For Mala, 26, it all started with a tooth ache and swelling in her right jaw. Initially, she thought painkillers would solve the problem, but it didn’t. In fact, the delay led to dental cellulitis and the swelling made its way to her throat. She got weaker by the day and when she could take it no longer, her mother admitted her to a hospital in Bengaluru. Her infection had spread to other organs and she was diagnosed with multiple organ dysfunction syndrome. Mala survived three minor cardiac attacks. She had to go through a tracheostomy, which is a surgical procedure where an incision in the windpipe is made to relieve an obstruction to breathing. The infection needed to be sucked out through the tracheostomy tube.
After surgery, she was referred to Dr Srivats Bharadwaj and was treated for the infections in her mouth. “Contrary to popular believe, oral hygiene is not restricted to one’s teeth alone. It plays an important role in preventing heart attacks, uncontrolled diabetes, strokes among others. Also, many medical conditions can be detected with symptoms in the mouth,” says Bengaluru-based dentist Dr Srivats Bharadwaj, founder, CEO and chairman, Vatsalya Centre for Oral Health. According to doctors, oral health directly impacts the outcome of heart surgeries since our mouth harbours a few hundred kinds of bacteria which are either beneficial or are known to cause tooth decay and gum disease. The dangerous ones can also enter the bloodstream and travel to organs distant from the mouth, such as the heart, and cause health complications.
Some bacterias that cause periodontitis have been found in the atherosclerotic plaque in arteries and this can cause heart attacks. Oral bacteria can also harm blood vessels or cause clots by releasing toxins that resemble proteins found in artery walls or the bloodstream. The immune system’s response to these toxins could harm vessel walls or make blood clot easily. Inflammation in the mouth can also rev up inflammation throughout the body.
Dr Bharadwaj says, “Undetected dental infection can be predominantly hostile if you are undergoing surgery. Patients who need cardiac procedures, will also need clearances from a dentist.” According to him, when dental infections get to the heart, it results in Infective Endocarditis (IE) which can be fatal. “This is also associated with a high mortality rate, and therefore, preventing such infections are important.”
Awareness about oral health care among people is very less. People come to us only when the toothache is unbearable, says Bengaluru-based dental surgeon Dr Ashish Doyizode.
“The usual procedure that is done for a cardiac patient is cleaning, however, with a heart surgeon’s permission, we also do root canals and tooth extractions but this is much before the heart surgery date. A dental check-up once every six months in advisable.”
Tooth decay can cause cardiac complications for all age groups. Sample this, nine-year-old Deepak from Ashoknagar, Madhya Pradesh, was diagnosed with Ventricular Septal Defect with Eisenmengers syndrome and Pulmonary Artery Stenosis. His oral check-up before the cardiac surgery showed that he needed an oral prophylaxis and tooth extraction. Hubballi-based Dr Atul Sattur, Professor, Oral Medicine and Radiology, SDM College of Dental Sciences & Hospital, Karnataka, says: “Most of my patients are 50 years and above. And most don’t bother telling their dentists about their heart condition, if they are diabetic or have high or low blood pressure. Without case histories, it becomes difficult to treat patients. They usually come with problems such as tooth decay, abscess and infections. Only with their physician’s consent, certain medications are stopped to undergo dental procedures.”
Dr Bharadwaj says dental consent before cardiac valve replacement surgery is obligatory to get rid of any potential sources of infection. Mobile or shaky teeth, loose caps and bridges should be taken care of before any anesthetic procedure.
He adds that the best way to make sure that dental problems don’t aggravate your heart health is by ensuring that dental sealants are applied without fail. "Home oral care measures such as brushing, gum massage and healthy diet will go a long way in preventing oral health issues.”
Government health programmes focus on tobacco-related diseases rather than a holistic peridontal health issue which is necessary for the general well being of a person. So it becomes imperative on our part to create awareness on how doctors need to refer serious health cases to dentists, says Dr Sattur. Stressing the need for dental insurance, Dr Doyizode says, “With dental insurance lacking in India, heart patients are not prepared to spend money on oral health.”