Paying attention to your dental hygiene and health -- especially your gums -- may pay you back with more than a gleaming, healthy smile and manageable dental bills. It may keep your heart healthy too.
However, experts emphasize that the keyword is may. Cardiologists and periodontists, the dentists who treat gum disease, have long debated the link between dental health and heart disease. But the issue still isn't completely resolved, says Robert Bonow, MD, past president of the American Heart Association and chief of cardiology at Northwestern University's Feinberg School of Medicine.
"It isn't clear whether gum disease actually has a direct link to heart disease," Bonow says. ''There are threads of evidence, but they’re not yet tied together. If it's true that people with poor oral health have more heart attacks, it doesn't mean the poor oral health leads to them. People with good oral hygiene may just be taking better care of themselves." In other words, people who floss and brush their teeth may also exercise regularly and follow other heart-healthy habits.
Gum Disease and Heart Disease: How Could They Be Linked?
Experts do agree that there are plausible reasons why dental health and heart health may be intertwined. For example, inflammation is a common problem in both diseases, Bonow says. Hardening of the arteries, or atherosclerosis, ''has a strong component of inflammation. Much of the progression of plaque [building up in the arteries] is actually an inflammatory process."
Gum disease also has an inflammation component, says Sam Low, DDS, associate dean at the University of Florida College of Dentistry in Gainesville, and president of the American Academy of Periodontology. Gingivitis, the beginning stages of gum disease, occurs when gums become inflamed and bacteria overtake the mouth.
What Research Shows About Gum Disease and the Heart
Experts in periodontology and cardiology recently reviewed more than 120 published medical studies, position papers, and other data on the heart and dental health link. They developed a consensus report, published simultaneously in the Journal ofPeriodontology and the American Journal of Cardiology.
The aim of the paper was to give cardiologists, periodontists, and other health professionals a better understanding of the links between gum disease and heart disease. But much of the information is helpful to consumers, too. The report makes these points:
- A review of several published studies finds that gum disease is, by itself, a risk factor for coronary artery disease.
- Analysis of the large National Health and Nutrition Examination Survey (NHANES) found that gum disease is an important risk factor for diseases of the blood vessels and the arteries that supply the brain, especially strokes involving insufficient blood or oxygen to the brain. Data from another study of more than 50,000 people found that those with fewer teeth and more gum disease had a higher risk of stroke. However, other studies have uncovered no association between gum disease and stroke.
- Other research found a direct link between clogged arteries in the legs and gum disease.
The Consensus: No Consensus
Although the report was a consensus of sorts, the link is far from definitive, experts say.
"At this point, there is a consensus that we are still unaware of solid science to show a direct link [between heart health and oral health] with the exception of two areas," Low says. These are:
- Bacteria found in both health problems are similar. "The bacteria we find in gum disease we also find in blood vessels that are going through atherosclerosis," Low says. "There are several types."
- Inflammation is another common denominator for both diseases. When people have moderate to severe gum disease, their levels of C-reactive protein (CRP), a protein that rises during whole-body inflammation, increase. CRP levels are also used to assess a person's risk of a heart attack.
Advice for a Healthy Heart and Gums
Bonow and Low say health-conscious people should take care of oral health and heart health. ''There are all kinds of reasons why you want people to take care of their heart health and their dental hygiene too, " Bonow says. "But it doesn't mean taking care of one is going to prevent the other."
The joint report also made these recommendations:
- Dentists should tell patients with moderate to severe gum disease that they may have an increased risk for heart and blood vessel problems. People who have moderate to severe gum disease and a known risk factor for heart disease, such as smoking, should consider getting a medical evaluation if it's been one year or longer since their last one.
- Physicians and their dentists should work together to focus on reducing heart disease risk and ensuring good periodontal care for patients with heart disease and gum disease.
- Patients with heart disease who also have signs or symptoms of gum disease (but have not yet been diagnosed with it) or a high CRP level should get a periodontal evaluation.