While a direct link between periodontal disease and heart disease has yet to be firmly established, doctors believe there is an important connection between oral and cardiovascular health.
You may have cultivated an excellent working relationship with a caring and competent physician. You may be eating a heart-healthy diet and exercising regularly. But have you seen your dentist lately? This is an important question, because the state of your teeth and gums may impact your cardiovascular system, independent of any healthy habits. The culprit is a common oral problem -- periodontal disease.
Periodontal disease is a chronic infection of the gums caused by the buildup of plaque. An estimated 75% of all Americans over 35 have some form of periodontal disease, according to the FDA. Most of us have experienced periodontal disease in its mild form, gingivitis -- inflammation of the gums that causes them to redden and swell. However, gingivitis may evolve into periodontal disease.
This happens when plaque builds up and the bacteria that live in plaque release a steady stream of toxins, provoking a chronic inflammatory response by the immune system. To fight infection, the body bombards the gums with white blood cells. A combination of toxins from the bacteria and substances released by the white blood cells breaks down the supportive tissue and bones that hold teeth in place. The result is tooth loss.
Periodontal bacteria and the toxins they produce may have an adverse effect on vascular health. As of yet, none of the evidence for an association between heart disease and periodontal disease comes from large clinical trials—which are the gold standard for establishing cause and effect.
An epidemiological study conducted by the Centers for Disease Control and Prevention, published in the journal Stroke, has found that greater tooth loss is associated with a higher risk of heart attack and stroke.
Similarly, a study published in the Journal of Lipid Research reported that blood samples drawn from 12 people with periodontal disease had relatively high levels of a more atherogenic subtype of LDL when compared with a control group of 12 people with healthy gums. According to the authors, this may translate into a greater risk of cardiovascular disease.
Observing a much larger group of 1,056 patients, a combined team of doctors and dentists with the Oral Infections and Vascular Disease Epidemiology Study (INVEST) reported in the journal Circulation that people with high levels of periodontal bacteria also had thicker internal linings of their carotid arteries—a major risk factor for stroke.
Most recently, researchers from the Coronary Event and Periodontal Disease study (CORODONT) reported in the Annals of Internal Medicine that high levels of periodontal bacteria were related to a higher incidence of heart disease among the 789 CORODONT participants.
All told, the available evidence indicates that a person’s oral health tends to reflect their vascular health, but these studies do not prove that periodontal disease is a direct cause of cardiovascular disease.
The studies cited above are small or observational, meaning they lack control populations for comparison. And despite research demonstrating that periodontal bacteria enter the blood stream, there is no evidence to prove that this contributes to the development of atherosclerosis.
Despite the fact that a direct link between periodontal disease and heart disease has yet to be firmly established, chances are there is an important connection between oral and cardiovascular health.
It may be that people who do not take care of their teeth and gums have less healthful diets and worse habits in general, which in turn increase their risk of heart attack and stroke. When you consider that the leading risk factors for periodontal disease, such as smoking and diabetes, are also leading causes of heart disease, this might indicate that a person with periodontal disease is still in danger of developing heart disease, even if periodontal disease is not a risk itself.
Moreover, some studies do suggest that periodontal disease may be an independent risk factor, which means that regardless of how healthy your eating habits are, or how diligently you exercise, you may be putting yourself at greater risk for heart attack and stroke if you do not take proper care of your teeth.
The most prominent warning signs of periodontal disease are sore and receding gums that bleed easily. Chronic halitosis, a change in the way your teeth fit together, or loose and crooked teeth are also indications. However, it is possible to have periodontal disease without experiencing tooth loss.
At the highest risk for periodontal disease are smokers, tobacco chewers, and those with diabetes, osteoporosis, or systemic autoimmune diseases like rheumatoid arthritis or lupus, which compromise the body’s ability to fight infections. Heredity is a risk factor. And it is possible to acquire periodontitis from someone who has periodontal disease, since oral bacteria are transmissible from toothbrush to toothbrush. It is a good idea to replace your toothbrush at least once every three months.
If you have already been diagnosed with periodontal disease, it can be treated with antimicrobial gels that are rubbed onto the gums. Studies also show that pulling teeth from infected areas of the gums and getting regular professional teeth cleanings can reduce the amount of periodontal bacteria that ends up in the bloodstream.
Further research still needs to be done to confirm that your oral health can impact your cardiovascular health. Nonetheless, it certainly does not hurt to take better care of your teeth and gums. And the good news is that, unlike getting on that treadmill every day, good dental hygiene may be an easy way to help reduce your risk of heart attack and stroke.
The bottom line is that brushing your teeth at least twice daily, flossing once daily, and seeing your dentist at least twice every year for regular cleanings and oral exams—the American Dental Association’s basic recommendations for staving off periodontal disease—might also be heart-healthy strategies.
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