Dental Health and Heart Disease

You know some of the common risk factors for heart disease: poor diet, sedentary lifestyle, smoking. But did you know that there’s a strong correlation between dental health and heart disease? Specifically, researchers have found that patients with gum disease are at an elevated risk for cardiovascular disease. We don’t fully know the mechanisms behind this correlation, but researchers are developing a better idea of why these two seemingly unrelated conditions appear to be linked. 

The Link Between Dental Health and Heart Disease 

The link between dental health and heart disease is firmly established. Research has shown that: 

• Nearly half of adults have some degree of gum disease. 
• People with gum disease—also known as periodontal disease—are 2 to 3 times more likely to have a heart attack, stroke, or other major cardiovascular event, according to data from Harvard Health. 
• Other research has found that an individual with gum disease is 20% more likely than the average person to develop heart disease. 
• A 2014 study examined patients living with both conditions concurrently. The researchers found that the patients who received proper care for their gum disease had 10-40% lower cardiovascular care costs. 

The correlation between dental health and heart disease is strong. The question is whether or not gum disease actually causes cardiovascular issues directly. 

Does Gum Disease Cause Heart Disease? 

There are two possible explanations for the link between dental health and heart disease: 

• The correlation is due to common lifestyle factors (e.g. poor diet) 
• The correlation is the result of a direct cause and effect (i.e. the effects of gum disease take a toll on the heart) 

There is likely some truth to both points, although researchers are still working to understand the extent to which each factor comes into play. Let’s look at them individually. 

Lifestyle Factors That Influence Both Gum Disease and Heart Disease 

Many of the most common risk factors for gum disease are also associated with heart disease. For example: 

• Age. Over 70% of Americans age 65 and older have some form of periodontal disease. Adults over 65 are also at the highest risk for heart disease and related conditions. This may influence the correlation data between gum disease and heart disease. 
• Smoking. Studies have shown that tobacco is one of the most significant risk factors for periodontal disease. Tobacco irritates gum tissue, causing gums to loosen around the teeth and creating a breeding ground for bacteria. Smoking is also responsible for roughly one in four cardiovascular deaths.
• Stress: Studies show that stress can inhibit the body’s ability to fight off infections, including periodontal diseases. Stress is also a leading contributor to hypertension, which elevates a person’s risks of cardiovascular events like heart attacks. 
• Medications: Certain medications are known to affect oral health and even exacerbate gum disease. These include common cardiovascular agents, anticoagulants, and blood pressure drugs. So if you’re taking certain medications to address a heart-related issue, it may have an adverse reaction on your gum health. 
• Diet: A diet that’s lacking in essential nutrients can compromise the immune system, making it more difficult to fend off infections like those associated with gum disease. In addition, researchers have found a link between obesity and periodontal disease. Two of the three biggest risk factors for heart disease (high blood pressure and high cholesterol) are also diet-related. 

By consistently making healthy lifestyle choices, you can minimize your risk for both periodontal disease and heart disease. 

How Gum Disease May Influence Heart Disease 

Researchers have not definitively identified a causal link between dental health and heart disease. However, there are some possible connections worth noting. The most likely instigator is inflammation. 

Gum disease occurs when bacteria-rich plaque accumulates around the teeth and gradually hardens. Early-stage gum disease is known as gingivitis. If it’s not treated early on, it can advance to periodontitis, a more severe form of gum disease. Periodontitis results in chronic inflammation of the gums, which must be treated before invasive treatments like dental implants can be performed. 

As noted by Penn Medicine and other leading medical authorities, many researchers suspect that the same bacteria that inflame the lungs can also travel through the bloodstream and contribute to inflammation in the heart’s vessels. Chronic inflammation is known to contribute to atherosclerosis, plaque accumulation in the arteries.

To break it down more simply, there’s growing evidence that inflammation in the mouth may narrow important arteries over time. Researchers have actually found traces of oral bacteria in the bloodstreams of atherosclerosis patients, so the link does seem to have some merit.

It’s also important to note that the correlation between dental health and heart disease is strongest among people with heart valve disease and those living with artificial heart valves. This may be a consequence of the bacteria traveling through the bloodstream and infecting the vulnerable heart valves.  

The Diabetes Link Between Dental Health & Heart Disease

There’s another prominent underlying factor that may partially account for the correlation between dental health and heart disease: diabetes. 

Diabetes contributes to excess glucose in the blood, and this same glucose is contained in the saliva. When saliva contains too much glucose, it can increase the likelihood of bacterial infection in the mouth. 

Over time, high blood glucose also damages the blood vessels and nerves connected to the heart. Diabetes is also commonly associated with other cardiovascular risk factors like hypertension, high cholesterol, high triglycerides, and obesity. More than two-thirds of diabetes patients over 65 die of heart-related complications.

If you have diabetes, it’s critical that you take steps to manage your condition every day. 

Beyond Gum Disease – The Link Between Tooth Loss and Heart Disease 

Researchers have noted a correlation between heart disease and tooth loss specifically. One clinical study examined data from nearly 16,000 patients in 39 countries and found that the likelihood of heart disease increased as the patients’ number of remaining teeth decreased. 

The reason for the correlation seems once again to be a combination of lifestyle factors and direct cause and effect. Patients with few teeth were also more likely to have other risk factors for cardiovascular disease, including: 

• High levels of LDL (bad) cholesterol 
• Being a current or former smoker 
• A high body mass index (BMI) 
• High blood pressure 
• High blood sugar associated with diabetes 

In addition, for every decrease in the number of teeth, researchers noticed an increase in the levels of inflammation-causing bacteria that can harden the arteries. 

How to Prevent Heart Disease if You Have Gum Disease 

Whether or not gum disease contributes directly to heart disease, it can serve as an important warning sign. The first step is to visit a dentist immediately if you notice any of the telltale signs of periodontal disease: 

• Swollen, puffy, or discolored gums 
• Sensitive or tender gums 
• Easily bleeding gums 
• Chronic bad breath (sometimes metallic) 

Depending on the severity of the disease, your dentist may be able to treat the condition using deep cleaning methods, antibiotics, or surgical intervention. 

Also remember to brush after every meal, floss daily, and use an antiseptic mouthwash to kill bacteria. Finally, be sure to address any lifestyle factors that may be causing or contributing to your dental issues, such as smoking, poor diet, or unmanaged diabetes. 

For risk factors beyond your control, such as advanced age or a pre-existing heart condition, there are still steps you can take to minimize your risk of a life-threatening event like a heart attack or cardiac arrest. 

• Focus on heart-healthy living (diet, exercise, avoid smoking) 
• Work with a cardiologist to assess your precise heart condition and develop a plan for healthy living 
• Take any prescribed heart or blood pressure medications
• Take steps to manage your diabetes or any other comorbidities 
• Practice stress management techniques  
• Invest in an automated external defibrillator (AED) in case of an emergency—thanks to models like the recertified Philips HeartStart OnSite, it’s now possible to own a professional-grade home defibrillator for under $600. 
• Visit your doctor immediately if you notice any warning signs (heart arrhythmias, chest pain, trouble breathing, etc…)

Dental health and heart health might seem like they’re a world apart, but they’re closely connected. So next time you reach for the mouthwash, remember that you just might be doing your heart a favor.