It may seem off to consider that how well your take care of your teeth affects whether or not you are at a greater risk of cardiovascular disease, but there are some important considerations to know about. With February being Heart Health Month, it’s important to understand all the ways you can benefit the health of your heart and prevent cardiovascular disease, and one way is by taking care of your oral health. Let’s further investigate this connection.
Many studies have observed that people with poor oral health have higher rates of cardiovascular problems. One study asked participants about their toothbrushing behavior, and they found that those who brushed less than twice a day for less than two minutes were three times more likely to develop heart disease.
While the connection between poor oral health and cardiovascular disease has been a consistent observation, scientists are less sure about the reasoning behind this link. In fact, it’s highly likely that there are many factors at play, and as such, there have been multiple theories proposed.
The first theory is that the bacteria which infect the gums and cause oral diseases such as gingivitis and periodontitis can travel to other blood vessels in the body. As we know, the blood vessels are part of the cardiovascular system, and when these bacteria travel through the blood vessels, they cause inflammation and damage to the blood vessels. This, in turn, can cause tiny blood clots, a heart attack, or a stroke to result.
Research supporting this theory has found the remnants of oral bacteria within plaque-filled blood vessels that were not near the mouth. This evidence suggests that the bacteria that infects the mouth of someone with poor oral hygiene may be able to travel through the circulatory system, and can then travel throughout the body through the blood vessels, causing damage along the way.
However, antibiotic use has not proven to be an effective way to reduce cardiovascular risk. Since antibiotics serve to eradicate bacteria, if bacteria are behind the relationship between oral health and heart health, there is likely more behind the story than scientists have been able to ascertain thus far.
Other theories propose that it may not be the bacteria that causes the problem but instead the body’s immune response. When faced with an unwanted contagion, such as bacteria, one aspect of the immune response is inflammation, which may cause the cascade of vascular damage the leads to cardiovascular disease. This aligns with other evidence of how inflammation affects heart disease risk.
Yet another connection between these two diseases may be related to hypertension, or high blood pressure. High blood pressure is one of the biggest risk factors for heart disease, and it is the force that the blood exerts on the artery wall as it is pumped through the blood vessels. While it is natural for blood pressure to fluctuate throughout the day, chronic high blood pressure can exert excess strain on the heart, damaging the heart and blood vessels. High blood pressure can also result in a buildup of plaque in the arteries, which can lead to a heart attack.
A recently published study found that gum disease worsens blood pressure, resulting in high blood pressure. In addition, gum disease also interferes with the medications used to treat hypertension. So, those who have high blood pressure and gum disease will have a more challenging time managing their blood pressure with medication alone, increasing the likelihood of chronic high blood pressure.
It’s possible that those who have good oral hygiene also have good heart health because their diligence to oral hygiene is also reflected in other aspects of their health. Or essentially, those that take the time to care for their teeth are also taking care of other aspects of their health, such as through diet and exercise.
So, the connection between oral and heart health may not be due to the diseases themselves, but more so that someone who has one disease might also have the other because they are not practicing good health habits all around. Here are some Heart Healthy Habits you should follow.
Yet another theory is that there is no link between oral health and cardiovascular disease, but they are instead connected by an outside factor. For example, one risk factor that is common for both these conditions is smoking. So, those who smoke are at an increased risk of both diseases, which would make it appear as though one condition leads to another. Additional outside risk factors include lack of exercise and poor access to healthcare.
One large study that investigated these outside factors found that, when considering smoking, the connection between oral health and cardiovascular disease was essentially nonexistent. Then again, other studies did find a connection even after considering smoking and other risk factors, so the evidence is scattered here.
While researchers are still unsure of the exact reasoning behind the relationship between oral health and heart disease, this connection is still observed in many different studies. The bacteria responsible for gum disease may lead to cardiovascular disease, or the observed connection might be because of shared risk factors that contribute to both diseases. It’s also possible that it could be any combination of these theories, which is evident by some studies finding connections in one regard while others find relationships in another way.
No matter the reason for the connection, it is still important to acknowledge that this relationship exists. So, ensure that you are brushing your teeth for at least two minutes twice a day to promote good oral hygiene and protect the health of your heart.
Batty, G., Jung, K., Mok, Y., Lee, S., Back, J., Lee, S., & Jee, S. (2018). Oral health and later coronary heart disease: Cohort study of one million people. European Journal Of Preventive Cardiology, 25(6), 598-605. doi: 10.1177/2047487318759112
Pietropaoli, D., Del Pinto, R., Ferri, C., Wright, J., Giannoni, M., Ortu, E., & Monaco, A. (2018). Poor Oral Health and Blood Pressure Control Among US Hypertensive Adults. Hypertension, 72(6), 1365-1373. doi: 10.1161/hypertensionaha.118.11528
Sanchez, P., Everett, B., Salamonson, Y., Redfern, J., Ajwani, S., & Bhole, S. et al. (2019). The oral health status, behaviors, and knowledge of patients with cardiovascular disease in Sydney Australia: a cross-sectional survey. BMC Oral Health, 19(1). doi: 10.1186/s12903-018-0697-x
Sanchez, P., Everett, B., Salamonson, Y., Ajwani, S., Bhole, S., & Bishop, J. et al. (2017). Oral health and cardiovascular care: Perceptions of people with cardiovascular disease. PLOS ONE, 12(7), e0181189. doi: 10.1371/journal.pone.0181189
Karim, M., Kartsonaki, C., Bennett, D., Millwood, I., Hill, M., & Avery, D. et al. (2020). Systemic inflammation is associated with incident stroke and heart disease in East Asians. Scientific Reports, 10(1). doi: 10.1038/s41598-020-62391-3
Matsui, S., Maruhashi, T., Kishimoto, S., Kajikawa, M., Yusoff, F., & Nakashima, A. et al. (2021). Poor toothbrushing behavior is associated with a high risk of cardiovascular events: A prospective observational study. International Journal Of Cardiology. doi: 10.1016/j.ijcard.2021.12.056
Aarabi, G., Heydecke, G., & Seedorf, U. (2018). Roles of Oral Infections in the Pathomechanism of Atherosclerosis. International Journal Of Molecular Sciences, 19(7), 1978. doi: 10.3390/ijms19071978