Periodontal Disease and Heart Health

Last Editorial Review: 4/6/2005

Brushing and flossing may actually save your life.

WebMD Feature

Reviewed By Charlotte Grayson

If you're worried about heart disease, you can easily spend thousands of dollars each year trying to prevent it, paying hand over fist for prescription medicines, shelves of healthy cookbooks, fitness machines for your home, and a gym membership.

Or maybe not. A number of recent studies suggest that you may already have a cheap and powerful weapon against heart attacks, strokes, and other heart disease conditions. It costs less than $2 and is sitting on your bathroom counter. It is none other than the humble toothbrush.

"There are a lot of studies that suggest that oral health, and gum disease in particular, are related to serious conditions like heart disease," says periodontist Sally Cram, DDS, a spokeswoman for the American Dental Association.

So can preventing periodontal disease, a disease of the gums and bone that support the teeth, with brushing and flossing prevent heart disease?

The evidence isn't clear yet, experts say, but it's intriguing. According to the American Academy of Periodontology, people with periodontal disease are almost twice as likely to have coronary artery disease (also called heart disease). And one study found that the presence of common problems in the mouth, including gum disease (gingivitis), cavities, and missing teeth, were as good at predicting heart disease as cholesterol levels.

Evidence Links Periodontal Disease and Heart Health

When it comes to the connection between periodontal disease and heart disease, epidemiologist Moise Desvarieux, MD, PhD, is used to dealing with skeptics.

"One of the talks I give is called, 'Investigating the Links Between Periodontal Infection and Vascular Disease: Are We Nuts?'" says Desvarieux, from Columbia University's Mailman School of Public Health. "It's not a connection that people naturally think of."

Desvarieux was the lead author of a recent study published in Circulation: Journal of the American Heart Association that studied 657 people without known heart disease. He and his co-authors found that people who had higher blood levels of certain disease-causing bacteria in the mouth were more likely to have atherosclerosis in the carotid artery in the neck. Clogging of the carotid arteries can lead to stroke.

Atherosclerosis, also called "hardening of the arteries," develops when deposits of fats and other substances in your blood begin to stick to the sides of your arteries. These deposits, called plaques, can build up and narrow your arteries, clogging them like a plugged-up drain. If these plaques ever block the blood flow completely, you could have a heart attack or stroke, depending on the location of the blockage.

(Note: Not all plaque is alike. The plaques in your arteries have nothing to do with dental plaque your dental hygienist scrapes off your teeth. Dental plaque is a sticky residue of bacteria, acid, and food particles that can irritate your gums and eat away at tooth enamel.)

So what might hardening of the arteries have to do with gingivitis, that minor villain of toothpaste and mouthwash commercials?

No one is sure yet. Experts know that bacteria from the mouth can enter the bloodstream through the gums. These same bacteria have been found clumped in artery plaques. So one theory is that these bacteria stick to the fatty plaques in the bloodstream, directly contributing to blockages.

Other possibilities lie in the body's own defense mechanisms against bacteria. One of the body's natural responses to infection is inflammation (swelling). It's possible that as these oral bacteria travel through your body, they trigger a similar response, causing the blood cells to swell. This swelling could then narrow an artery and increase the risk of clots.

That inflammation could be the root of the problem adds to data researchers are gathering that suggest more and more diseases, including periodontal disease, heart disease, and arthritis, are partially caused by the body's own inflammatory response.

Could Periodontal Disease Cause Heart Attacks?

So could periodontal disease, gingivitis, or another dental disorder, pericoronitis (when gum tissue around the molars becomes swollen and infected) cause heart attacks and strokes? It's far too early to say.

"There's no question that there appears to be a connection," says Gordon Douglass, DDS, past president of the American Academy of Periodontology. "But the exact relationship between cardiovascular disease and periodontal disease isn't clear."

"It's like the chicken and the egg," says Desvarieux. "In our study, we know that people who had higher levels of the bacteria had more arteriosclerosis, or atherosclerosis. But we can't say whether one caused the other." The only way to know, he says, is to follow up the people in his study to see how they fare in the long term.

But even if periodontal disease isn't actually causing heart disease, the connection could still be important. For instance, periodontal disease might be an early sign of cardiovascular problems. Heart disease can be hard to catch early, because many of the conditions that precede it have no symptoms. You won't ever feel your arteries hardening or your cholesterol rising. But you might notice bleeding or painful gums.

If further studies bear out the connection between periodontal disease and heart disease, the next step would be to try treatment, Desvarieux says. Might taking antibiotics not only help heal oral infections but, as a result, also lower your risk of heart disease? No one's sure, but it's possible.

It's still too early for official preventive steps, since researchers don't know exactly how heart disease and periodontal disease are connected.

"Obviously, people worried about heart disease need to pay attention to the established risk factors," Desvarieux tells WebMD. "I wouldn't want people to think that if they just started to brush their teeth more, they could go back to smoking or ignore their diabetes."

If you're at risk of heart disease, do the obvious:

But Cram of the ADA argues that everyone should make a special effort to prevent oral health problems. That's especially true, she says, for people who are at higher risk of developing heart disease. And Douglass adds that if you already have periodontal disease, you certainly shouldn't ignore it. In many cases, you may just need to learn better brushing and flossing habits. More advanced cases of periodontal disease may require a trip to the dentist for a careful cleaning of the roots of the teeth, called scaling and root planning, or surgery.

"I think the evidence indicates that you should clear up any periodontal disease," Douglass tells WebMD. "It's fairly easy to do, and why not get rid of a potential risk factor for heart disease?"

He also stresses that people who have heart problems or recently had cardiac surgery may need to take antibiotics before having any dental procedures. Medication will lower the risk that bacteria from the mouth will wind up infecting the tissues of the heart, causing a dangerous condition called endocarditis.

For most people, however, Douglass says that sticking with commonsense tips can head off problems. "If you keep your mouth clean, it's very hard for the bacteria that cause periodontal disease to get started," he says. You'll also reap other benefits -- fewer fillings, healthier gums, and a brighter smile.

"We've always known that a little prevention goes a long way, but we used to think of it in terms of avoiding cavities and things like that," says Cram. "Now it seems that by using your toothbrush and your floss, you might also be preventing much more serious health problems down the road."

Published April 4, 2005.

SOURCES: Moise Desvarieux, MD, PhD, MPH, department of epidemiology, Mailman School of Public Health, Columbia University, New York. Gordon Douglass, DDS, past president, American Academy of Periodontology. Sally Cram, DDS, spokeswoman, American Dental Association. Desvarieux, M. Circulation, Feb. 8, 2005; vol 111: pp 576-582. Gordon, D. Circulation, March 9, 2004; vol 109: pp 1076-1078. Janket, S. Circulation, March 9, 2004; vol 109: pp 1095-1100. The Cleveland Clinic. American Heart Association. American Dental Association. American Academy of Periodontology.

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