You know that you are supposed to brush your teeth twice per day and floss regularly to prevent significant dental problems. However, did you know that keeping those pearly whites in tip top shape also helps with overall health, especially heart health? How are your teeth and your heart related? How can better dental health lead to better cardiac health?
Periodontal disease is extremely common and has well know associations with various forms of heart disease. Periodontal disease is a process that affects the supporting structure of the teeth, the gums, the surrounding tissue and the bones supporting the teeth. Periodontal disease is caused by plaque or bacteria on the teeth. This leads to inflammation causing local damage. The bacteria can also enter the bloodstream and lodge in arteries, including the heart arteries. There are two types of periodontal disease: gingivitis and periodontitis. Gingivitis is the milder form of the disease and involves only inflammation of the gums. Periodontitis is a more serious process and a chronic inflammatory disease that affects the teeth, the gums and the bones. Symptoms of periodontal disease include red, swollen, painful or bleeding gums, loose teeth, loss of teeth, and pockets of infection between the teeth and the gums. It is reported that periodontal disease affects more than 1 billion people and is considered the sixth most common disease worldwide.
Many studies have tied periodontal disease to systemic inflammation. Inflammation can be good and it can be bad. Inflammation can fight an injury to the body and help promote healing once the injury has been cured. However, unchecked and ongoing inflammation can also cause long term tissue damage. The bacterial infection in periodontal disease provides a textbook example. Bacteria that are present in dental plaque are also found in the blood stream. The bacteria enter the body through small perforations in the dental tissue and can also be released by tooth brushing. Once in the blood, the bacteria lodge in various arteries, including the heart arteries. Once there, they initiate an inflammatory reaction which leads to damage of the arterial wall and ultimately plaque and blockage in the heart artery. In addition, the dental bacteria increase low density lipoprotein (LDL cholesterol) which then promotes further plaque and blockage in the heart arteries. Studies have shown increased levels of C reactive protein (a marker of inflammation in the blood) associated with periodontal disease. Treatment of periodontal bacteria with antibiotics decrease bacteria in dental plaque, lower levels of C reactive protein and reduce LDL cholesterol.
Many, many studies in thousands of patients and in populations from around the world have linked periodontal disease to heart artery disease, heart attack, stroke and cardiac death. Two large studies tied periodontitis (the severe form of periodontal disease) to heart attack. One study reported a 16% increased risk for heart attack with periodontitis and the other had a 28% increased risk. A more recent study (October 2024) found a 9% increase in heart artery disease in all patients with periodontal disease (gingivitis and periodontitis). Another recent study was the first to show that periodontal disease was associated with congestive heart failure (CHF).
Last month (February 2025), an additional association was made between periodontal disease and atrial fibrillation (Afib) and stroke. The study followed 6200 people, average age 62, for 25 years. Patients who flossed their teeth at least once per week had a 22% lower risk for stroke and a 12% lower risk for Afib. Flossing more led to even further reductions in risk. The benefit of flossing was on top of tooth brushing and regular dental appointments. This may be because flossing cleans the gums better than tooth brushing, removing food and plaque from in between teeth.
To treat periodontal disease, dentists will prescribe antibiotics. Antibiotics have been shown to kill the bacteria found in dental plaque and reduce inflammatory markers. To treat severe cases, oral surgeons will do surgery. To prevent periodontal disease and subsequent heart artery blockage and heart attack, stop smoking (smoking causes both periodontal disease and heart disease), brush your teeth twice per day and go for regular dental checkups. To prevent Afib and stroke, floss for your life.
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