Dental health affects more than just appearance. While dentists encourage patients to brush and floss their teeth to achieve bright, white smiles, these daily habits have far-reaching effects on the body. Most notably, keeping teeth and gums clean could potentially go a long way toward preventing heart disease.
Staving off gum disease, in particular, can potentially reduce the risk of heart attack, stroke, and other cardiovascular conditions. Nearly half of American adults (47%) have gum disease1, and the percentage is similar (48%) for heart disease2. Although not every person with gum disease will have a heart condition, and vice versa, learning more about the connection could help reduce those percentages in the long run.
Before diving into the reasons for the potential association, it’s important to understand gum disease.
Overview of gum disease
Certain factors — such as diabetes, pregnancy, certain medications, obesity, poor diet, and genetics — can increase the risk of gum disease. It is also more prevalent in men, people over 65, and smokers than other groups. Poor dental health, however, is the main cause.
Without following a consistent dental health routine, plaque can build up on the teeth. Plaque is a film of bacteria that sticks to teeth, and everyone has it because it forms from saliva, fluids, and foods — particularly the sugary variety. If it’s left untreated, plaque hardens and becomes tartar, which only a dentist can remove. The bacteria buildup can cause cavities as it breaks down enamel that protects the teeth from decay. If it gets above the gum line, gum disease, which comes in multiple stages, can also develop.
Gingivitis is the earliest and mildest form of gum disease. It’s signified by redness, swelling, tenderness, bad breath, and bleeding while brushing or flossing. It can occur around one tooth or throughout the mouth. Fortunately, gingivitis is reversible if people develop healthy dental care habits: brushing (preferably with an electric toothbrush), flossing twice per day, and scheduling biannual dentist visits.
However, gingivitis can develop into periodontitis if it goes untreated. Periodontitis is an advanced stage of gum disease that is more difficult to treat. As tartar stays on the gum line longer, it damages tissue and causes the gums to pull away from the teeth — called “receding gums.” This opens up pockets between the gums and teeth, allowing bacteria to build up and wear down surrounding bone. Teeth become loose as bone deterioration progresses, and severe cases can also cause severe tooth and gum pain, bad breath, and pus.
In the early stages of periodontitis, dentists can treat the infection via nonsurgical methods such as scaling, root planing, and antibiotics. However, advanced periodontitis usually requires surgery to prevent tooth loss and the spread of infection.
The connection between heart and gum disease
What does any of this have to do with the heart? Those with gum disease have a two to three times higher risk of heart attack and stroke3. Given that heart disease is the leading cause of death worldwide, researchers are naturally interested in how to reduce it — and preventing gum disease may be one viable solution.
Studies have explored the connection between the two diseases for decades, although results have varied on how strong the association is. One study found that people with coronary disease are 1.5 times more likely to have another heart event4 (e.g., a heart attack) if they develop gum disease. Other studies determined the risk of heart disease increases by as much as 20%5 for those with gum disease%. In a 2016 study published in the American Heart Association journal Circulation, 43% of patients who had heart attacks also had gum disease6 versus only 33% in heart-healthy participants.
While researchers haven’t definitively found that gum disease causes heart disease, there is a clear association between the two.
The possible reasons for the link relate to inflammation — the body’s natural response to infection and a known contributor to atherosclerosis7. When gums are affected by gingivitis or periodontitis, they become inflamed and swollen because they’re exposed to bacteria buildup. If this inflammation goes untreated and becomes chronic, it triggers inflammation in other parts of the body. Chronic inflammation increases the risk of heart disease8 because it can cause plaque growth in arteries or trigger blood clots.
Researchers have also proposed that mouth bacteria can absorb into the bloodstream and lead to further inflammation in blood vessels. This can lead to atheroma formation4, a buildup of plaque in the arteries that causes atherosclerosis. Additionally, studies have revealed mouth bacteria in blood vessels of people who had strokes9.
Moreover, midlife tooth loss — a potential consequence of gum disease — is related to coronary heart disease. In a 2018 Circulation study, researchers studied adults between 45 and 60 who had 25 to 32 natural teeth at the beginning of the study. Those who had lost two or more by the time of the follow-up several years later had a 23% higher chance of developing heart disease10.
Despite the association, however, researchers can’t conclude any causation between gum and heart disease because other factors are in play. For example, people who brush and floss their teeth according to dentist recommendations may also take better care of their overall health by exercising and eating a healthy diet, thus leading to reduced risk of heart disease.
Gum and heart disease also share other common risk factors, including high blood pressure, smoking, poor access to healthcare, lack of exercise, and age. That makes it challenging to declare gum disease as an independent risk factor for heart conditions.
There is little doubt, though, that a connection between the two diseases exists. Dieting and exercising are at the top of the list for preventing heart issues, but people should also follow a strict dental regimen to prevent gum disease. Part two of this series will detail how people can brush and floss better as well as other habits to form.