherosclerosis.[10][11] Similar to endothelial dysfunction, thickening of the carotid intima (the inner two layers of the carotid artery) also indicates atherosclerotic disease.[12]


Given the severity, prevalence and ramifications of cardiovascular disease and periodontal disease, it is vital to understand the nature of the relationship between the two conditions. By identifying and studying the correlating or possible causal relationships, therapies and preventative measures can be developed.







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Oral Structure and Function

Our teeth are multilayered structures that connect to our jaw and form a functional relationship allowing us to chew, speak, and drink. The part that we see when we open our mouth is the dental crown which is covered by enamel, a tough bodily tissue that covers the surface. Below the surface is the tooth root.[13] Dentin is the tissue that makes up the tooth between the dental crown and the tooth root. It is within the enamel and cementum, however is not as tough as enamel.[13] Cementum is a connective tissue on the surface of the tooth root. It attaches the alveolar bone with the tooth by the periodontal ligament which is mainly fibrous tissue and prevents injury to the alveolar bone while we chew. The alveolar bone is the jaw bone that supports the tooth that is implanted in it. This structure is greatly affected by periodontal disease. Lastly are the gingiva and gingival sulcus. The gingiva is the soft tissue that surrounds the alveolar bone. It is commonly known as the gums. The gingival sulcus is a tiny space in between the tooth and the gums. This pocket grows due to inflammation. When it deepens, it is referred to as the periodontal pocket. [13]

Cardiovascular System

Our cardiovascular system is incredibly complex and central to our survival. It is fundamental to circulating oxygen and nutrients to our entire body and removing waste. It is made up of our heart and blood vessels distributed throughout our body.[14]) Our blood carries the oxygen, nutrients, and waste throughout our body. There are certain functions of the circulatory system such as vasodilation/vasoconstriction and coagulation. These functions play a role in maintaining the conditions of the heart. Especially vasodilation and constriction which affect blood pressure. Vasodilation and vasoconstriction are the widening and narrowing of blood vessels, respectively. When vasoconstriction occurs, blood flow to bodily tissues is limited and also results in increased blood pressure. High blood pressure can put undue stress on the heart.[15] Coagulation refers to the blood transforming into a semi-solid gel like state. This is the formation of a blood clot. To be able to clot is vital for survival. For example, if you scrape your knee and are bleeding, clotting occurs so that eventually, the bleeding will stop. This is critical so that people don’t bleed out anytime they get an injury (internally or externally).[16] The heart constantly works to circulate thousands of gallons of blood every day. Veins bring blood to your heart while arteries carry blood away.[14] Coronary arteries bring oxygenated blood to the muscle of the heart. These arteries wrap around the entire outside of the heart.[17]. Another important artery is the carotid artery. This is a major blood vessel that is responsible for transporting both blood and oxygen to the brain.[18] Two important circulation processes are pulmonary circulation and systemic circulation. Pulmonary circulation brings blood without oxygen that enters the right side of the heart to the lungs to be oxygenated and ensures the removal of carbon dioxide (waste). The now oxygenated blood enters the heart again through the left side. Systemic circulation takes the newly oxygenated blood that just reentered the left side of the heart out to the rest of the body’s cells to receive oxygen and nutrients.[14]

Cardiovascular Disease

As mentioned, there are several categories of heart disease. Cardiovascular disease is classified as any disease pertaining to the cardiovascular system outlined above. This includes disease of the coronary arteries, carotid artery, or peripheral arteries. Causes of heart disease can be environmental or genetic. Certain lifestyle choices can be beneficial to preventing heart disease such as increased exercise, reduced salt or fatty food intake, and not smoking.[19] Specifically looking at atherosclerosis, a disease of the arteries that is due to a buildup of plaque and fatty material, there is a clear increase in incidence with patients that also have chronic inflammatory diseases such as periodontitis.[8][19] Plaque consists of white blood cells (which are launched as an immune response), fatty substances, and cholesterol.[19] There are certain biomarkers (a measure of what is happening within a cell at a certain time) that indicate heart disease. [20][21] These biomarkers include low-density lipoprotein (LDL) and C-reactive proteins (CRP). The presence of these biomarkers indicates the activation of pathways that indicate an infection.[20] Lipoproteins transport cholesterol which is a fatty substance in the blood. [22] There are two types of lipoproteins: high density lipoprotein (HDL) and low density lipoproteins (LDL). HDL is often referred to as good cholesterol and LDL bad cholesterol. [22] High levels of LDL is a major indicator of atherosclerosis. [23] The ingestion of LDL causes lipid oxidation resulting in the formation of and accumulation of lipid products in the arterial vascular wall. High CRPs can be a predictor of future strokes or systemic arterial hypertension. They indicate that there is an infection or increased inflammation. They also play a role in endothelial cell dysfunction which as previously mentioned are essential for regulating the heart.[8] [10] Another type of cardiovascular disease is infective endocarditis (IE). Infective endocarditis is the result of a bacterial infection on the endocardial surface of the heart [24] The endocardium is a smooth and thin tissue that lines the chambers and valves of the heart.[25] There is an interaction between bacteraemia and the endocardium. Bacteraemia is an infection of the bloodstream (usually due to the presence of bacteria).[25] Invasive or pathogenic microorganisms and host immune system interaction with bacteraemia sometimes results in infection, affecting the endocardial tissue composition. Typically, the valvular endothelium resists bacterial colonization. However, with IE, the tissue is modified which produces a site for bacterial attachment and subsequently bacterial colonization.[25]

Section 4

Conclusion

References

  1. ↑ 1.0 1.1 Eke PI, Dye B, Wei L, Thornton-Evans G, Genco R. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. J Dent Res. Published online 30 August 2012:1–7.
  2. ↑ 2.0 2.1 Kholy, K., Genco, R., & Van Dyke, T. (2015). Oral infections and cardiovascular disease. Trends In Endocrinology &Amp; Metabolism, 26(6), 315-321. https://doi.org/10.1016/j.tem.2015.03.001
  3. ↑ Centers for Disease Control and Prevention. Underlying Cause of Death, 1999–2018. CDC WONDER Online Database. Atlanta, GA: Centers for Disease Control and Prevention; 2018. Accessed March 12, 2020
  4. ↑ 4.0 4.1 4.2 Dietrich, T., Webb, I., Stenhouse, L. et al. Evidence summary: the relationship between oral and cardiovascular disease.Br Dent J 222 , 381–385 (2017). https://doi.org/10.1038/sj.bdj.2017.224
  5. ↑ Virani SS, Alonso A, Aparicio HJ, Benjamin EJ, Bittencourt MS, Callaway CW, et al. Heart disease and stroke statistics—2021 update: a report from the American Heart Association. Circulation. 2021;143:e254–e743.
  6. ↑ Mathews, M.J., Mathews, E.H. & Mathews, G.E. Oral health and coronary heart disease. BMC Oral Health 16, 122 (2016). https://doi.org/10.1186/s12903-016-0316-7
  7. ↑ Friedewald, V.E., Kornman, K.S., Beck, J.D., Genco, R., Goldfine, A., Libby, P., Offenbacher, S., Ridker, P.M., Van Dyke, T.E. and Roberts, W.C. (2009), The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Journal of Periodontology,80: 1021-1032. https://doi.org/10.1902/jop.2009.097001
  8. ↑ 8.0 8.1 8.2 Lockhart, P., Bolger, A., Papapanou, P., Osinbowale, O., Trevisan, M., & Levison, M. et al. (2012). Periodontal Disease and Atherosclerotic Vascular Disease: Does the Evidence Support an Independent Association?. Circulation , 125(20), 2520-2544. doi: 10.1161/cir.0b013e31825719f3
  9. ↑ C-Reactive Protein (CRP) | Labcorp. Labcorp.com. (2022). Retrieved 16 April 2022, from https://www.labcorp.com/help/patient-test-info/c-reactive-protein-crp.
  10. ↑ 10.0 10.1 Endothelial Function Testing | Cedars-Sinai. Cedars-sinai.org. (2022). Retrieved 16 April 2022, from https://www.cedars-sinai.org/programs/heart/clinical/womens-heart/conditions/endothelial-function-testing.html#:~:text=The%20endothelium%20is%20a%20thin,substance%20in%20the%20blood)%20adhesion.
  11. ↑ Topics, H. (2022). Thrombocytopenia | Platelet Disorders | MedlinePlus. Medlineplus.gov. Retrieved 16 April 2022, from https://medlineplus.gov/plateletdisorders.html#:~:text=Platelets%2C%20also%20known%20as%20thrombocytes,injured%2C%20you%20start%20to%20bleed.
  12. ↑ Carotid Intima-Media Thickness Test (CIMT) | Cedars-Sinai. Cedars-sinai.org. (2022). Retrieved 16 April 2022, from https://www.cedars-sinai.org/programs/heart/clinical/womens-heart/conditions/cimt-carotid-intima-media-thickness-test.html.
  13. ↑ 13.0 13.1 13.2 The Roles and Structure of Teeth｜Lion Corporation. Lion.co.jp. (2022). Retrieved 15 April 2022, from https://www.lion.co.jp/en/oral/role/01.htm
  14. ↑ 14.0 14.1 14.2 (What Is Your Cardiovascular System?. Cleveland Clinic. (2022). Retrieved 15 April 2022, from https://my.clevelandclinic.org/health/body/21833-cardiovascular-system.
  15. ↑ Vasodilation: Your Blood Vessels Opening. Healthline. (2022). Retrieved 16 April 2022, from https://www.healthline.com/health/vasodilation.
  16. ↑ Coagulation - Wikipedia. En.wikipedia.org. (2022). Retrieved 16 April 2022, from https://en.wikipedia.org/wiki/Coagulation.
  17. ↑ Coronary arteries - Wikipedia. En.wikipedia.org. (2022). Retrieved 16 April 2022, from https://en.wikipedia.org/wiki/Coronary_arteries.
  18. ↑ Macleod, M. (2022). PubMed: http://www.pubmed.org. Retrieved 16 April 2022, from https://www.hopkinsmedicine.org/health/conditions-and-diseases/carotid-artery-disease
  19. ↑ 19.0 19.1 19.2 Wakim, S., & Grewal, M. (2021, September 4). Cardiovascular Disease. Butte College. https://bio.libretexts.org/@go/page/17137
  20. ↑ 20.0 20.1 Cite error: Invalid <ref> tag; no text was provided for refs named qq
  21. ↑ Biomarkers. National Institute of Environmental Health Sciences. (2022). Retrieved 16 April 2022, from Biomarkers(short%20for%20biological,warning%20systems%20for%20your%20health.
  22. ↑ 22.0 22.1 Lipoprotein(a): What it is, test results, and what they mean. Medicalnewstoday.com. (2022). Retrieved 16 April 2022, from https://www.medicalnewstoday.com/articles/lipoprotein-a-what-it-is-test-results-and-what-they-mean.
  23. ↑ Grundy, S. (2002). Low-Density Lipoprotein, Non-High-Density Lipoprotein, and Apolipoprotein B as Targets of Lipid-Lowering Therapy. Circulation, 106(20), 2526-2529. https://doi.org/10.1161/01.cir.0000038419.53000.d6
  24. ↑ Holland, T. L., Baddour, L. M., Bayer, A. S., Hoen, B., Miro, J. M., & Fowler, V. G., Jr (2016). Infective endocarditis. Nature reviews. Disease primers, 2, 16059. https://doi.org/10.1038/nrdp.2016.59
  25. ↑ 25.0 25.1 25.2 Gurarie, M. (2022). What to Know About the Endocardium. Verywell Health. Retrieved 16 April 2022, from https://www.verywellhealth.com/endocardium-definition-5088789#:~:text=The%20endocardium%20is%20a%20thin,and%20contains%20necessary%20blood%20vessels.



Authored for BIOL 238 Microbiology, taught by Joan Slonczewski, 2022, Kenyon College

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