World Heart Day, launched by the World Heart Federation (WHF), is celebrated each year on the 29th of September. The global event aims to raise awareness and encourage action for heart health.

Cardiovascular disease (CVD) is the leading cause of death in the Western world. The most common cardiovascular diseases are coronary heart disease, heart failure, and cerebrovascular disorders. More than 20.5 million people die from these diseases each year. Cardiovascular diseases affect the heart and blood vessels, leading to severe and possibly even fatal complications. However, the WHF estimates that 80% of premature deaths from the disease are preventable (1).

– By making small changes to our lifestyles, we can better manage our heart health and beat cardiovascular disease, the WHF encourages.

Such changes include actions that help improve oral health. Good oral hygiene is more than just a beautiful smile. It is essential to look after your teeth and mouth because even seemingly harmless oral conditions can put you at risk of serious diseases.

Oral pathogens are not limited to the mouth

Tommi Pätilä, a cardiac and transplant surgeon at the New Children’s Hospital (HUS), stresses that a healthy heart requires a healthy mouth and thorough daily oral hygiene. Oral biofilm bacteria are the cause of 95 percent of dental diseases.

– Simple measures such as regular brushing and cleaning of the interdental spaces and regular dental check-ups can help prevent the onset of gum disease and, at the same time, minimise the risk of bacteria or their structures in the mouth entering the bloodstream and spreading to the rest of the body, says Pätilä.

Even chewing food can spread bacteria or parts of bacteria that cause oral infections to the rest of the body through infected gums. This results in a persistent inflammatory condition within the body, which may subsequently give rise to serious health conditions, including cardiovascular disease, Pätilä notes. 

– On the other hand, sudden problems occur when live bacteria infect the heart valves, Pätilä continues.

In 2016, Pätilä operated on a severe bacterial heart valve infection and was motivated to make a difference in oral health. 

– It turned out that the cause of the patient’s severe heart infection was bacteria from the mouth. At that point, I knew something had to be done to combat the residual plaque that causes disease and plagues in peoples’ mouths despite brushing and flossing.

Pätilä is one of three Finnish researchers who have developed the antibacterial Lumoral method. Lumoral is a patented medical device that treats and prevents oral diseases at home. The Lumoral treatment can remove 99.99% of plaque bacteria from the tooth surface (2).

Prevention and early diagnosis pays off

– In contrast to commonly held beliefs, a toothbrush is only capable of eliminating approximately 60% of oral biofilm. It's no surprise then that cavities and gingivitis stand as the most prevalent diseases worldwide. If we want to improve oral health outcomes, we need to tackle the plaque left behind by tooth brushing, says Timo Sorsa, Professor of Oral and Maxillofacial Diseases at the University of Helsinki.

In Finland, it is estimated that up to two out of three people over 30 suffer from periodontitis. This common gum disease can lead to tooth loss if left untreated – but it is also linked to severe heart events. According to a study, individuals with periodontal disease are 30% more likely to experience a first heart attack compared to their healthy counterparts of the same age (3).

According to another study published in the Journal of Periodontology, people with periodontal disease were almost twice as likely to develop coronary artery disease (CAD) than those with healthy gums (4). 

Meanwhile, a 2020 European Journal of Preventive Cardiology report found that poor oral health was associated with an increased risk of cardiovascular disease, particularly among those with gum disease (5).

Professor Sorsa stresses that periodontal disease prevention is vital to maintaining a patient’s oral and overall health.

– Untreated periodontitis leads to low-grade inflammation that affects the whole body, contributing to conditions like cardiovascular disease, diabetes, Alzheimer's disease, and potentially even cancer.

Periodontitis revealed in minutes

According to Professor Sorsa, in the long term, the prevention and rapid diagnosis of periodontal disease benefit the patient, public health, and the economy. This is also possible with the new modern diagnostic and treatment methods available that are revolutionising the whole field of dentistry.

Professor Sorsa’s extensive research career has long focused on developing an immunological rapid test for active matrix metalloproteinase-8 (aMMP-8). The quick test can detect whether a person’s gum tissue is undergoing periodontal breakdown before it is visually apparent. 

The test can be performed by a healthcare professional or the consumer independently at home – similar to the COVID-19 antigen test or the traditional rapid pregnancy test (6).

–The aMMP-8 rapid test can measure and assess active periodontal adhesive tissue loss and the risk of its progression within five minutes in the dental chair non-invasively, i.e. without disturbing the tissue under examination. The test complements the diagnosis, follow-up, and maintenance treatment of periodontitis and peri-implantitis, says Professor Sorsa.

When discussing new treatment methods and prevention of periodontitis, he highlights Lumoral therapy. He calls Lumoral a drug-free alternative for treating and preventing severe gum disease. 

– Lumoral enhances the effect of the toothbrush, and studies show that it also significantly improves the results of professional oral care. At the same time, the device can potentially reduce the need to use drugs traditionally used to treat gum disease, such as antibiotics and chlorhexidine.

Based on photodynamic therapy, a light-activated antibacterial effect, Lumoral slows down plaque formation and significantly reduces the burden of harmful bacteria in the mouth. The product’s user profile is suitable for all ages, but it is particularly recommended for those with a history of problems with common oral diseases, tooth decay, and gum disease (2).

References:

1. https://world-heart-federation.org/news/deaths-from-cardiovascular-disease-surged-60-globally-over-the-last-30-years-report/
2. Pakarinen, S., Saarela, R. K. T., Välimaa, H., Heikkinen, A. M., Kankuri, E., Noponen, M., Alapulli, H., Tervahartiala, T., Räisänen, I. T., Sorsa, T., & Pätilä, T. (2022). Home-Applied Dual-Light Photodynamic Therapy in the Treatment of Stable Chronic Periodontitis (HOPE-CP) Three-Month Interim Results. Dentistry Journal, 10(11), [206]. https://doi.org/10.3390/dj10110206
3. Rydén L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, Kjellström B, Lindahl B, Norhammar A, Nygren Å, Näsman P, Rathnayake N, Svenungsson E, Klinge B: Periodontitis Increases the Risk of a First Myocardial Infarction. A Report From the PAROKRANK Study. 13.1.2016 Circulation. 2016;133:576–583 https://doi.org/10.1161/CIRCULATIONAHA.115.020324
4. Nesarhoseini V, Khosravi M. Periodontitis as a risk factor in non-diabetic patients with coronary artery disease. ARYA Atheroscler. 2010 Fall;6(3):106-11. PMID: 22577425; PMCID: PMC3347825.
5. Pirkko J Pussinen, Eija Könönen, Oral health: A modifiable risk factor for cardiovascular diseases or a confounded association?, European Journal of Preventive Cardiology, Volume 23, Issue 8, 1 May 2016, Pages 834–838, https://doi.org/10.1177/2047487316636506
6. Sorsa, T., Lähteenmäki, H., Pärnänen, P., Tervahartiala, T., Mäkitie, A. Pätilä, T. &   Räisänen, I. T., (2022). Aktiivisen MMP-8:n vieritestaus ja pikadiagnostiikka, Suomen Hammaslääkärilehti 2022; 14: 26–33. 

The link between oral and general health is widely understood, but is this reflected in Finland's health care system and people's oral health? To mark World Health Day, Jukka Meurman, Professor Emeritus of Oral Infectious Diseases, and Tommi Pätilä, cardiac and transplant surgeon at the New Children's Hospital of HUS, reflect on the issue from the perspective of oral health.

World Health Day, launched by the World Health Organisation (WHO), is celebrated worldwide on April 7 to raise awareness of various health concerns. This year's theme – Health for All – focuses on health equity. In other words, the state in which everyone has a fair and just opportunity to attain their highest level of health. 

What about health equity in Finland? Does everyone have equal opportunities to attain their highest level of health in Finland, a country ranked the world's happiest for the sixth year in a row in 2023?

Health inequality is a national challenge also in Finland. Also, in terms of oral health equity. Although the health of Finns has improved considerably over the last decades, according to indicators such as morbidity, work capacity, and mortality, poverty and exclusion are also reflected in Finns' teeth and oral health.

Poor socio-economic status and low education and income levels have a negative impact on oral health. The Finnish Dental Society Apollonia has warned that there is still a lack of comprehensive and adequate oral health care services for the adult population. The poor oral health situation in Finland is also reflected in children.

According to Professor Jukka Meurman, the lack of resources for public oral health care is also directly reflected in the quality of oral health care for people with physical disabilities and, thus, in the prevalence of oral diseases. There is also an urgent need for more staff trained in oral health care for people with disabilities.

Cross-border cooperation for more efficient use of health resources

Oral health is directly linked to a person's overall health and well-being. However, oral health problems are challenging because they are often asymptomatic and may go unnoticed. Undetected chronic oral infections such as caries and periodontitis can contribute to the development of serious diseases such as cardiovascular disease, diabetes, and cancer and, for example, increase the risk of premature birth in expectant mothers (1). 

- Although the link between oral health and general health has been discussed since ancient times, much remains to be done, especially among the public. The issue is becoming well understood in the medical profession, but there is still a need to add dental education to medical curricula and vice versa, says Meurman.

According to the WHO, periodontal disease is estimated to affect around 19% of the world's adult population. This means more than one billion cases worldwide.

In Finland, it is estimated that up to two out of three people over 30 suffer from periodontitis. The disease is even more common in people with diabetes. If left untreated, persistent gum disease can put people at risk of tooth loss - but it is also linked to severe heart events. 

According to a study, the first heart attack is 30% more common in people with periodontal disease than in healthy people of the same age (2).

According to Meurman, many doctors in Finland check the oral health status of their patients in their practices and refer them for further treatment if necessary. Diabetes, for example, is a good example of a disease where the importance of latent inflammation is already widely understood.

Meurman further believes that cooperation between doctors and oral health professionals in Finland should be significantly increased, even during basic training. This would make sharing the workload and managing the health workforce easier. Finland should also consider offering new training programs to ease the shortage of resources in the dental healthcare sector.

- While current dental training takes 5-6 years, an "oral health therapist" training course would only take about 2.5 years, Meurman suggests.

The ideal situation would be for dental training to be similar to specialist training in, say, ophthalmology. Moreover, many practical dental procedures could be carried out by specialists with a university of applied sciences degree.

Meurman admits that such a situation has not yet been fully achieved anywhere in the world. However, in countries such as Singapore and New Zealand, professionals receiving Oral Health Therapist training have, for many years, already eased the workload of dentists. Oral Health Therapists examine dental decay and gum disease and provide routine dental treatments such as teeth cleaning, polishing, teeth extraction and treatment for patients under the prescription of dentists.

Preventive oral care brings benefits to individuals and society

Tommi Pätilä, a cardiac and transplant surgeon at the New Children's Hospital at HUS, believes that oral health is not sufficiently taken into account for patients coming to specialized care. The problem is the frequent lack of time. In specialized care, it is easy to think that a dentist can examine the patient's mouth in due course.

Oral health should always be considered at the basic examination stage for hospital patients. The information should be regularly recorded in the medical records – just like blood pressure values are routinely monitored, says Pätilä. 

More resources for oral health care would be necessary for Finland. It would also be economically worthwhile for society, as it would help prevent the onset of many general diseases.

According to Meurman, preventive health care, including using the antibacterial Lumoral method to improve oral hygiene, will quickly pay for itself.

Pätilä stresses that investing in oral health care and prevention would reduce the development of chronic diseases and the exacerbation of those that have already developed. This would be particularly important for people with cardiovascular disease, diabetes, and rheumatic diseases.

- Preventive oral health care brings significant savings to society. This applies not only to dental care but to the entire healthcare system. Lumoral supports regular mechanical dental hygiene and helps to achieve gum health and prevent inflammation when regular dental hygiene is not enough, says Pätilä.

References:

1) Jacobsson B, Kacerovsky M, Menon R, Musilova I, Radochova V, Slezak R, Stepan M, Vescicik P (2019) ‘Association between periodontal disease and preterm prebalor rupture of membranes'. Journal of Clinical Periodontology.

2) Rydén L, Buhlin K, Ekstrand E, de Faire U, Gustafsson A, Holmer J, Kjellström B, Lindahl B, Norhammar A, Nygren Å, Näsman P, Rathnayake N, Svenungsson E, Klinge B: Periodontitis Increases the Risk of a First Myocardial Infarction. A Report From the PAROKRANK Study. 13.1.2016 Circulation. 2016;133:576–583