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Cardio-vascular Health

Sudden Heart Attack, Infection and Coronary Disease

Should You Put Your Toothbrush in the Dishwasher?

By Dr. W. Gifford Jones

September 24, 2000

Why did the patient die from a sudden heart attack? The victim was a thin, middle©aged who had never smoked and exercised regularly. Blood cholesterol values had always been normal and there was no history of diabetes. Moreover, both parents were still living and well. Could this death have been prevented by the household dishwasher?

I was skeptical two years ago when I first read about a possible relationship between infection and coronary attack. Now a report from the Harvard Medical School in its publication "Focus", links chronically infected gums (periodontal disease) to coronary heart disease (CHD).

Periodontal disease affects one in five adult North Americans and is responsible for 70 percent of adult tooth loss. It gets worse with aging.

Gingivitis is the mildest form of gum disease. It begins with the accumulation of plaque, a form of dental rust. A colourless sticky film accumulates between gum tissue and the teeth and eventually becomes hard.

In contrast to healthy gums that are coral pink and firm, unhealthy gingival tissue is inflamed, dark red, infected and receding from the teeth. The first sign of gingivitis is bleeding gums when the teeth are brushed.

Periodontal disease is the advanced stage of gum disease. A progressive bacterial infection of the gums destroys the fibers that attach teeth to bone.

In 1996 Dr. Joseph B Muhlestein at the University of Utah reported a startling discovery. His research team found a bacterium called Chlamydia pneumoniae in 79 percent of patients undergoing coronary bypass surgery. This is not the same bacteria that is associated with sexually transmitted disease.

In sharp contrast this organism was only present in one of 24 patients examined during autopsy or heart transplantation.

Now a report from Johns Hopkins says that other studies have also implicated Chlamydia pneumoniae. In addition, the bacterium H pylori that causes the majority of stomach ulcers has been linked to CHD along with infectious agents that cause periodontal disease.

Everyone laughed when it was first announced that H pylori triggered stomach ulcers. After all, peptic ulcers had long been associated with stress and high living. But everyone was wrong. Ô 0*0*0* But how can bacteria cause heart attacks? Harvard researchers believe that chronic infection, such as periodontal disease, causes inflammation that often goes unnoticed by patients.

Inflammation is usually a helpful reaction because it sends an army of white cells to fight the infection.

But the Harvard report claims these inflammatory cells also secrete a substance called C©reactive protein (CRP). This, they believe, promotes the growth of atherosclerosis.

Researchers also found that men with the highest levels of CRP had 3 X as many heart attacks as those with the lowest levels.

Researchers then discovered that patients who were taking a daily Aspirin had the lowest levels of CRP. Aspirin, they concluded, decreased the risk of CHD by it's anti©clotting action and anti©inflammatory properties.

Other researchers think that bacteria are released into the circulation from inflamed pockets in the gums. This encourages platelets, which are part of the blood clotting mechanism, to form a clot in coronary arteries.

So what should we all do ? One novel idea comes from Dr. Wilma Bergfeld, head of clinical research at the Cleveland Clinic. She told a meeting of dermatologists in Washington that for years she has placed her toothbrush in the dishwasher. The high heat and detergent kills all bacteria.

But more important you have nothing to lose and everything to gain by practising good dental hygiene. This has to be repeated over and over again when you consider that by age 60 one in three people have lost all of their teeth, Today without too much trouble you should be able to keep your gums healthy and your teeth a lifetime. But you won't achieve this by just brushing teeth three times a day. This invariably leaves food particles between teeth, setting the stage for periodontal disease.

The obvious solution is to follow brushing with the use of dental floss after each meal. Dental associations also recommend the use of antiseptic mouthwash which helps to kill germs. Particularly in those hard to reach places between teeth and below the gum line. This interrupts chemical reactions that create plaque and helps to hinder bacterial growth. Readers know that I've always believed that there's more to coronary heart disease than elevated blood cholesterol. I suspect we will hear more about the role of bacteria and CHD in the future. Meanwhile don't get lazy about dental care. And I'm wondering what my wife will say when she spots my toothbrush in the dishwasher!


W. Gifford-Jones M.D Most recent columns

W. Gifford-Jones M.D is the pen name of Dr. Ken Walker graduate of Harvard. Dr. Walker's website is: docgiff.com.
Dr. Walker can be reached at info@docgiff.com















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