______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
Disproportionate disease prevalence exists among certain populations in the United States. Results of a prospective, large, population-based study in the United States revealed that African American patients have a significantly higher risk of heart failure compared to White, Hispanic, and Chinese American patients (Lu et al., 2018). The statistics also indicate that both the age-adjusted death rate and premature death rate from strokes were higher for African Americans than for other groups. The risk of having a first stroke is about twice as high for African Americans compared to the risk for Caucasians, with the former having the highest death rates caused by a stroke (CDC, 2024b).
INTRODUCTION The oral presentation of microvascular diseases such as dia- betes is well documented, but many common cardiovascular conditions, including ischemic heart disease, also present with oral manifestations. In addition, patients with specific vascular diseases, such as granulomatosis with polyangiitis (formerly called Wegener’s granulomatosis ), may present with pathognomonic oral lesions. In some instances, oral involvement precedes the appearance of other symptoms or lesions at other locations. To aid in diagnosis and guide the approach to dental treat- ment, dental healthcare professionals should recognize oral manifestations of cardiovascular diseases and other systemic or multiorgan diseases with a vascular component. A thorough understanding of the potential oral side effects of therapeutic agents commonly used to treat cardiovascular diseases is very helpful in overall patient management. Given the prevalence of cardiovascular disease in the United States, dental profession- als and other healthcare providers are critical to the appropriate and safe delivery of oral healthcare to this patient population. This intermediate-level course addresses current concepts regarding the relationship between oral health and vascular and cardiovascular diseases, including the impact on oral health of common cardiovascular pharmacotherapies. This course is intended for dentists, dental hygienists, and dental assistants, as well as other healthcare professionals involved in the management of patients with selected vascular and cardiovascular diseases.
Self-Assessment Quiz Question 1
As a dentist, it is highly likely that you will treat patients with a history of having a previous heart attack. According to the latest information, which of the following statements is true? A) In the United States, someone has a heart attack every 40 seconds, affecting roughly 800,000 people. B) In the United States, someone has a heart attack every hour, affecting roughly 200,000 people. C) In the United States, someone has a heart attack every 3 hours, affecting roughly 175,000 people. D) In the United States, someone has a heart attack every 6 hours, affecting roughly 800,000 people. The correct answer is A. Rationale : In the United States, someone has a heart attack every 40 seconds, affecting roughly 800,000 people. About one in five heart attacks are silent, where the person is unaware of it. 695,000 people in the United States died from heart disease in 2021—one in every five deaths. PUTATIVE LINK BETWEEN PERIODONTAL DISEASE AND ACQUIRED CARDIOVASCULAR DISEASE Studies have reported a link between oral health and car- diovascular disease, which encompasses conditions such as congestive heart failure, infective endocarditis, cerebrovascular disease (stroke), and peripheral vascular disease (Kotronia et al., 2021). Although the relationship is complex and a causal relationship has not been confirmed, a growing number of studies are showing a weak to moderate statistically significant association between periodontal disease and cardiovascular disease (Leng et al, 2023).
EPIDEMIOLOGY OF CARDIOVASCULAR DISEASE
Despite declining overall death rates from cardiovascular heart disease and stroke, cardiovascular disease still poses a major disease burden in terms of mortality, morbidity, and health- related quality of life (Amini et al., 2021). Figure 1 shows the frequencies of selected circulatory diseases among American adults. The American Heart Association (Benjamin et al., 2019) reports that the most prevalent circulatory disease in the United States in 2019 was hypertension. Additionally, the CDC estimates that in 2023 approximately 38.4 million Americans had undiagnosed or diagnosed diabetes, a common endocrine disorder that has negative effects on the vascular system (CDC, 2023a). In the United States, someone has a heart attack every 40 seconds, affecting roughly 800,000 people. About 1 in 5 heart attacks are silent, where the person is unaware of it. 695,000 people in the United States died from heart disease in 2021— one in every five deaths (CDC, 2023c).
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