HEALTH MATTERS: Gum disease not a cause of heart disease

Q. I’ve heard people say that gum disease can cause heart disease. Is that true?

A. Except for one situation that I’ll discuss shortly, the answer is no.

For many years there was a concern that people with gum disease were predisposed to coronary heart disease (disease of the blood vessels that feed the heart and cause heart attacks when blocked up) and stroke. After all, it is known that all three conditions are associated with inflammation, and thus there was a supposition that inflammation in the gums might lead to inflammation in the blood vessels in the heart or brain. However, a review of over 500 scientific papers that looked at this found no evidence of an association between gum disease and heart disease or stroke.

Now that doesn’t mean you can skip flossing—quite the contrary. It is important to maintain good dental hygiene to avoid bigger problems in the mouth. It’s just that preventing gum disease will not appreciably lower your risk of heart disease or stroke. But there is one situation where gum and dental disease can lead to heart problems, and that’s when bacteria from the mouth can cause an infection inside the heart. It turns out that in predisposed individuals the bugs that grow in the mouth and on the gums can travel through the blood stream and infect the heart.

To prevent this serious complication, we give antibiotics to at-risk patients before they have gum or dental procedures—even something as seemingly innocuous as dental cleaning. This prevents the bacteria from growing on the heart valves and causing major problems. Who is at risk and should get antibiotics? Only those with prosthetic valves, a prior episode of heart valve infection, certain people with complex congenital heart disease, and those who have undergone heart transplantation.

Having just a heart murmur no longer necessitates prophylactic antibiotics, because the guidelines were changed several years ago.

Q. I am a healthy middle-aged woman and I recently had a complete physical exam. The doctor found that I have a bladder infection, but I have absolutely no symptoms. Do I need treatment?

A. For most otherwise healthy people with no symptoms (that is, no burning when urinating, no back or flank pain, no fever or chills), no treatment is required when bacteria are found in a culture of the person’s urine. In such a situation, it is rare for the bacteria to cause any serious problem, and for most people, treatment not only doesn’t make them better but can predispose them to the development of antibiotic-resistant bugs that is becoming a serious problem worldwide.

One situation where treatment is advisable is for pregnant women with asymptomatic urinary tract infections, because more than half may develop a more serious kidney infection if not treated. Similarly, people who have had a urinary catheter in place or a kidney transplant may profit from antibiotics. But for you—a healthy middle-aged woman without symptoms—fear not, because you’ll do just fine with no treatment.

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Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences, and a professor of medicine. He is a cardiologist by training.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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