Your Mouth Is a Window to Heart Health

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By Rachel Hedstrom

A healthy smile is great for your attitude — but did you know it can also be crucial for good heart health?

The American Heart Association recently released a study that says brushing your teeth twice a day for at least two minutes may lower your risk of cardiovascular diseases. Previous studies found a link between heart disease and periodontal disease, a condition marked by gum infection, gum inflammation and tooth damage.

What does your mouth have to do with your heart?

Everything, says Dr. Barbara McClatchie, a dentist at Complete Health Dentistry of Columbus in Worthington, Ohio. As the first dentist in the U.S. who shares her practice with a cardiologist, they look at what’s happening in a patient’s mouth to see what might be happening with their heart.

“We like to say, ‘On a good day, we save a smile. On a great day, we save a life.’ That’s how important this is,” she says.

Seven years ago, Dr. McClatchie began doing saliva tests on her patients, looking for high-risk oral bacteria that affect other areas of the body. Of those bacteria, five are related directly to cardiovascular disease. “You don’t know how at-risk you are until you have an objective test like this,” she explains, “but it’s an oral-systemic connection. What happens in your mouth travels through your bloodstream and to your heart.”

Dr. McClatchie has devoted her career to dental health. But it all changed when she heard a talk from Drs. Brad Bale and Amy Doneen, authors of Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease, Stroke, and Diabetes.

They also created the Bale-Doneen Method, which focuses on identifying signs of inflammation before it surfaces as cardiovascular disease, and Dr.
McClatchie realized that oral health was also a window into future cardiac issues.

“That’s when I realized I could save someone’s life,” she says.

Sharing Hearts

Dr. McClatchie knew that a partnership with a physician — preferably a cardiologist — could help her fulfill her vision of systemic health for her patients. She didn’t have to look far, since her husband, Dr. Eric Goulder, is a cardiologist. “When we go to American Academy of Oral Systemic Health meetings, we are known as ‘the match made in heaven,’” she laughs.

Dr. Goulder had worked in a hospital setting for more than 35 years, practicing what he refers to as “standard of care cardiology.” “We were being asked to see more and more people in less time, and essentially, we were putting Band-Aids on problems. You have a heart attack, you get a stent and I’ll see you back in five years for another heart attack and stent. It goes on and on, but it doesn’t get to the root of it. Now, we are able to use information to look for the ‘why’ under all of this,” he says.

Their practice is the first in the U.S. to combine dentistry and cardiology in this unique way, and they expect others will follow. Patients come from all parts of the U.S. and even countries like Russia. Because insurers don’t cover it, the practice is considered concierge medicine, where patients pay with cash. Dr. McClatchie says that as the medical community understands more about good preventive care, she hopes this approach will become the new standard. “Everyone is so sick that they’re just seeing and treating end-stage disease. Meanwhile, we are seeing and reversing inflammation and infection so we can avoid disease.”

Gathering and using information is key to this oral-systemic approach, Dr. McClatchie emphasizes. She tests her patients’ saliva for key markers of bacteria and inflammation.

Dr. Goulder’s patients receive an evaluation and blood work at least once a quarter, as well as genetic testing and inflammatory testing to look at markers besides just cholesterol and blood sugar. They also receive carotid intima-media thickness testing (CIMT) to measure the thickness of the inner two layers of the carotid artery — the intima and media — and alert Dr. Goulder to any thickening, even before patients show symptoms. Dr. Goulder’s patients also receive frequent teeth cleanings from Dr. McClatchie. “I can’t keep my people from having heart attacks and strokes if I can’t have a dentist to work with who understands what my patients need,” Dr. Goulder says.

Saving Lives

A shift in perspective to keeping people well before a cardiac event occurs is one that can save lives. Dr. McClatchie says she loses count of those close calls, but their stories remain close to her heart. An old acquaintance of hers is one of those stories.

Needing a new dentist, this friend had come to see Dr. McClatchie. His health history had “red flags” all over it: His dad had had a stroke and died of a heart attack; he now had high cholesterol and blood pressure himself in addition to sleep apnea.

“We did the saliva test, and he lit up the screen with bad bacteria,” Dr. McClatchie says. “He had 43 sites of bleeding in his gum evaluation.” She ordered a 3D cone beam scan and found that he had calcification in his carotid artery. Dr. Goulder ordered a CIMT performed, and this patient’s results came back that his cardiac “age” was 20 years older than his numeric age.

“Does he know any of this? No, he just knows he has bad cholesterol and high blood pressure,” Dr. McClatchie says.

Now a patient of both Dr. Goulder and Dr. McClatchie, this patient has achieved good results. His markers for inflammation are down, and he has reduced the sites of bleeding in his mouth down to three. Dr. McClatchie sent him for a sleep study with an apnea appliance from another provider, which was found to be ineffective, so Dr. McClatchie is addressing that as well.

“Had he not walked into this office, he’d have periodontal disease, soft plaque and sleeping issues that could have caused a cardiac event at any time. We have lots of those good stories,” she says.

Dental Health and You

For anyone interested in reducing their risk of a cardiovascular event, whether they’ve had one before or not, prevention is key. Dr. Goulder stresses the importance of working with your dentist to ask the right questions: Do I have periodontal disease? Do I have bleeding on probing? Do I have pockets of four millimeters or more? If so, don’t we need to know what kind of bacteria is there? “You want to know what kind of bacteria is present in your mouth so we, as physicians, can look for systemic inflammation driven by the oral bacteria,” he says.

“On your X-ray, is there any evidence of carotid disease on that? Do they see calcifications there? Ask for a CIMT.”

“More people see their dentist than see their physician,” Dr. McClatchie says, “so look for a complete health dentist. Have them look for signs and symptoms of periodontal disease, bleeding gums, odor, mobile teeth and self-monitor your blood pressure daily.”

“We’re making such an impact on people’s lives,” Dr. McClatchie says. “Dentistry has come a long way.