cardiovascular+disorders

 **The Influence Caridovascular Disorders Have on the Periodontium ** People with severe periodontitis have the strongest link to cardiovascular disease. These people also have the greatest amounts of pathogenic bacteria and systemic factors that may contribute to an altered immunoinflammatory response. Orally derived bacteremia infecting damaged heart valves is the strongest association between dental plaque/periodontal inflammation and systemic diseases. Cardiovascular diseases are the most prevalent of all systemic disease and increases with age. Periodontal bacteria and/or their byproducts may also gain access to the circulation by direct invasion of periodontal tissues. Bacteremia from oral origin appears to be directly related to the severity of periodontal inflammation. There is a correlation between periodontal disease and cardiovascular diseases. Ischemic heart disease, thrombogenesis, myocardial infarction, and cerebrovascular accident are all examples of cardiovascular diseases.


 * **Ischemic Heart Disease**
 * Ischemic Heart Disease manifests as angina or myocardial infarction.
 * It is caused by a decreased coronary blood flow and an increase demand of myocardial oxygen or both.
 * high viscosity of blood causes increased thrombus (clot) formation
 * fibrinogen and WBC levels are often increased in patient's with periodontitis; patient's will have a higher risk of clot formation and more coagulation factors when poor oral health is present
 * periodontal infection leads to greater risk of central and peripheral vascular disease
 * periodontitis may predispose people to higher incidence of bacteremia
 * regarding infective endocarditis, 8% of cases are associated with patient's who have not had a preceding dental procedure but who have periodontal or dental disease
 * endotoxins are released from gram-negative microorganisms and can be held in the periodontium of patients with periodontal disease; endotoxins can travel into circulation and cause negative cardiovascular effects


 * **Thrombogenesis**
 * Conditions that predispose to thrombus formation include abnormalities in blood flow, blood constituents, and the vessel wall.
 * A freshly formed thrombus interrupts blood flow and causes ischemic injury of the mycadium, eventually leading to myocardial necrosis.
 * Plaque rupture is mediated by enzymes such as collagenase, gelatinase, and stromelysin, which degrades components of the interstitial matrix.
 * Several cytokines also contribute to the plaque rupture.
 * Bateria from periodontal disease may enter the circulation and contribute directly to the atheromatous or thrombotic processes.
 * The platelets bind to certain strains of //S. sanguis// and //P. gingivalis// which are common in periodontal disease; binding can cause alterations of blood pressure, heart rate, cardiac contractility, and ECG readings consistent with MI
 * The process of thrombogenesis is the final event for the occlusion of the coronary artery.


 * **Myocardial Infarction**
 * some individuals with heavy plaque and high counts of pathogenic organisms appear relatively resistant to bone loss while others exhibit extensive periodontal bone loss with low levels of plaque and pathogenic organisms
 * high LDLs may increase secretion of cytokines that are responsible for destruction and inflammation resulting in elevated periodontal destruction amongst pathogenic microorganisms.
 * Myocardial Infarction patients usually have poor dental health. This is due to the link between heart disease and smoking, age, cholesterol levels, hypertension, and diabetes.


 * **Cerebrovascular Accident**
 * Cerebrovascular accident occurs more frequently in patients with existing cardiovascular disease, especially hypertension.
 * A stroke occurs when there is a sudden interruption of blood flow to the brain, depriving the brain of oxygen.
 * To prevent a repeat stroke, active infections should be treated aggressively because even minor infections may alter blood coagulation and trigger thrombus formation and ensuing cerebral infarction
 * Often with a stroke patient, they lose dexterity with their hands. It is important the clinician spend extra time with oral hygiene instructions to ensure the patient is receiving proper hygiene.