Interviewer: In your upcoming book, you talk a lot about, and we discussed this already, about oral health and the relation to cardiovascular health. A lot of people see a complete disconnect there. How are the two linked, exactly?
Dr. Bradley Bale: Yeah, that's amazing.
Dr. Bradley Bale: Yeah, because even the American Heart Association did a huge review of the literature, and last year in their journal Circulation, published the conclusions of that review. One of the conclusions was we have level A evidence, that's the toughest evidence to acquire, level A evidence that periodontal diseases independently associated with cardiovascular risk. That's huge. That statement was in there. They went on to say that, well, we don't have data to prove causality, so everybody jumped on that, well, you can't prove it causes it, so the heck with it, it doesn't matter. Now most of our guidelines that we have for therapies and management and medicine, only about 20 percent are based on level A evidence, because we can't get level A evidence. So once you have that type of evidence in our opinion, any program set up to maintain to the wellness of the arteries has to take into account oral health. That's all you need, you don't need to prove causality. Actually, it's inflammation again that causes arterial disease, and we know of several ways in which oral pathogens cause inflammation of the arteries, one of which I mentioned a little earlier, the real bad pathogens that cause periodontal disease, generate this substance called lipopolysaccharide, and that we know can attach again to the receptors on the inside lining or the artery, and drive inflammation. We now have the science, and we know the biochemistry of how some of those germs can also directly attach to that tennis court, and when they do that, they increase the permeability of the tennis court, so the germs themselves can get through. The size of a germ compared to the size of cholesterol particles, what the germ can get through, believe me, the cholesterol particles can get through too, and that's why that most recent study, it wasn't a surprise to us, but it probably did shock some people. They actually found live pathogens, live germs, in a third of the clots that they looked at with electron microscopy. These germs get in there. Do you think when they get inside the wall of the artery they're going to cause some inflammation?