OCCLUSIVE CARDIOVASCULAR DISEASE

Atherosclerosis (hardening of the arteries) is a process that slowly narrows arteries throughout the body. When atherosclerosis affects the arteries that supply blood to the heart (coronary arteries) it is called occlusive coronary artery disease. Heart disease is the number 1 killer of men and women in the United States. About 650,000 Americans die each year from coronary artery disease. Occlusive peripheral arterial disease (PAD) is blockage or narrowing of an artery in the legs (or rarely the arms), usually due to atherosclerosis and resulting in decreased blood flow. Symptoms depend on which artery is blocked and how severe the blockage is. Often there is pain in the legs.

PERIODONTAL DISEASE/INFLAMMATION CAN CONTRIBUTE TO OCCLUSIVE CARDIOVASCUALR DISEASE IN SEVERAL WAYS:

Direct invasion of periodontal bacteria (such as P gingivalis) into the walls of arteries
Harmful alteration of the cells (endothelial cells) that line the walls of arteries (endothelial dysfunction)
Harmful alteration in the normal clotting process (fibrinogen dysfunction)
Lipid abnormalities resulting in the overproduction of “bad cholesterol” (low density lipoproteins/LDL)

TREATMENTS FOR OCCLUSIVE CORONARY ARTERY DISEASE:

Initially treatment may involve diet, exercise, prescription medications and elimination of harmful habits such as smoking. More advanced conditions may require invasive treatments such as placement of stent(s) or coronary artery bypass graft surgery (CABG). After stent placement, cardiologists may prescribe an anti platelet blood thinner like Plavix or a Plavix substitute (Effient, Brilinta). This prevents formation of a clot inside the stent. If an invasive dental procedure (extraction, implant placement, periodontal surgery etc) is needed, the patient may need to discontinue Plavix in order to prevent free bleeding during and/or after the procedure. Discontinuing Plavix puts the patient at risk for restenosis of the stent.

The above images are courtesy of a patient in a P3 dental practice. They were taken in the hospital cath lab immediately before and after stent placement. The images clearly show reopening of a major coronary artery (circumflex) after placement of the stent.

Example of a drug eluting/coated stent. 17mm x 3mm

Steps associated with placing a vascular stent:

1. Place the stent at the area of occlusion via catheter.

2. Inflate the balloon to deploy the stent.

3. Deflate the balloon and remove it via the catheter.

P3 is a dental locally applied antibiotic (LAA) formulation that is effective in preventing and controlling periodontal inflammation at the cellular and molecular levels. This results in better prevention and management of occlusive cardiovascular disease.

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