The Gum-Heart Connection

Nearly 20 years have passed since the British Medical Journal announced a previously unknown correlation between dental problems and systemic diseases including stroke, heart disease, and diabetes. Those with periodontal disease (the progressive deterioration of gums, bones, and other tissues around the teeth) have a significantly higher incidence of heart disease, stroke, and premature death than those with healthy teeth and gums, research found.

Since then, studies conducted around the world have confirmed that periodontal disease is an important risk factor for heart disease—perhaps even more critical than smoking, cholesterol levels, being overweight, or not exercising.

“If you want to assess a person’s general health,” says former New York State Dental Society president James R. Orcutt, DDS, “look first in their mouth.”

Linking Oral and Heart Health

Bleeding or infection in the mouth can contribute to endocarditis, a serious inflammation of heart valves or tissues. This is why the American Heart Association and the American Dental Association recommend that patients with heart disease take antibiotics before professional teeth cleaning, tooth extractions, or other dental procedures. Tooth loss is another warning sign of cardiovascular disease.

Research finds that the prevalence of plaque in the carotid arteries, which feed the brain, increased in patients age 55 and older with the number of teeth they’d lost. Of those with 9 or fewer missing teeth, 45 percent had carotid artery plaque, and 60 percent of those missing 10 or more teeth had plaque buildup.

Other heart risk factors include pericoronitis (an infection around the third molar), gingivitis or gum inflammation, root remnants that remain after a tooth has decayed, and dental caries, or cavities. In a 2004 study, lead author Sok-Ja Janket, DMD, MPH, suggests that dentists encourage patients with poor oral health to have cardiac examinations even if they don’t yet have obvious symptoms of heart disease.

She notes that poor oral health contributes to heart disease not only through the inflammation process but also by interfering with chewing, digestion, and nutritional intake. Heart problems are not restricted to the middle-aged or elderly. Children with chronic diseases often have dental health problems; preventive dental care may not be as much a priority as treatment of the disease.

Risk for cardiovascular disease because of poor oral health is also high in men under 50.

Harmful Bacteria

The culprit in the dental-heart link appears to be bacteria. The first report to draw this conclusion was presented in March 2005 at the 83rd General Session of the International Association for Dental Research. Dental plaque samples were taken from 657 subjects of different races whose average age was 69. The higher the levels of bacteria causing periodontal disease, the thicker the patients’ carotid arteries, a strong predictor of cardio-vascular disease. This connection even extends to pets. A recent analysis of 90,000 dogs (half with advanced periodontal disease and half with no recorded dental disease) showed those with periodontal disease have more than eight times the incidence of endocarditis and five times more heart murmurs than the control group. Chronic dental disease has also been shown to lead to infected heart valves in cats.

Protect Your Health

Fortunately, periodontal disease can be prevented. Fruit-flavored drinks are a leading cause of dental cavities in infants and toddlers, while small, low-fiber meals and frequent sweet treats cause dental problems in older children.

Sugar is a major risk factor for all ages. Avoiding sweetened juices, candy, and cookies is a simple way to improve one’s oral health. The strongest weapons against periodontal disease are the most affordable—a toothbrush and dental floss. As Gordon Douglass, DDS, past president of the American Academy of Periodontology, explains, “If you keep your mouth clean, it’s very hard for the bacteria that cause periodontal disease to get started.”

Most health food stores carry a variety of oral health products that contain natural bacteria fighters: neem, tea tree oil, grapefruit seed extract, bee propolis, herbal extracts, and essential oils in toothpaste, tooth powder, mouthwash, dental floss, toothpicks, and mouth sprays.

Also consider canine and feline toothbrushes, toothpaste, and other oral care products for pets.

Diet and Exercise Count

Foods that help prevent periodontal disease include blackberries, blueberries, cherries, elderberries, gooseberries, raspberries, and strawberries, all of which contain proanthocyanidins, substances that strengthen gum tissue cell walls. The supplement CoQ10 (coenzyme Q10), 50 mg per day, can help prevent periodontal disease when taken orally or applied directly to the gums. Recent research demonstrates the positive effects of regular exercise and high vitamin D levels on dental health and the prevention of gum disease.

Two studies were based on data collected in the third National Health and Nutrition Examination Survey, which examined the health and nutritional status of people in the United States between 1988 and 1994. In one study, 2,521 adults whose exercise patterns hadn’t changed in 10 years had their mouths examined. Moderate exercisers were 33 percent less likely to have gum disease than those who reported no regular physical activity.

Those subjects who engaged in intensive exercise three or more times a week or got moderate exercise five or more times per week had the lowest incidence of gum disease—52 percent lower than individuals who were not active. In the second study, 6,700 adults had their blood vitamin D levels tested and underwent dental exams.

Those with the highest vitamin D levels were 20 percent less likely to have gum disease than those with the lowest levels. A daily tablespoon of cod liver oil can help prevent vitamin D deficiencies, especially in people who receive little sun exposure or who winter in northern latitudes.