Gum Disease and Heart Disease: Are They Related?

It seems strange, but oral health and heart health may be more connected than you think. There is growing evidence to support a surprising discovery: people with poor oral health seem to have higher rates of cardiovascular health issues like coronary heart disease, heart attack, and stroke. Keep reading to discover more about this interesting connection and how you can keep your heart and mouth happy!  

Practice good oral hygiene to keep your smile bright and your heart healthy!

What is gum disease?

Gum disease, also known as periodontal disease, is a chronic inflammatory disease of the gums and supporting tissues of the teeth. (15) This inflammation is typically caused by oral bacterial plaque and biofilms, layers of bacteria that stick to the surface of teeth. (12) According to the Centers for Disease Control and Prevention (CDC), nearly half of American adults aged 30 and older have some stage of gum disease. (7) There are two main types of gum disease: gingivitis and periodontitis. Gingivitis is characterized by inflammation of the gums and is typically reversible through proper oral hygiene. Left untreated, however, gingivitis can progress into periodontitis, in which the inflammation spreads beyond the gums into the connective tissue, roots, and bones of the teeth. Once inflammation has progressed this far, the damage is much harder to treat. (12)

Signs of gum disease

As gum disease progresses, inflammation starts to damage the supportive tissues in the mouth. (23) Common signs of gum disease include:

• Bad breath
• Receding gums
• Red, sore, swollen, and bleeding gums
• Sensitive teeth

In advanced periodontitis, teeth may even shift position, start wobbling, or cause pain when chewing or eating. (10) Untreated gum disease can result in tooth decay and even tooth loss. (4)

Did you know? Gingivitis generally doesn’t cause pain, so symptoms may remain unnoticed for some time. (10)

Risk factors for gum disease

Several factors increase the risk for periodontal disease, including:

• Age
• Medical conditions such as cardiovascular disease, diabetes and dry mouth
• Poor oral hygiene
• Smoking status
• Stress (15)

The prevalence of gum disease also appears to be higher in males. In the 2009 and 2010 National Health and Nutrition Examination Survey (NHANES), males were found to have a 50% greater risk of periodontitis compared to females. (12)

What is heart disease?

Heart disease, or cardiovascular disease (CVD), is an umbrella term for conditions affecting the heart and blood vessels. Examples of CVD include coronary heart disease (CHD), arterial disease, congenital heart disease, and blood clots in the veins of the body. (22) When blood vessels to the heart become blocked or narrowed, this can lead to a heart attack or stroke. (12)

How are gum disease and heart disease connected?

Evidence is mounting that periodontal disease is a risk factor for developing coronary heart disease. In one example, a meta-analysis of nine studies found that gum disease was associated with a 19% increase in the risk of CVD. This risk increased further to 44% in people aged 65 and over. (15) Another 2016 case-control study suggested that periodontitis increased the risk of heart attack and CHD, even after adjusting for possible confounding factors. (18) A large study using the Taiwanese National Health Insurance Research Database reported a significantly higher incidence of atrial fibrillation (irregular beating of the heart) in individuals with periodontal diseases compared to healthy individuals. (19) Furthermore, in a cross-sectional study conducted with over 10,000 military staff, periodontal disease was shown to be positively associated with higher blood cholesterol levels, linking coronary heart disease to periodontal status. (11) The relationship between gum disease and heart disease can be explained through three main theories: inflammation, bacterial transmission, and smoking as a confounding variable.

1. Inflammation

Although inflammation is a normal part of our body’s defense system, chronic inflammation can lead to long-term damaging effects and contribute to a number of health conditions, including cardiovascular disease. (24) Since periodontal disease is characteristically inflammatory and chronic in nature, (12) research has demonstrated significantly higher levels of C-reactive protein (CRP), a measure of inflammation, in people with gum disease versus healthy individuals. (19) Similarly, individuals with atherosclerosis (the buildup of plaque in the artery walls) have also been reported to have higher levels of CRP in their blood. (12) When cholesterol or calcium is deposited in the lining of arteries, a systemic inflammatory response takes place involving immune reactions and local tissue stress. Thus, inflammation plays a significant role in the development of CVD and is a contributing factor to heart attack and stroke. (12) A 2007 report in the Journal of Periodontology suggested that individuals with periodontitis and high CRP levels (due to periodontal bacterial burden) have an elevated risk of CHD compared to those without gum disease. (14) Another study of hospital-based patients found that gum disease may be a significant risk factor for CHD and further coronary events, especially in males aged 40 to 50 years. They suggested that the presence of a hyper-inflammatory molecule was the common mechanism linking the two diseases. (20)

2. Bacterial transmission

Approximately 800 species of bacteria have been identified in the oral cavity. (15) Various activities can cause these oral bacteria to travel and enter the bloodstream, including normal daily routines, such as chewing, flossing, or toothbrushing, and more specific treatments from your dental professional, such as tooth extraction, polishing, or scaling. (19) When oral bacteria travels from its original environment into circulation, it can cause inflammation and potentially aggravate the development of harmful deposits in the walls of the arteries, thus increasing an individual’s risk of coronary heart disease. (15) A large case control study called Coronary Event and Periodontal Disease (CORODONT) focused on the microbiological association between periodontitis and CHD. After examining 263 patients aged 43 to 72 years with clinically stable CHD, they concluded a statistically significant association between periodontal pathogens (oral bacteria present in gum disease) and CHD. They also suggested that the inflammatory activity of periodontitis may continually increase the presence of bacteria in the bloodstream. (21)

3. Smoking as a confounding variable

Since periodontitis and heart disease share common risk factors, such as age, body fat percentage, smoking, stress, and socioeconomic status, the potential for confounding variables is important to consider. (9) Smoking may be a common denominator in people who have both poor oral health and cardiovascular health. A 2018 cohort study of one million people examined the role of smoking in the relationship between oral health and coronary heart disease. As a whole, the cohort showed a positive association between tooth loss and coronary heart disease in both men and women. However, when the analysis was adjusted to restrict smokers, the causal relationship between oral health and heart health was eliminated in males. Therefore, the authors concluded that the connection between poor oral health and cardiovascular disease risk may be explained by the linked behaviour, cigarette smoking. (2)  

Following a Mediterranean-style diet focused heavily on fish, fruits, vegetables, and nuts, may lower your risk of CVD.

How to prevent heart disease

Since heart disease is the leading cause of death in the United States, (5) prevention is key. Heart disease prevention starts with a diet rich in heart-healthy foods. For example, following the Mediterranean diet, rich in green leafy vegetables, fruits, nuts, extra virgin olive oil, and fish, has been shown to lower the risk of CVD. (16) In addition, using certain dietary supplements may provide extra support and fill in any nutritional gaps. Supplements for heart health include:

• Aged garlic extract (17)
• Coenzyme Q10 (25)
• Fish oil (high EPA) (8)
• Magnesium (1)

The Centers for Disease Control and Prevention (CDC) recommends teeth brushing twice a day to maintain good oral hygiene.

How to prevent gum disease

Developing healthy lifestyle habits, including the suggestions below, may help prevent gum disease:

• Practice good oral hygiene.
• Quit smoking. (15)
• Reduce sugar intake.
• Consider taking a vitamin C supplement. Vitamin C is important for preventing periodontal disease (23) and may also reduce heart disease risk (13)

Did you know? Prolonged exposure to vitamin C may erode tooth enamel, due to its acidic nature. If you take vitamin C regularly, consider a capsule form, as opposed to chewable tablets. (3)

Best oral hygiene practices

In addition to the recommendations for preventing gum disease above. the Centers for Disease Control and Prevention (CDC) recommend the following activities to help maintain optimal oral health and strong teeth:

• Avoid smoking.
• Brush your teeth twice a day.
• Floss daily between the teeth to remove dental plaque.
• Limit your intake of alcoholic beverages.
• Visit your dentist at least once a year. (6)

The bottom line

Although the connection between heart disease and gum disease still warrants more research, one message is clear: taking care of your oral health is an important part of developing healthy habits to reduce your risk for chronic disease.