Few people realize how closely oral health is linked to cardiac health, says Dr. Michael Froeschl, an interventional cardiologist at the University of Ottawa Heart Institute.

"Oral health is critically important in patients who are at risk of developing infections of the heart and heart valves," says Froeschl.

"This is particularly true for patients who have had a valve replacement with either biologic material or a mechanical valve."

This is why dental assessments are required before heart-valve surgery and why "patients are encouraged to practise very conscientious oral hygiene and make regular dentists' visits as the most important thing they can do to decrease the risk of infection of their new valve,"he says.

"We used to emphasize the importance of (patients taking) antibiotics around the time of a dental visit," Froeschl adds.

"That is still recommended for people with artificial valves -the evidence is not as established for patients who have had valve repair though it is still recommended -but now the emphasis is really on regular dental visits and oral care at home."

Heart patients on blood thinners -for example, people with stents (tubes used to hold blocked arteries open) -are placed on blood thinners for up to a year, he says.

"After a scenting procedure, patients need to be on two blood thinners for up to a year, depending on the kind of stent. A dental visit while on blood thinners is a real issue that comes up all the time. Decisions have to be made about the urgency of the dental work and protecting that stent and preventing clots from building up on it," says Froeschl.

"I really recommend close communication between the dentist and the cardiologist to negotiate between these two, sometimes competing, interests."

A third issue, "potentially big but not clearly established," Froeschl says, is the hypothesis that periodontal disease and vascular disease are linked.

Gum disease is also a major concern for people with diabetes, says Liverpool, N.S., dentist Dr.

Martin Gillis, a member of the faculty of dentistry at Dalhousie University and the consultative section with the International Diabetes Federation.

"While the prevalence of periodontal disease is no different for people with diabetes as compared to the general population, the concern is that when people with diabetes develop periodontal disease, it is usually more severe and may affect their ability to control their diabetes," he says.

Oral care also has a significant impact on lung and respiratory disease, says Cindy Fletcher, executive director of the British Columbia Dental Hygienists Association.

"About three million Canadians have serious lung disease," she says.

"If they have periodontal disease that's not treated, it will severely complicate or worsen the lung disease they already have.

"If residents in a long-term care facility or hospital receive oral hygiene care, it can reduce their risk of developing pneumonia by up to 60 per cent. We know that pneumonia can often be a fatal complication for the frail elderly and people who are very sick. If we can control that complication, it obviously has a huge implication on their overall health."