The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition _ _____________________
One hypothesis is that oral bacteria and their metabolic products directly affect the vascular endothelium. Researchers hypothesize that periodontal inflammation activates mono- cytes and macrophages, which consequently enter vessel walls and produce cytokines (Liccardo et al., 2019). The cytokines then promote additional systemic inflammatory responses, eventually damaging the endothelial vasculature (Liccardo et al., 2019). Additionally, several researchers have reported the presence of periodontal bacteria in atheromatous plaque (Czerniuk et al., 2022). In one study, the same type of periodontal bacteria ( Aggregatibacter actinomycetemcomitans ) was found in an indi- vidual’s subgingival plaque, blood, and blood vessels, provid- ing evidence of spread via bacteremia (Czerniuk et al., 2022). In 2019, the European Federation of Periodontology along with the World Heart Federation published their consensus report detailing the evidence that there are significant associa- tions between periodontitis, cardiovascular disease, and the effects of periodontal therapy on cardiovascular outcomes (Sanz et al., 2020). The effect of nonsurgical mechanical periodontal treatment on cardiovascular disease markers has also been examined. Over the course of several visits, dental professionals treated patients who had severe untreated chronic periodontitis. The visits included oral hygiene instruction, monitoring of oral health, supragingival and subgingival scaling, and root planing using manual and ultrasonic tools. Two months after treatment, the median values of C-reactive protein (CRP) had decreased (Saquib et al., 2023). SIGNS, SYMPTOMS, AND ORAL MANIFESTATIONS OF CARDIOVASCULAR DISEASES AND DIABETES As part of a patient’s overall healthcare team, dental profes- sionals must know the signs and symptoms of cardiovascular disease, diabetes, and other systemic illnesses, as well as how these diseases can manifest in the oral cavity. RHEUMATIC HEART DISEASE Acute rheumatic fever, an inflammatory disease more com- mon in developing nations than in industrialized areas, often develops following pharyngitis caused by group A streptococcal infection. Symptoms and manifestations include heart murmur or heart failure, arthritis, chorea, subcutaneous nodules, rash, fever, high inflammatory markers, and evidence of streptococ- cal infection. Valvular damage caused by acute rheumatic fever can result in rheumatic heart disease. However, patients who have never had symptoms of acute rheumatic fever can also present with rheumatic heart disease (Franczyk et al., 2022).
Self-Assessment Quiz Question 2
As part of a patient’s overall healthcare team, dental profes- sionals must know the signs and symptoms of cardiovascular disease, diabetes, and other systemic illnesses, as well as how these diseases can manifest in the oral cavity. Symptoms and manifestations of rheumatic heart disease include which of the following? A) Arthritis
B) Rash C) Fever D) All of the Above The correct answer is D.
Rationale : Symptoms and manifestations include heart murmur or heart failure, arthritis, chorea, subcutaneous nodules, rash, fever, high inflammatory markers, and evidence of streptococcal infection. Valvular damage caused by acute rheumatic fever can result in rheumatic heart disease. However, patients who have never had symptoms of acute rheumatic fever can also present with rheumatic heart disease. INFECTIVE ENDOCARDITIS Infective endocarditis is an infection of the endocardium, the inner lining of the heart chambers and valves. Bacteria, fungi, or other microbes enter the bloodstream and produce biofilms that can consequently cause infection (Cuervo et al., 2021). Although the incidence of infective endocarditis remains stable, its epidemiological profile has changed. The incidence caused by Staphylococcus aureus has increased, now making S. aureus the most common causative organism for infective endocarditis in industrialized nations. Infective endocarditis occurs in 50-70% of patients with acute rheumatic fever and can result in long-term disability and death (CDC, 2022a). Patients with subacute infective endocarditis may have fever, fatigue, flulike symptoms, a mild fever which ranges from 99 to 101 degrees Fahrenheit, sweating, and anemia. Patients with acute bacterial endocarditis usually present with a high fever (102 to 104 degrees Fahrenheit), tachycardia, fatigue and raid and extensive heart valve damage (CDC, 2022a). Because oral cavity procedures cause bacteremia, dental profes- sionals must be aware of ways to prevent infective endocarditis, including considering the use of antibiotic prophylaxis for at- risk dental patients (Hollingshead & Brizuela, 2024). However, the American College of Cardiology and the American Heart Association currently recommend prophylaxis only for patients at highest risk (Thornhill et al., 2022). Compared with other physical manifestations, the oral manifestations of infective endocarditis are relatively trivial but include mucous mem- brane pallor and multiple small petechiae that do not blanch under pressure. The petechiae gradually fade after several days. Larger, slightly elevated purpuric lesions may also be seen and are usually tender to palpation.
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