______________________ The Impact of Vascular and Cardiovascular Diseases on Oral Health, 4th Edition
ISCHEMIC HEART DISEASE Ischemic heart disease results from narrowed heart arteries, which restrict blood flow. Consequently, the heart receives less oxygen-rich blood (AHA 2022). Ischemic heart disease (also known as coronary heart disease, coronary artery disease ) occurs when plaque accumulates on the inner walls of coronary arter- ies, narrowing and stiffening them. Besides restricting blood flow to the heart, plaque buildup increases the likelihood of blood clot formation. Blood clots that completely or partially restrict blood flow may cause a heart attack (NIH 2022c). A common symptom of ischemic heart disease is angina pectoris. Angina pectoris is a feeling of pressure, pain, or discomfort in the chest (NIH, 2022c; Joshi and De Lemos, 2021). Besides the chest, patients can also experience angina in the shoulders, arms, neck, jaw, or back. The discomfort may resemble a toothache or pressure-like pain. On rare occasions, patients may describe a burning sensation in the tongue and hard palate. Myocardial ischemia-induced orofacial pain gen- erally occurs along with chest pain, although a small number of patients may present with the orofacial region as the only site of discomfort. Ironically, in 6% of patients, craniofacial pain may be the first and only symptom of cardiac ischemia (Kaur 2023). The pain is generally short-lived (less than 15 minutes) unless an infarc- tion is occurring. Emotional and physical stress can precipitate angina pectoris in the dental office. Other orofacial manifestations of angina pectoris are related to antianginal medications such as nitroglycerin. (See the discussion in the section on oral presentations and symptoms resulting from the use of common cardiovascular agents). MYOCARDIAL INFARCTION Myocardial infarction , also known as a heart attack , occurs when the flow of oxygen-rich blood to the heart ceases. The most common symptom is chest pain. As with angina pectoris, myocardial infarction in some patients may manifest as chest pain that radiates to the head and neck (Mayo Clinic, 2018; Kikuta, et al, 2019). The pain is more often in the mandible and is described as pressure or a dull ache, usually concurrent with retrosternal pain. Typically, the pain is reduced (but not eliminated) by nitroglycerin. Emotional and physical stress in the dental office can precipitate a myocardial infarction. However, unlike angina, the pain usually does not stop after a few minutes. Other symptoms of myocardial infarction include discomfort in the arms, back, neck, jaw, or upper part of the stomach; shortness of breath; nausea, vomiting, light-headedness, fainting, or breaking out in a cold sweat; and sleep problems, fatigue, or lack of energy (NIH 2023). It has been shown that “periodontal bacteria are able to invade both human coronary artery endothelial cells and coronary artery smooth muscle cells, so persons with periodontal infec- tion have greater risk of myocardial infarction” (Borgnakke, 2015, p. 900).
Self-Assessment Quiz Question 3
Infective endocarditis is an infection of the endocardium, the inner lining of the heart chambers and valves. _______ is the most common causative organism for infective endocarditis
in industrialized nations. A) Pyrophormonas gingivalis B) Fusobacterium C) Staphylococcus aureus D) Bacterioides The correct answer is C.
Rationale : Bacteria, fungi, or other microbes enter the blood- stream and produce biofilms that can consequently cause infection. 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. VALVULAR HEART DISEASE Valvular heart disease results if one or more of the four heart valves do not function properly. Heart valve problems can result in regurgitation, stenosis, or atresia. During regurgita- tion, blood leaks back into the heart instead of forward through the heart or into the arteries (i.e., backflow). Stenosis prevents the heart valve from fully opening, and atresia occurs if a heart valve is missing an opening through which blood can flow (NIH, 2022a). The primary sign of valvular heart disease is a heart murmur. Such defects can compromise cardiac output and produce signs of hypoxia such as cyanosis of the lips and oral mucosa. Other symptoms include unusual fatigue; swelling in ankles, feet, legs, abdomen, and neck veins; and shortness of breath (NIH, 2022b). HYPERTENSION About 119 million adults (48.1%) aged 18 and older in the United States have hypertension. Hypertension , also known as high blood pressure , is generally defined as systolic blood pres- sure of 130 mmHg or higher or diastolic blood pressure of 80 mmHg or higher (CDC 2023a). Hypertensive patients may have gingival bleeding, and those with malignant hypertension may present with facial nerve paralysis (Ietropaoli, et al, 2020). Many of the oral manifesta- tions associated with hypertension result from the adverse effects of antihypertensive drug therapy. These oral manifesta- tions include hyposalivation, lichen planus-like lesions, gingival lesions, and gingival enlargement (Frazin, et al., 2016).
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