Nygaard thought she was in good shape, with low body fat, controlled cholesterol and a lifetime of good health.
“I’d never missed a day of work in 18 years. I missed only one week after each baby. I never had anything ever,” she said of her medical history.
After numerous tests ruled out a structural defect, clotting disorder, leaking valve or other known causes of stroke, the doctors told her it was of unknown origin.
“I wasn’t accepting that as an answer,” she said. “My kids were 5 and 7. I knew my dad had cardiovascular disease. He had a heart attack by 40. My mom had heart disease. I knew I was a walking time bomb.”
So Nygaard went to the Heart Attack and Stroke Prevention Center, where, she said, a series of tests revealed her arteries were inflamed, putting her at high risk for another stroke.
After making numerous lifestyle changes to improve her cardiovascular health, including diet, exercise and medication, follow-up tests were discouraging.
“I was doing all those things and in spite of doing them my stroke risk wasn’t getting better,” Nygaard said.
That’s when medical director Amy Doneen asked about Nygaard’s dental care.
“I’m a gum dentist but I hadn’t had an appointment in three years,” admitted Nygaard, noting a subsequent saliva test showed she had high levels of oral bacteria that correlate with cardiac event risk. She also had bleeding gums.
“I had one pocket that had a sore that was bleeding. Most dentists ignore one sore that bleeds,” she said.
But after six weeks treating the gum disease, Nygaard said her stroke markers dropped from dangerous into the healthy zone.
“We believe her periodontal inflammation was part of the cascade,” said Doneen, a nurse practitioner. “It’s one piece of the pie.”
While Doneen looks at other factors that lead to cardiovascular disease and artery wall inflammation, she stressed that good oral health is crucial to overall health, especially cardiovascular health.
“There’s evidence that what goes on in the mouth has systemic implications,” she said, adding, “It’s never normal to have bleeding gums.”
Nygaard said many patients aren’t informed about their gum health and the risks that go up with inflamed, bleeding gums or high amounts of decay-causing bacteria. “A lot of dentists and hygienists don’t tell patients because they don’t believe it makes a difference,” she said.
Directors of the RIDE dental program at Riverpoint campus aim to change this with a holistic approach to dental education.
RIDE – Regional Initiatives in Dental Education – is a University of Washington School of Dentistry program that partners with Eastern Washington University and Washington State University. It offers professional education, where students learn alongside other future health care providers, including medical, pharmacology, physical therapy, occupational therapy, auditory, and dental hygiene.
“We’re trying to get the message out that the mouth isn’t separated from the rest of the body. You’re not going to be healthy unless you have a healthy mouth,” said Dr. Jim Sledge, RIDE’s regional clinical director.
Still, Sledge said, many people think oral health is only about teeth and cavities.
“There’s a larger concern with periodontal disease and cardiovascular health. What happens in the mouth can affect cardiac disease,” Sledge said.
In fact, Dr. Art DiMarco, Spokane director of RIDE, said studies show gum disease has a strong correlation to cardiovascular disease, putting people at higher risk of diabetes, heart attack and stroke.
A diabetic who has swollen or bleeding gums, for example, may have trouble controlling blood sugar. In turn, uncontrolled diabetes can contribute to gum inflammation.
For a pregnant woman, Sledge said, oral disease increases the risk of gestational diabetes as well as the prevalence of prostaglandin, a hormone that stimulates uterine contractions, which increases the odds of delivering a low-birth weight baby.
Additionally, he said, studies have shown that primary caregivers pass oral bacteria directly to their children. The mom who pops a pacifier in her mouth to clean it, for example, passes decay-causing bacteria to her child.
“There is direct transmission of bad bacteria that causes cavities. You have infected your baby,” he said, noting that’s another reason pregnant women should go to the dentist and address any oral issues. “Get moms in good oral condition before birth so there’s less chance of that transmission.”
Yet according to a recent survey by the Washington Dental Service Foundation, 23 percent of adults in Washington State haven’t had a dental check up in the last year.
While oral disease can be prevented and treated, DiMarco said it may go unchecked because, unlike an oozing forehead wound that would get immediate medical attention, bleeding or inflamed gums aren’t so visible.
“People can close their mouths and hide disease,” he said. “But it is disease.”