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  Posted by: The Probe      4th April 2020

Atrial fibrillation is a heart condition that affects around 1 million people in the UK.

It can occur at any age, but is more common in adults over 65. Atrial fibrillation occurs when atria (upper chambers of the heart) contract randomly or so fast that the heart muscle cannot relax properly between contractions. Abnormal electrical impulses fire in the atria which disturb the normal rhythm of the heart, resulting in an irregular or abnormally fast heart rate. This disturbance can last for a few seconds or minutes, it may be occasional or persistent and individuals with atrial fibrillation may notice palpitations, feel dizzy, short of breath or tired.[1]

Although atrial fibrillation can have no underlying cause, it tends to occur more often in people with other conditions such as high blood pressure, atherosclerosis, heart valve disease1 and diabetes.[2] It can also be triggered by exercise, drinking excessive amounts of alcohol, smoking, being overweight, consuming a large amount of caffeine, lack of sleep and certain over the counter cough or cold medications.[3] The problem with atrial fibrillation is that insufficient contraction reduces the efficiency and performance of the heart. Blood in parts of the atria can become stagnant and form clots which can travel anywhere in the body, including the brain. Most worryingly, the risk of ischemic stroke is increased by a factor of five in patients with atrial fibrillation[4] and it is also associated with a three-fold risk of incident heart failure.[5]

A recent study confirms that patients with atrial fibrillation have a very high risk of being admitted to hospital for both cardiovascular and non-cardiovascular causes.[6] Indeed, strokes cause over 36,000 deaths in the UK each year and are the biggest cause of severe disability.[7] Also, approximately 920,000 people in the UK have been diagnosed with heart failure and it remains the leading cause of death worldwide. In 2019, the British Heart Foundation stated that the number of people in the UK dying from heart and circulatory diseases before the age of 75 is rising.[8] It has been suggested that the growing population is partly the reason, but risk factor prevalence is increasing, and a growth in obesity, high blood pressure and type 2 diabetes is keeping the death toll high.[9] Consequently, public health initiatives with attention to risk factors, lifestyle changes and preventive strategies are urgently needed.

Poor oral hygiene can encourage the accumulation of dental plaque and bacteria, which can establish a basis for inflammatory changes in the periodontal tissues.[10] Inflammation is a source of chronic and acute infection and is a key contributor to many health problems. Certainly, there is a growing body of evidence connecting periodontal disease with stroke, atherosclerosis and cardiovascular disease (CVD) as well as diabetes.[11],[12], [13]  Furthermore, periodontal disease is likely to increase the risk of CVD by 19 per cent and this risk increases to 44 per cent in individuals of 65 years and over.10 There is also evidence to support the theory that endodontic (or root tip) infections may be associated with increased risk for coronary artery disease via similar pathways as periodontitis.[14]  At the Perio-Cardio Workshop 2019 it was agreed that greater awareness of these disease links is needed and patients with periodontitis should be advised that they have a higher risk of heart disease. It was also concluded that the progression of CVD may be influenced by good oral hygiene and successful periodontal treatment.[15]

Most recently, in a nationwide study, Korean researchers reported that poor oral hygiene can provoke transient bacteraemia and systemic inflammation. They studied over 161,000 individuals over ten years and discovered that people that brushed their teeth frequently had a significantly reduced risk of atrial fibrillation and heart failure compared to those that brushed their teeth less often. It was therefore concluded that healthier oral hygiene with frequent tooth brushing and professional dental cleaning may reduce the risk of atrial fibrillation and heart failure.[16] Again, this study emphasises the significant role that dental professionals have in the prevention and treatment of oral diseases as a means of reducing the risk of heart disease.

As well as encouraging patients to attend regular check-ups, dental professionals can assist patients by delivering oral health instruction and devising strategies to help them improve their oral hygiene. For instance, patients are more likely to floss their teeth daily if they are introduced to the Waterpik® Water Flosser. It makes flossing so much quicker and easier, plus the water pulsation technology enables it to clean areas that other devices cannot reach. In fact, the Waterpik® Water Flosser is clinically proven to be significantly more effective at reducing plaque, gingivitis and gum disease than both string floss[17] and interdental brushes.[18]

It is evident that good oral hygiene is far more important than many patients think. But dental professionals can help to raise awareness and contribute with education and preventive measures to reduce the risks of life-threatening diseases.

 

For more information on the Waterpik® Water Flosser please visit www.waterpik.co.uk or book a free Waterpik® Professional Lunch and Learn at
 
www.waterpik.co.uk/professional/lunch-learn/

Waterpik® products are available from Amazon and
in store or online at Asda, Boots and Superdrug.

 

[1] NHS. Health A to Z. Overview. Atrial fibrillation. https://www.nhs.uk/conditions/atrial-fibrillation/ Last reviewed April 2018. https://www.nhs.uk/conditions/atrial-fibrillation/

[Accessed 16th December 2019]

[2] Bohne L.J. et al. The association between diabetes mellitus and atrial fibrillation: Clinical and mechanistic insights. Front. Physiol., 26 February 2019. https://www.frontiersin.org/articles/10.3389/fphys.2019.00135/full [Accessed 16th December 2019]

[3] Groh C.A et al. Patient-reported triggers of paroxysmal atrial fibrillation. Heart Rhythm. 2019 Jul;16(7):996-1002. https://www.ncbi.nlm.nih.gov/pubmed/30772533 [Accessed 16th December 2019]

[4] Oladiran O. et al. Stroke risk stratification in atrial fibrillation: a review of common risk factors. J Community Hosp Intern Med Perspect. 2019 Apr; 9(2): 113–120. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6484493/ [Accessed 16th December 2019]

[5] Kotecha D. et al. Atrial fibrillation in heart failure: what should we do? Eur Heart J. 2015 Dec 7; 36(46): 3250–3257. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670966/ [Accessed 16th December 2019]

[6] Meyre P. et al. Risk of hospital admissions in patients with atrial fibrillation

[7] British Heart Foundation. Facts and Figures. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/contact-the-press-office/facts-and-figures [Accessed 16th December 2019]

[8] British Heart Foundation. Mitchell J. News 13th May 2019 Heart and circulatory disease deaths in under 75s see first sustained rise in 50 years. https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/may/heart-and-circulatory-disease-deaths-in-under-75s-see-first-sustained-rise-in-50-years

[9] Nowbar A.N. et al. Mortality from ischemic heart disease: Analysis of data from the World Health Organization and coronary artery disease risk factors from NCD risk factor collaboration. Cardiovascular Quality and Outcomes. 2019;12, No. 6. https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.118.005375 [Accessed 16th December 2019]

[10] Nazir M.A. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci (Qassim). 2017 Apr-Jun; 11(2): 72–80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5426403/ [Accessed 16th December 2019]

[11] Straka M. et al. Periodontitis and stroke. Neuroendocrinol Lett 2013; 34(3):200–206. http://www.phdsagra.com/education/perio-and-stroke.pdf [Accessed 16th December 2019]

[12] Li X et al. Systemic diseases caused by oral infection. Clin Microbiol Rev. 2000 Oct; 13(4): 547–558. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC88948/ [Accessed 16th December 2019]

[13] D’Aiuto F. Et al. Periodontal disease and C-reative protein associated cardiovascular risk. J Periodontal Res. 2004 Aug;39(4):236-41.https://www.ncbi.nlm.nih.gov/pubmed/15206916?dopt=Abstract [Accessed 16th December 2019]

[14] Liljestrand J.M. et al. Association of endodontic lesions with coronary artery disease. Journal of dental research. 2016; 95: 1358-1365. https://journals.sagepub.com/doi/10.1177/0022034516660509 [Accessed 16th December 2019]

[15] European Federation of Periodontology. Latest News; 21st Feb 2019. Perio & Cardio Workshop ends with call for more awareness of disease links. https://www.efp.org/newsupdate/perio-cardio-workshop-consensus/ [Accessed 16th December 2019]

[16] Chang Y, et al. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: A nationwide population-based cohort study. Eur J Prev Cardiol. 2019 Dec 1:2047487319886018. https://www.ncbi.nlm.nih.gov/pubmed/31786965 [Accessed 16th December 2019]

[17] Barnes CM et al. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. 2005;16(3):71-7. https://www.ncbi.nlm.nih.gov/pubmed/16305005 [Accessed 16th December 2019]

[18] Goyal CR et al. Comparison of water flosser and interdental brush on reduction of gingival bleeding and plaque: a randomized controlled pilot study. J Clin Dent 2016. 27: 23-26. https://www.ncbi.nlm.nih.gov/pubmed/28390208 [Accessed 16th December 2019]


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