Dental Health Plays Vital Role in Cardiovascular Well-Being

Although poor dental care does not directly cause cardiac dysfunction, periodontal disease has been associated with various cardiovascular events, including atherosclerosis, coronary heart disease, myocardial infarction, and thromboembolism.^1-3 Oral microbes (Table 1^2,4) have been detected in many organs and tissues, including the heart, showing that oral health can have a systemic effect on overall health and vice versa.^3,5 One hypothesis suggests that gum and heart diseases trigger inflammation as part of the body’s immune system in arterial and gingival walls, leading to disease potentiation in both.^2,6

Types of Diseases

Gingivitis (gum inflammation) can progress to periodontitis (severe gum disease) when bacteria migrate along the roots of the teeth and into the bone structure.² As periodontitis triggers inflammation in the oral cavity, the signaling can travel to other tissues, exerting a systemic effect on the body.^7,8

Infective endocarditis, or infection on the cells of the heart’s surface, can be linked to the process of bacteria originating in the oral cavity, inducing systemic effects.^2,6

Oral bacteria can also be traced to platelet aggregation in atherosclerosis and thromboembolism.^2,5

In addition to periodontitis, the incidence of cardiovascular events increases in patients with other chronic inflammatory diseases such as psoriasis, respiratory and urinary tract infections, rheumatoid arthritis, and systemic lupus erythematosus.⁸ Microbes contained in the biofilm that grow in dental plaque can generate metabolites (ie, immune cells, inflammatory cytokines, and toxins) that exert local and systemic effects throughout the body.⁹ As a result, events such as a stroke can be triggered in severe cases.⁹

Who is susceptible?

Dental cavities and ischemic heart disease share common risk factors in terms of the various populations of affected individuals. For example, diabetes and smoking tend to increase the risk for both diseases.^2,5

As an individual’s risk factors increase, so does susceptibility to disease. Individuals who are critically ill in intensive care units have an increased risk for gingivitis and periodontitis because of a lack of regular dental care. In addition, study results have shown that dental health is worse in patients with acute myocardial infarction.^7,10

Advancing age, a family history of cardiac and oral diseases, and a lack of physical activity are risk factors for atherosclerotic disease that are common in patients with periodontitis.⁷ Chronic stress and obesity are also risk indicators for periodontal disease.^5,8 Table 2^2,5,8 lists other risk factors.

Individuals who are immigrants, have low income, or live in rural areas are at greater risk for poor dental outcomes because of lack of access to quality care and poor health literacy.^6,11 The need for comprehensive health care, specifically for children, in low-resource communities is critical, as well.¹¹ Ethnic and racial oral health disparities are also evident among Black and Hispanic individuals.¹¹ Studies show that the number of dental cavities is associated with education, income, and occupation, emphasizing that there needs to be a greater awareness of the importance of dental health in reducing potential complications.²

Dental Care Standards

The American Dental Association (ADA) recommends brushing teeth twice a day with fluoride toothpaste for 2 minutes.⁵ It is important to replace toothbrushes every 3 months; once the bristles are worn, toothbrushes can become a bacteria reservoir if they are used for too long.⁵ The ADA also recommends flossing once daily, in addition to a chlorhexidine gluconate or fluoride mouthwash to fully disrupt plaques that can build on the tooth enamel surface.⁵ In addition to a regular at home dental regimen, experts recommend seeing a dentist twice a year for more effective removal of bacteria biofilm and in-depth screenings for potential gum diseases.⁸

Conclusion

Although direct causation has not been proven, we cannot deny the shared mechanisms between cardiac and dental diseases. One may exacerbate the other, and taking preventive measures to ensure good oral hygiene can lower the potential risks.

Although it would not be correct to say that individuals can directly prevent heart disease by practicing good dental care, dental health is recommended. This reduces the risk for potential exacerbations of other health conditions by encouraging good overall health.⁶

Oral health is an area of interest for the role it plays in overall systemic health, but more research is needed to determine to what extent it can directly cause cardiovascular issues. Dental care is also being researched for its connection to other chronic diseases, neurological disorders, pulmonary infections, and even cancer.⁹

References

1. Periodontitis. American Dental Association. Updated June 9, 2022. Accessed October 18, 2022. https://www.ada.org/resources/research/ science-and-research-institute/oral-health-topics/periodontitis

2. Gianos E, Jackson EA, Tejpal A, et al. Oral health and atherosclerotic cardio-vascular disease: a review. Am J Prev Cardiol. 2021;7:100179. doi:10.1016/ j.ajpc.2021.100179

3. Fiorillo L, Cervino G, Laino L, et al. Porphyromonas gingivalis, peri-odontal and systemic implications: a systematic review. Dent J (Basel). 2019;7(4):114. doi:10.3390/dj7040114

4. Chang Y, Woo HG, Park J, Lee JS, Song TJ. Improved oral hygiene care is associated with decreased risk of occurrence for atrial fibrillation and heart failure: a nationwide population-based cohort study. Eur J Prev Cardiol. 2020;27(17):1835-1845. doi:10.1177/2047487319886018

5. Sedghi L, DiMassa V, Harrington A, Lynch SV, Kapila YL. The oral micro-biome: role of key organisms and complex networks in oral health and disease. Periodontol 2000. 2021;87(1):107-131. doi:10.1111/prd.12393

6. Shmerling RH. Gum disease and the connection to heart disease. Harvard Health. April 22, 2021. Accessed October 28, 2022. https://www.health.harvard.edu/diseases-and-conditions/gum-disease-and-the-connection-to-heart-disease

7. Mattila KJ, Nieminen MS, Valtonen VV, et al. Association between dental health and acute myocardial infarction. BMJ. 1989;298(6676):779-781. doi:10.1136/bmj.298.6676.779

8. Friedewald VE, Kornman KS, Beck JD, et al. The American Journal of Car-diology and Journal of Periodontology Editors’ Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol. 2009;104(1):59-68. doi:10.1016/j.amjcard.2009.05.002

9. Liu YCG, Lan SJ, Hirano H, et al. Update and review of the gerodontology prospective for 2020’s: linking the interactions of oral (hypo)-functions to health vs systemic diseases. J Dent Sci. 2021;16(2):757-773. doi:10.1016/j.jds.2020.09.007

10. Naderi S, Merchant AT. The association between periodontitis and cardiovascular disease: an update. Curr Atheroscler Rep. 2020;22(10):52. doi:10.1007/s11883-020-00878-0

11. Northridge ME, Kumar A, Kaur R. Disparities in access to oral health care. Annu Rev Public Health. 2020;41:513-535. doi:10.1146/an-nurev-publhealth-040119-094318

About the Author

Jessica Bylyku is a PharmD candidate at the University of Connecticut School of Pharmacy in Storrs.