By Andrew Schlosser, MS, CEP, CPT

White teeth and healthy gums are always desirable — not just for a beautiful smile but for a strong heart! Perhaps you’ve heard someone advise that “flossing your teeth is good for your heart.” This is true! But many others don’t realize that failure to practice proper dental care may have negative consequences on cardiac health. As professionals working with populations recovering from heart events, we should understand — and convey to our cardiac rehab participants — how gum disease can occur, progress, and become severe enough to contribute to CVD.           

Without recommended oral hygiene care, dental plaque buildup can lead to bacteria collecting around the teeth and on gums. The first red flags are inflammation, swelling, and/or bleeding of the gums — or what is known as gingivitis, the first stage of gum disease. Left untreated, gingivitis can progress to periodontitis, a more severe form of gum disease that damages tissue around the teeth and can destroy bones that support teeth.¹ Periodontitis consists of stages 2-4 of gum disease, with each phase resulting in further tooth and gum decay,¹ and often results in multiple extractions because the affected teeth are simply no longer able to survive.¹ Losing teeth is traumatic enough; but it’s just the tip of the iceberg if gradual dental decay begins to contribute to heart problems.

Information to Chew On

When gums break down from periodontitis, bacteria in the mouth can flow through the tooth roots and enter the bloodstream. This bacteria has been found to contribute to atherosclerosis, or the narrowing and hardening of coronary arteries on the heart.⁵ When the blood vessels on the heart become narrow, a blockage becomes more likely as time goes on. Once blocked, blood is unable to flow through that artery and supply oxygen to the heart. This is what is known as a heart attack. It is possible to survive; however, once such an event has occurred, sections of the heart that did not receive blood flow during the attack become damaged. This can make it more likely to suffer another event in the future. 

The negative impact of periodontitis has been associated not only with coronary arteries on the heart, but other areas of the cardiovascular system as well. Research finds that severe periodontitis is a risk factor for peripheral artery disease (PAD).⁶ This is a form of CVD where arteries on the “peripheral” sections of the body, the arms and legs, become narrowed. The lack of blood flow to the affected limbs during physical activity can result in varying levels of pain.  Additionally, evidence indicates that gum damage from gum disease and tooth loss is associated with narrowed arteries in people who already have cardiovascular disease.⁴           

Furthermore, it is not just the blood vessels throughout the body that can be impacted by gum disease. Research suggests that bacteria found among the plaque in gum disease can enter the bloodstream and eventually trigger inflammation in the heart valves, or what is called endocarditis.⁵ This condition can diminish the function of the heart valves and potentially  require a heart valve repair or replacement at some point. 

Recognizing the implications of gum disease on the cardiovascular system is important, but so is knowing who’s most at risk. Risk factors for gingivitis and periodontitis include many aspects of an unhealthy lifestyle, such as smoking, high cholesterol, weakened immune system and, as already discussed,  poor oral hygiene.⁵ In addition to red, swollen, or bleeding gums, receding gumline is another red flag, as this condition can eventually expose tooth roots to bacteria. Loose or sensitive teeth and painful chewing are other warning signs of gum disease.⁵

The good news is that gum disease is preventable with proper care. An 18-year-long study found that proper oral hygiene greatly lowered the risk of cardiovascular mortality compared to poor oral hygiene.² It is recommended to brush teeth two times per day and to floss at least once daily. Doing so will greatly reduce plaque and bacteria that may contribute to the development of gum disease. Flossing is especially crucial because it removes plaque from between teeth.³ Additionally, it’s important to visit the dentist twice a year for visual examination of the mouth, deep cleaning of teeth, and any other necessary therapy. X-rays can also help the dentist to detect cavities and bone loss patterns.⁵ 

While dental care may seem like a no-brainer, it’s important to be reminded of all healthy habits that contribute to wellbeing. Living a heart-healthy lifestyle comes in many forms, including regular exercise, healthy eating, and reduced stress. Taking dental health seriously will add another proactive component to living a robust lifestyle while fending off diseases. 

So, for heart’s sake, take care of your smile!

Andrew Schlosser is an exercise physiologist at Bryn Mawr Hospital Cardiac Rehab. He specializes in training the senior population as well as educating them on methods of heart healthy living and overall wellness.

References

1. https://my.clevelandclinic.org/health/diseases/16620-periodontitis
2. https://www.nature.com/articles/s41415-023-5507-4#:~:text=Mouthwash%20usage%20did%20not%20show,rendered%20by%20brushing%20and%20flossing
3. https://onlinelibrary.wiley.com/doi/10.1111/jre.12191
4. https://onlinelibrary.wiley.com/doi/10.1111/j.1600-051X.2011.01775.x
5. https://www.pennmedicine.org/updates/blogs/heart-and-vascular-blog/2019/march/gum-disease-and-heart-disease#:~:text=
6. https://pubmed.ncbi.nlm.nih.gov/27450785/