There is a difficult to attribute quote most often uttered by folks who are a bit obsessive about their dental health that goes something like: "Death comes through the gums."

It is a cryptic reference to the suspected but elusive proof that good dental hygiene can also play a role in good heart health, which was not coincidentally the subject of a February 6 Heart Month talk by Garrett B. Golisano, DDS, who practices at Dudley, Condon and Golisano on Mt Pleasant Road.

The local dentist was the special guest February 6 at the Newtown VNA's monthly meeting. As part of his talk, Dr Golisano reviewed revised guidelines from the American Heart Association (AHA) regarding the recommendations for antibiotics prior to dental treatment.

According to Newtown Health District Director Donna Culbert who was on hand for the talk, the connection between taking care of your teeth and preventing heart disease is not necessarily a linear "cause and effect" relationship; however, there appears to be more than a few connections between oral health and heart disease.

In fact, the Heart Association published a Statement in April 2012 supporting an association between gum disease and heart disease.

That AHA statement pointed out that scientific data at the time did not indicate whether regular brushing and flossing or treatment of gum disease would decrease the incidence, rate, or severity of the narrowing of the arteries (called atherosclerosis) that can lead to heart attacks and strokes.

At the same time, many studies show an as-yet-unexplained association between gum disease and several serious health conditions, including heart disease, even after adjusting for common risk factors.

That same year, as Dr Golisano referenced during his VNA talk, the Heart Association updated its recommendations regarding taking a precautionary antibiotic before a trip to the dentist. According to the AHA, that formerly recommended practice is no longer necessary for most people and, in fact, might do more harm than good.

Updated Recommendations

Those AHA guidelines were first published in its scientific journal, in July 2012 - and recommended that only people who are at the greatest risk of bad outcomes from a condition called infective endocarditis (IE) should receive short-term preventive antibiotics before routine dental procedures.Circulation, 

Infective endocarditis is an infection of the heart's inner lining or the heart valves, which results when bacteria enter the bloodstream and travel to the heart.

The guidelines say that many patients who have taken preventive antibiotics regularly in the past no longer need them, including people with the following conditions:

*Mitral valve prolapse

*Rheumatic heart disease

*Bicuspid valve disease

*Calcified aortic stenosis

*Congenital heart conditions such as ventricular septal defect, atrial septal defect, and hypertrophic cardiomyopathy.

The risks of taking unnecessary antibiotics include adverse reactions and, more significantly, the development of drug-resistant bacteria the AHA statement noted. In addition, a comprehensive review of published studies suggests that IE is more likely to occur as a result of everyday activities than from a dental procedure.

Scientists found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection, as their hearts already are exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.

Some conditions still warrant preventive antibiotics, however. The AHA states that patients at the greatest risk of bad outcomes if they developed a heart infection, and for whom preventive antibiotics prior to a dental procedure are worth the risks, include those with the following conditions:

*Artificial heart valves

*A history of having had IE

*Certain specific, serious congenital (present from birth) heart conditions

*A cardiac transplant that develops a problem in a heart valve

Ask Your Doctor

The AHA advises that patients and their families should ask a primary care doctor or their cardiologist if there is any question at all as to whether they should continue to take preventive antibiotics based on these new guidelines. Patients and their families should ask careful questions of their doctors and dentists anytime antibiotics are suggested before a medical or dental procedure.

They should also be aware that overuse of antibiotics many times can lead to a worse outcome than if they were not used at all. Because of the overuse of antibiotics, there has been a huge increase in the number of bacteria that are now resistant to them. When this happens, new antibiotics must be created to kill these new bacteria. The new bacteria are typically more severe and can cause more serious illnesses.

In addition to keeping your teeth and gums healthy, Ms Culbert and the VNA are promoting good heart health through an informational tabletop display in the Newtown Municipal Center.

"I like the American Heart Association's Healthy for Good recommendations," Ms Culbert said. "It's a great resource with realistic doable suggestions and guidance on how to get Healthy For Good.

Healthy For Good is a revolutionary movement to inspire individuals to create lasting change in their health and their life, one small step at a time.

The approach is simple: Eat smart. Add color. Move more. Be well.

Learn more about the program and sign on at healthyforgood.heart.org.

"It's about taking steps toward your goals, short-term and long-term," Ms Culbert said. "And we'll be talking more about steps as we walk our way out of this winter onto the varied terrains of walking paths and trails here in town."