Oral health and the heart

It’s American Heart Month, but keeping a healthy ticker also means minding your mouth.

Periodontitis, or severe gum infection, is a known heart disease risk factor that can be prevented or alleviated through proper oral health care, says Dr. Carlos Parra, clinical assistant professor in periodontics at Texas A&M College of Dentistry. He cites “robust evidence” supporting a link between periodontitis and cardiovascular disease based on epidemiological studies. Fittingly, February is also Gum Disease Awareness Month.

The link between oral health and cardiovascular disease, or CVD, has been studied for decades, although the connection has gained more intense interest in the past 20 years. Most evidence is based on observational studies, Parra says. Longitudinal studies—which make comparisons showing cause and effect over a long time—have been limited.

“Inadequate oral health, as well as other systemic and local factors, leads to periodontal disease (that is, gingivitis and/or periodontitis), which increases the body’s inflammatory burden,” he says. “This inflammation is caused mainly from the own host that is trying to fight the bacteria and its byproducts found on the plaque and calculus buildup on the teeth. This inflammatory burden appears to be one of the main links in this relationship.”

Periodontal health starts with prevention, Parra says, including these key approaches: regular dental checkups (every six months is ideal), good oral hygiene habits (brushing two to three times each day, daily flossing), no smoking, a healthy diet and balanced lifestyle habits.

“Although prospective randomized controlled periodontal intervention studies where patients with both periodontal disease and CVD have received periodontal treatment are lacking, observational evidence suggest that several oral health interventions—including self-performed oral hygiene habits, dental prophylaxis, increased dental visits and periodontal treatment—produce a reduction in the incidence of CVD,” he says.

According to a recent Centers for Disease Control and Prevention report, about 47% of U.S. adults ages 30+ have some form of periodontal disease. By age 65, it is even more prevalent with about 70% of U.S. adults with periodontitis. The CDC also reports that about 6.7% of adults ages 20+ have coronary artery disease. Atherosclerotic vascular disease—hardening of the arteries via plaque buildup, cholesterol and fats—is a leading U.S. cause of disability and mortality. That means 1 in 4 deaths are related to heart disease, according to “Heart Disease and Stroke Statistics” from the American Heart Association.

Many contributors to periodontal disease and cardiovascular disease are often shared, Parra says, such as smoking or diabetes.

“Recent research points toward inflammation as the key factor linking periodontal disease and other systemic diseases,” he says.

A myriad of other health issues can arise from unhealthy gums. Periodontal disease has been linked to other systemic diseases, including diabetes, he says. That relationship between periodontitis and diabetes mellitus, or “sugar diabetes,” has been most widely studied compared to other related systemic diseases. On the upside, when periodontal disease improves with treatment, a patient’s diabetes mellitus also improves, and vice versa. Less compelling evidence has also found an association between periodontal disease and osteoporosis, adverse pregnancy outcomes, respiratory disease, Alzheimer’s, cancer and even COVID-19 deaths.