The connection between oral hygiene and heart disease

Can your mouth really affect your heart? Perhaps there’ve been instances when the words you spoke created some “heartache”. But it’s not your language choices Mark O’Shaughnessy, MD, PPG – Cardiology, wants to address, but rather, the choices you make with your oral hygiene.

The risks

Poor oral hygiene, and specifically periodontal or gum disease, has been the subject of debate for decades as a possible cause or risk factor for the development of cardiovascular disease. While there is currently no firm data to support a direct correlation between gum disease and heart disease, there appears to be more to the story.

Based on the current understanding of atherosclerosis (blockages of the arteries), it is believed that inflammation plays an integral role in the development and progression of this disease, ultimately resulting in obstruction of an artery, which is the root cause of a heart attack. The exact mechanism of this inflammatory process is unclear but there is compelling data to suggest that chronic low grade states of inflammation may play a role in the development of an atherosclerotic plaque. There is mounting evidence that it is actually our immune response to this ill-defined inflammatory process that is the culprit in the development of atherosclerosis.

Periodontitis is a chronic inflammatory process involving the gums, most commonly caused by poor oral hygiene. This chronic infection/inflammatory process results in painful gums, bleeding with brushing and ultimately oral bone and tooth loss. There have been several studies that have documented a correlation between chronic periodontitis and heart disease, however, to date there have been no studies that have been able to document a change in cardiovascular risk or outcomes (heart attack, stroke or death) by treating the gum disease. This could mean that we just aren’t looking at the right targets. If it is our immune response to chronic inflammation, and not the direct effect of the inflammation, it is possible that with immune modulation we might be able to demonstrate that indeed chronic oral inflammation plays a more direct role in heart disease. With current data, however, we cannot accurately conclude that chronic inflammatory periodontal disease plays a direct role in heart disease.

Bacterial endocarditis, a very serious infection of the heart valves, has been clearly shown to have a direct correlation to poor oral hygiene. Bacteria from the mouth can find their way into the bloodstream, and if the circumstances are just right, can “set up shop” on our heart valves, causing significant destruction of the valves and life-threatening complications. Poor hygiene and the subsequent damage to the normal barriers within our mouths can create the perfect environment for these bacteria to find their way through the normal barrier and into our bloodstreams.

Prevention

As a cardiologist, I wouldn’t say that the lack of evidence that there is a direct correlation between chronic gum disease and chronic heart disease means we shouldn’t make our oral hygiene a priority. Every preventative precaution helps. We suggest that, in addition to your heart health, there are a host of reasons to practice good oral hygiene, not the least of which is maintaining a beautiful smile! There are only a few simple rules to follow:

  • Brush your teeth twice a day
  • Floss daily
  • Change your tooth brush every 3 months or sooner if the bristles are flattened
  • Visit your dentist regularly

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