Floss For Your Life

 

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.

Hearts on Fire

 

The wild fires that have engulfed California are now considered one of the worst natural disasters in US history. Homes have been lost, communities have been destroyed and 40,000 acres have burned, fueled by Santa Ana winds and a prolonged drought. Across the globe, wild fires have become more frequent. In the US, there are more than 70,000 fires per year and the acreage burned has more than doubled over the past 30 years. In addition to property damage, the particulate matter in wild fire smoke is a huge health concern. Cardiac and respiratory deaths have increased over the past twenty years due to wild fires. How do wild fires and the smoke they produce affect heart health?

 

It is well established that air pollution is a major factor in global health. Air pollution causes millions of premature deaths every year, especially in the very young (children < 6 years old), the elderly (over age 65) and in vulnerable groups (those with pre-existing lung or heart disease). Air pollution has been linked to almost every major cardiac disease process including heart attack, heart failure, arrhythmias, hypertension, stroke and cardiovascular death. Polluted air contains particulate matter, fine particles that are suspended in the air. Particulate matter is produced by burning fossil fuels (for example car exhaust), smoke from manufacturing plants, and agricultural activities (such as burning crop residues). These particles are inhaled into the lungs and enter the blood stream. Once particulate matter has entered the body it can trigger various adverse reactions such as inflammation, oxidative stress, stiffening of the wall of the arteries, loss of function in the blood vessels, and increased risk for blood clotting.  

 

Wildfires produce smoke that have similar effects on the body as air pollution. The smoke contains particulate matter, gases (carbon monoxide, nitrous oxide), heavy metals (lead, mercury), and toxic carcinogens (similar to cigarette smoke- benzene, benzopyrene). Wildfire smoke is especially harmful to human health due the fact that smoke can travel thousands of miles and the particulate matter is very dense (wildfire events can increase particulate matter in the air to levels that equal the most polluted cities). Wildfire smoke can impact health in many different ways. It affects respiratory health by worsening lung function, increasing asthma episodes and increasing the risk for lung infections. Particulate matter is also known to affect the kidneys, the gastrointestinal system and can lead to diabetes. Wildfire smoke is associated with high blood pressure, episodes of chest pain, cardiac arrest and worsening heart failure. Exposure to smoke increases hospital admissions for cardiac events. Even short-term exposure to wildfire smoke can result in harm as this type of smoke is more toxic than the particulate matter found in urban air pollution.  It doesn’t take a full wildfire to produce the risks. Even the particulate matter from wood smoke (such as fire pits or camp fires) can trigger these adverse reactions. 

 

Wildfires are not just something that occur 3,000 miles away on the west coast but have happened in our own backyard as well. The 2023 wildfire season in Canada was among the worst in its history. In June 2023, the wildfire smoke traveled more than 2000 miles and affected the Eastern US.  The smoke was gathered and analyzed on the Piscataway campus of Rutgers University. Researchers found that the smoke had very large concentrations of fine particulate matter as well as high amounts of cancer-causing organic compounds. On June 7 2023, the air quality in New York City was the worst on record in 50 years. In addition, on that day, the level of particulate matter was 10 times higher than the national air quality standard. How did that affect health? Asthma related emergency room (ER) visits increased by 82% on June 7 in New York State and by 63% in New Jersey. The New York area was not the only one involved. In Baltimore, the level of particulate matter was 9 times higher on June 7 than any other day in 2023. This resulted in increased visits to ERs and urgent care facilities for heart and lung related problems.

 

What can you do to protect yourself when the next wave of wildfire smoke descends on New Jersey? The best recommendations include staying indoors, with air conditioning or an air purifier. Don’t do any strenuous activity outside (for example exercising, mowing the lawn, gardening). If you have to go out, wear a face mask, preferably an N95 mask. Let’s hope for a fire free 2025.