If you've been putting off that visit to the dentist, figuring if you don't have a toothache there's nothing to worry about, think again.
In addition to watching out for your teeth and gums, dentists also look for oral cancers and other health conditions that may announce themselves in your mouth.
A growing body of scientific evidence suggests there is a link between dental health and heart disease. That's one reason why your dentist may prescribe aggressive treatment for gum disease, or even send you to the cardiologist.
St. Petersburg dentist John Ferullo is among those who think the link is strong enough to warrant screening some patients with gum disease for a blood protein called CRP. High levels of C-reactive protein are associated with increased heart attack and stroke risk, though exactly how they're linked isn't fully understood.
The screening, which he gives to patients whose gums are swollen and bleed easily, is a simple finger-prick blood test.
"Five years ago people wouldn't have been open to it," Ferullo said. "But now, because they've seen it on TV shows like Oprah and Dr. Oz, they are receptive to the idea and the screening."
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In the past 20 to 25 years, a number of studies published in major medical journals have looked at the connection between gum disease, heart disease and stroke. One theory is that bacteria in the mouth can get into the bloodstream and travel to plaque deposits in the arteries. That can cause the deposits to become swollen and unstable, and more likely to rupture and cause a heart attack or stroke.
The same bacteria found in the mouth have been found attached to plaques in the arteries. (But dental plaque and arterial plaque are two different things.)
Dental bacteria may also trigger blood cells to swell and arteries to narrow, which can impede blood flow.
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While the finger-prick test Ferullo uses, known as an hs-CRP test, can detect inflammation in the body, it can't tell precisely where it's occurring. It might be in any number of places, such as the arteries or gums, or due to diseases like arthritis or inflammatory bowel disease.
Ferullo thinks in-office screening may narrow the field of possible causes. "If after aggressive treatment (for gum disease) they still have elevated CRP, we refer them back to their physician because something else is definitely going on," he said.
A spokesman for the Florida Dental Association, Tampa dentist Terry Buckenheimer, said the CRP screening is not considered standard practice because CRP can be elevated by many causes.
"But that's not to say it's not right" to screen, he said. "It might save a life, and that has value."
An American Academy of Periodontology spokesman said most dentists aren't doing this screening, though it's likely the practice will increase in coming years.
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But Dr. Patrick Cambier, an interventional cardiologist with Morton Plant Hospital in Clearwater, says that like all screening tests, this one needs to be approached with caution.
Scientists long have been looking for markers in the blood to detect heart disease, and CRP has gotten a lot of attention. While it may detect inflammation in the blood vessels associated with atherosclerosis, the test doesn't tell doctors if those plaques are likely to rupture and cause heart attacks or stroke.
"We have to be cautious about screening for the sake of screening," he said. "It is costly, can lead to false positives, more tests, more cost and more anxiety for patients."
The American Heart Association does not recommend routine CRP screening for the general public. But it does support the use of an hs-CRP test like the one Ferullo uses, along with other screening tests, for people who are thought to be at elevated risk of heart attack.
Cambier selects patients for CRP screening based on multiple risk factors such as family history of heart disease, tobacco use, diabetes, high cholesterol and shortness of breath on exertion. "CRP really is helpful as an added piece of evidence, more so than as a stand-alone, absolute confirmatory test," he said.
Dr. Leslie Miller, chairman of the department of cardiovascular sciences at USF Health, said hs-CRP is too much of a "nonspecific test for inflammation'' to be used for heart screening in dental offices.
In 2009, the American Journal of Cardiology and the Journal of Periodontology published a consensus report on gum disease and heart disease risk. Their conclusion: Gum disease can increase inflammation, and so it may increase the risk for cardiovascular disease. But that doesn't mean that gum disease actually causes heart disease, they emphasized.
While scientists sort it all out, it's important to follow a heart-healthy lifestyle: Exercise, maintain a healthy weight, don't smoke, eat right and watch cholesterol, blood pressure and diabetes.
And no matter your risk for heart disease, brush and floss regularly — and book that overdue dental appointment.
Irene Maher can be reached at firstname.lastname@example.org.