Where Oral Meets Systemic

July 15, 2013
Oral inflammation is the tipping point of health care, but tools are where the rubber hits the road. Oral-systemic health is the most important advancement in health care since the germ theory of the 1800s.

by Dan Sindelar, DMD

Oral inflammation is the tipping point of health care, but tools are where the rubber hits the road. Oral-systemic health is the most important advancement in health care since the germ theory of the 1800s. It now appears that every inflammatory disease is hugely affected by oral inflammation, the No. 1 source of inflammation in humans. Inflammation kills.

Groundbreaking research emerges daily on the importance of oral health and overall health. Take these studies, for instance:

Circulation 3/2013

The American Heart Association journal cites groundbreaking research showing the direct connection between oral pathogens (associated with periodontal disease, endodontic lesions, and caries) and acute heart attacks! It tells us that as many as half of heart attacks are being triggered by oral pathogens. Oral bacteria were found in every thrombus, and 30% had live oral pathogens in the clot.

Dental infection and oral bacteria are associated with development of acute coronary thrombosis. Oral health and dental care should be part of heart attack prevention.

Stroke 2/2013

With more than a half million participants, it was shown that periodontal disease is an important risk factor for stroke. Most importantly, it showed that periodontal treatment reduced risk for stroke.

Most of the time, we cannot see inflammation. It does not even hurt. But dental professionals can now test for it. There is a medical need to test for it.

Oral inflammation has a direct effect on three important, measurable, and quantifiable tests that can now be done in the dental office. It has been shown that by reducing oral inflammation with advanced professional care and advanced home care, these three important health factors can often be brought back into the "safe zone":

Lp-PLA2 (via PLAC® Test)

75% of all heart attacks and most strokes are caused by plaque rupture and blood clots, not the narrowing of arteries.

The PLAC® Test tells us if the arteries around the heart are inflamed, the most important test in assessing risk for heart attack and stroke -- often more important than cholesterol testing. The PLAC® Test is cleared by the FDA to evaluate risk for both heart attack and stroke.

Why do we care?

The only known factor to reduce Lp-PLA2 levels is reducing oral inflammation with periodontal treatment. Dental professionals across the country are helping to lower Lp-PLA2 levels back to a safe level with advanced periodontal treatments, thereby playing a key role in reducing risk for heart attack and stroke. The PLAC® Test is becoming one of the most important parts of an advanced inflammatory panel. Dental professionals can now be on the front line.

A1c (Glycated Hemoglobin Levels)

This test tells us how the patient's blood sugar levels are being regulated. The higher your A1c level, the higher your average blood glucose levels are. Elevated A1c typically occurs in those with diabetes and insulin resistance.

Why do we care?

Periodontal disease and diabetes are directly connected. Ninety-three percent of those with diabetes have periodontal disease. Research now shows us that with advanced periodontal treatment, dental professionals can lower A1c levels as well as most medications without all of the terrible side effects. Nonsurgical periodontal treatment improves glycemic control in Type 2 diabetes. Advanced periodontal treatment has also been shown to reduce health complications for patients with diabetes, reducing annual health-care costs by 25%.

hs-CRP (C-Reactive Protein)

Risk for heart attack and stroke increases with elevated CRP levels, as much as with cholesterol and HDL levels. With an elevated hs-CRP, there is infection somewhere in the body, and there is a good chance it's in the mouth.

Why do we care?

CRP levels can be up to seven times higher in patients with periodontal disease. If you know there is high CRP, you know there is an infection in the body. It is imperative that anyone with high CRP levels be evaluated and treated with advanced periodontal treatment, so the mouth does not become a risk factor for cardiovascular disease and diabetes. Research and experience tells us that diabetic patients with infections have potentially life-threatening health-care complications.

Simplified, these three tests help us determine who is at risk for:

  • Heart attacks
  • Strokes
  • Diabetes
  • Other inflammatory diseases

We know what the problem is. By now, the research is obvious. But the missing component -- the "secret sauce" -- has always been knowing how to put it into effect.


A new finger stick test called the Heart Smart Screen™ allows dental professionals to determine all three factors of inflammation in our offices.

Innovation always shows up at the right time. The most important components of innovation are the new tools that appear. Most of these new tools are involved in genomics, genetic testing, and advanced inflammatory testing. The new tools trump the old tools.

So what other area of health care uses the same tools that they used 50 years ago? The answer: None.

We now have tools for advanced genetic testing, tools to determine microbial burden, and now perhaps the most important tool: a simple finger stick done in the dental office to determine these three keys to oral inflammation.

With this new Heart Smart Screen, dental professionals can learn more about the health risks and future health of patients than almost any other health-care professional in a patient's life.

By using the new tools, we can quantify problems.

From this, we

  • Expand our treatment for better care and improve patients' lives
  • Increase revenues and referrals with other health-care professionals
  • Stand out in an overcrowded dental market
  • Protect ourselves from future malpractice lawsuits

I have always been told, "Ignorance is when you don't know any better. Stupid is when you know better and do nothing about it." Don't be stupdi! Organizations such as the American Academy for Oral Systemic Health were created -- to not only help spread awareness of the oral-systemic connection but also to provide resources for practical application of this information into dental practices.

I believe it is to a dentist's advantage to offer advanced inflammatory testing to patients and then document it with a form, especially if they deny it. Contact me if you wish to obtain this form. I believe it will not be long before someone with an elevated Lp-PLA2 has a heart attack and the dentist is blamed. I do not want to see this happen to anyone, especially the patient.

One of the unforeseen consequences of doing advanced inflammatory testing is the increase in communications with referring physicians. These tests are important for different reasons. By using simple forms that can be found on the oralheartcare.com website, we increase the communication between medical and dental teams, simplify coordinated care, and increase cross-referrals.

Next, treatments we provide need to take into account "dental solutions for medical problems." While we follow strict dental guidelines, we must not overlook the overall health of patients.

Just the other day, a patient of mine said: "I'm not as worried about that back molar as you are, Doc, but I'll do anything for my health." Never forget. We play a key role in our patients' health.

Recently, I was proud to be one of three dentists invited to attend the 2012 Cleveland HeartLab Symposium at the Lou Ruvo Center for Brain Health. Speakers mentioned oral inflammation's role in heart disease, stroke, diabetes, dementia, and many other chronic conditions.

It has been amazing to see how fast the medical community has embraced oral inflammation as an important contributor to systemic inflammation. Some are promoting it and are seeking dentists with whom to partner. As dental professionals, we have an opportunity to improve lives and lower health-care costs. A recent UC Wellness oral health study shows there is a direct connection between good oral health and lower medical costs.

With the combination of professional dental care and advanced home care, annual medical costs are significantly lowered for most chronic diseases, including diabetes, heart disease, stroke, rheumatoid arthritis, and pregnancy complications. This saves patients thousands of dollars per year.

As health care faces some of its biggest challenges, dentistry is in the "sweet spot" for those who take the step of reducing the effects of oral inflammation on overall health. Dental professionals have a unique opportunity to improve patients' lives and transform practices at the same time.

To learn more about the steps to incorporate advanced inflammatory testing into your practice, visit oralheartcare.com.

For more information on the American Academy for Oral Systemic Health, visit aaosh.org.

References available upon request.

Dan Sindelar, DMD, is the co-founder and current president of the American Academy for Oral Systemic Health. He is one of the first dentists to earn a Preceptorship certification in the prevention of heart attacks, strokes, and diabetes. He has developed an educational video series on "how to incorporate OralHeartCare into your practice." For more information, visit OralHeartCare.com.

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