OPEN HEART SURGERY PATIENTS HEAD
FIRST TO THEIR DENTIST By: Jorge Pinero, DDS

(Milwaukee, Wl)

If you are facing some form of heart surgery, you would think the last person with whom your Cardiologist would confer would be your dentist. However, if you have some form of gum disease, that may be the most appropriate professional to include in your care in order to reduce the risk of infection, failure, or even death.

Studies that have been conducted within the United States and in other major countries over the past two decades have traced bacterial organisms from the oral cavity to the heart. The consequences of these bacteria to a heart surgery patient can have fatal repercussions. Since over seventy percent of American adults have some form of Periodontal (gum) disease, the potential for this bacteria to penetrate one's vital organs is far greater than ever suspected.

The National Institute of Dental Research recently awarded the University of North Carolina (Chapel Hill) a $2.2 million grant for an 18-month study to reveal the risk elements of bacteria in the gums in relation to heart disease. This grant may create a whole new attitude for Americans who ignore the brush-&-floss lecture at dental checkups.

Bacteria is not uncommon following many invasive procedures. However, only a limited number of bacterial species create the highest incidence for Endocarditis. Endocarditis is relatively rare, but is a serious heart infection that may lodge on damaged or abnormal heart values, implanted values or pumps, and transplanted hearts. When Bacterial Endocarditis results from periodontal disease, the environment can become fatal to heart surgery patients.

Milwaukee dentist Dr. Jorge Pinero has intensely followed research on the link between Periodontal disease and heart disease. In conjunction with area heart specialists. Dr. Pinero has treated and tracked 92 patients who had some form of periodontal disease prior to undergoing heart surgery at St. Lukes Medical Center in Milwaukee. Two Cardiovascular Surgeons who participated in the study, conducted between 1994 and 1997, were Dr. Francis Downey and Dr. Leonard Kleinman. The study revealed findings that verifies take out advantages of a unified effort of medical and dental professionals to increase the success rate of heart surgery.

"The blood cultures from patients who are periodontally compromised after dental surgery are bacterially positive 52% of the time, versus the fourteen percent rate of positive bacteria associated with surgery, "states Dr. Pinero. "By treating periodontal disease before the patient undergoes heart surgery, we find that they are at a dramatically reduced risk."

The American Heart Association has issued guidelines for the prevention of Bacterial Endocarditis, but cautions these guidelines as the "standard of care." First, the patient is placed on an antibiotic, such as amoxicillin or penicillin prior to a thorough cleaning. The antibiotic is recommended to occur one hour prior to any oral surgery, including extractions or periodontal surgery. This reduces the incidence of bacteria but does not eliminate it totally. In addition, resistant strains of oral bacteria may still be present that can cause Bacterial Endocarditis.

Currently, the disadvantage is the time requirement to reduce the bacterial risk in periodontally-infected patients preparing for heart surgery. Patients treated with antibiotics before proceeding with open heart surgery reduces the risk potential. However, many patients who test positive for bacteria in the bloodstream and are in urgent need of heart surgery are often delayed between one to two weeks to eliminate the bacterial contamination in the mouth and bloodstream.

Dr. Pinero has found a way to significantly reduce the bacterial risk factor, enabling patients to undergo cardiac surgery within a timely fashion, most often within 24 hours. He utilizes a laser to combat areas harboring oral bacteria in conjunction with the guidelines as set forth by the American Heart Association to significantly improve the patient's surgical outcome.

In a study involving 92 patients awaiting heart surgery. Dr. Pinero carefully monitored their pre-cardiac surgery with a combination of oral medicine, dental evaluation, and laser treatment. Monitored patients, who ranged in age from 42 to 91, were diagnosed as having various dental infections, from chronic periodontitis to acute periodontal abscesses.

Once the surfaces were ridded of bacterial plaque and calculus, the teeth were irrigated with cleansing agents. Using the Biolase Nd Yag Laser, Dr. Pinero then carefully performed laser surgery on all gum tissue surrounding all teeth, whether periodontally-compromised or not. The laser is used in pulses along with air and water irrigation as a coolant. Doctors utilizing a laser in this capacity must be specially-trained to avoid contact with tooth or bone surfaces due to repercussions from laser heat.

With the patient's laser treatment complete. Dr. Pinero drew blood samples within 15 to 30 minutes to determine the presence of bacterial elements. Afterwards, patients were placed on chlorohexidiene rinses for five days prior to open heart surgery. Following their dental surgery, blood samples of these 92 subjects revealed a zero percent bacterial presence or growth, even after three days post-operatively. "This is remarkable, considering that most of these patients suffered from acute periodontitis before treatment, "exclaims Dr. Pinero.

The American Heart Association has issued guidelines for the prevention of bacterial Endocarditis, but cautions these guidelines as the "standard of care." First, the patient is placed on an antibiotic, such as amoxcicillin or penicillin prior to a thorough cleaning. The antibiotic is recommended to occur one hour prior to any oral surgery, including extractions or periodontal surgery. This reduces the incidence of bacteria but does not eliminate it totally. In addition, resistant strains of oral bacteria may still be present that can cause bacterial Endocarditis.

Currently, the disadvantage is the time requirement to reduce the bacterial risk in periodontally-infected patients preparing for heart surgery. Patients treated with antibiotics before proceeding with open heart surgery reduces the risk potential. However, many patients who test positive for bacteria in the bloodstream and are in urgent need of heart surgery are often delayed between one to two weeks to eliminate the bacterial contamination in the mouth and bloodstream.

Dr. Pinero has found a way to significantly reduce the bacterial risk factor, enabling patients to undergo cardiac surgery within a timely fashion, most often within 24 hours. He utilizes a laser to combat areas harboring oral bacteria in conjunction with the guidelines as set forth by the American Heart Association to significantly improve the patient's surgical outcome.

In a study involving 92 patients awaiting heart surgery. Dr. Pinero carefully monitored their pre-cardiac surgery with a combination of oral medicine, dental evaluation, and laser treatment. Monitored patients, who ranged in age from 42 to 91, were diagnosed as having various dental infections, from chronic periodontitis to acute periodontal abscesses.

Once the surfaces were ridded of bacterial plaque and calculus, the teeth were irrigated with cleansing agents. Using the Biolase Nd Yag Laser, Dr. Pinero then carefully performed laser surgery on all gum tissue surrounding all teeth, whether periodontally-compromised or not. The laser is used in pulses along with air and water irrigation as a coolant. Doctors utilizing a laser in this capacity must be specially-trained to avoid contact with tooth or bone surfaces due to repercussions from laser heat.

With the patient's laser treatment complete. Dr. Pinero drew blood samples within 15 to 30 minutes to determine the presence of bacterial elements. Afterwards, patients were placed on chlorohexidiene rinses for five days prior to open heart surgery. Following their dental surgery, blood samples of these 92 subjects revealed a zero percent bacterial presence or growth, even after threee days post-operatively. "This is remarkable, considering that most of these patients suffered from acute periodontitis before treatment, "exclaims Dr. Pinero.