Oral Health and Heart Disease
Cardiovascular diseases (CVD) like angina pectoris and acute myocardial infarction have been some of the major health problems in the developing countries. About 12 million people who suffer from CVD die every year. Nowadays, periodontal disease (gum disease) is a common dental problem, especially in people with cardiovascular diseases. It has been revealed that a good dental health can prevent heart diseases, particularly among those who had a family history of heart diseases or have experienced heart problems themselves.
Large scale interventional clinical studies have provided evidence to support the association between periodontal disease and cardiovascular diseases. The emergence of periodontal disease as a potential risk factor for heart diseases is leading to a convergence in healthcare that will only benefit the public health.
Studies conducted earlier used nonspecific clinical definitions of periodontal disease for infectious exposure; whereas some recent studies have enhanced the specificity of the infectious exposure definitions by measuring antibodies to the selected periodontal pathogens or by a direct quantification of the oral microbiota from the sub-gingival dental plaque. Results showed a positive relation between the periodontal disease and cardiovascular diseases.
The potential role of periodontal disease to be associated with cardiovascular diseases can be explained in such a way, that both of the diseases mentioned above should have many common factors to support a moderate link between them.
Usually, the diseases of the heart and blood vessels are related to the thickening of the artery walls (atherosclerosis). This condition results from damage caused to the artery walls that results from the inflammatory blood vessels along with the fat deposits. The fat deposits along with the artery wall inflammation lead to the development of plaque (Atheroma).
Researchers believe that this inflammatory damage is caused by infections from various sources; the bacteria from gum infections enter the bloodstream via the gum pockets.
When your gums bleed, it creates a path for the bacteria to enter your bloodstream, which can spread to distant sites of the body, including the heart. While that happens, the arteries become less elastic and the interior walls are reduced in size resulting in small blood clots. These blood clots clog the arteries and cut off their blood flow which might result in a stroke or heart attack depending on the location of the blood clot.
The incidence of coronary heart disease increases when the age-adjusted alveolar bone loss is more. This suggests a dose response, such as higher the prevalence of periodontal disease at the baseline, the greater is the incidence of coronary heart diseases.
- Bleeding gums during eating or brushing
- Gaps develop between the teeth
- Swollen or tender gums
- Receding gums (gums pulling back from the teeth) and changes in the way your teeth fit while biting
- Persisting bad breath
- Pus between teeth and gums
- Mouth soreness
It has been reported that more than 400 bacterial species are found to proliferate in the sub- gingival plaque (The sticky deposits found in the gums). The most common bacterial species include Fusobacterium nucleatum, Porphyromonas gingivalis, Actinobacillus actinomycetemcomitans, Prevotella intermedia, Tannerella forsythensis (Bacteroides forsythus) and spirochetes. Bacterial infection has also been the main cause of heart failure. Studies have reported that bacteria are present in the gum pockets of heart disease patients. Thus, it is evident that oral infections have an important role in the implementation of heart diseases and maintaining a good oral hygiene can help in preventing different heart problems.
Bacterial infections have been postulated to have a profound effect on macrophages, endothelial cells, lipid metabolism, monocytes, thrombocytes and blood coagulation. Dental infections are the single risk factor, excluding the other common classic coronary risk factors for developing a heart problem. It is observed that dental infections are a significant risk factor for developing new cardiovascular events.
C-Reactive Protein (CRP)
C-reactive protein levels were recorded highest in patients who had an infection due to periodontal pathogens and also CRP been a single risk factor for cardiovascular diseases. When periodontal disease patients were treated with root planing, scaling, and flurbiprofen, they exhibited lower levels of CRP after a year.
In the year 1989, a study conducted in Finland reported that people with evidence of oral infection were 30% more likely to present with myocardial infarction than people having no dental problem. They conducted two separate case-control studies involving 100 patients who were diagnosed with acute myocardial infarction and they performed a dental examination on all of them.
Mattila and co-workers, who worked on a case-control study, noted the association between dental infections and the degree of atherosclerosis (ATH). They examined the patients who were first diagnosed with coronary angiography and their total dental index score was taken (The dental index score was taken as a general score for periodontal infections, dental caries, and periapical lesions). It was found that there was a significant association between severe coronary atheromatosis and dental infections.
Coronary Heart Disease
The association between cardiovascular disease and periodontal disease was assessed with the help of a national survey. It was found that those with periodontitis had a 25% increased risk of coronary heart disease. Also, it was observed that in the male population, who were below 50 years of age and with periodontitis had 72% higher risk of developing a coronary heart disease.
A tooth abscess is a complicated tooth decay condition, that occurs when a tooth is chipped or broken. Openings in the tooth enamel allow bacteria to enter and infect the center of the tooth, also known as pulp. The infection spreads from the root to other areas of the body, resulting in complications like endocarditis, brain abscess or pneumonia. Endocarditis is inflammation of the endocardium (the tissue lining of the inner chambers of the heart) and it can be a life-threatening infection. It occurs when bacteria spreads through the bloodstream and proliferate inside the heart. Certain dental procedures are more likely to cause bacteraemia (presence of bacteria in the blood). High-risk dental procedures that cause bleeding or tissue damage are dental extractions, periodontal procedures like scaling, root planning, surgery, routine periodontal cleaning and people who are at risk of endocarditis are recommended to take antibiotics. ‘Streptococcus viridians’ are the most common cause of endocarditis after dental procedures and use of antibiotics are recommended to prevent endocarditis infection.
While poor oral hygiene has been linked to CVD, the relation between preventive dentistry and the reduction of heart diseases have been undetermined. Taiwanese researchers studied this association by using a population-based cohort study. The results revealed that tooth scaling was an independent factor for reducing the risk of myocardial infarction and other cardiovascular diseases.
Oral infections have turned out to be an important factor in determining the hypothesis of dental infection of being a cardiovascular disease risk factor. Gum infections have been reported to be one of the leading culprits, with studies reporting the link between heart diseases and periodontal diseases. It has been firmly established that a connection exists between periodontal disease and cardiovascular diseases. There is an epidemiological association between the periodontal infections and the cardiovascular diseases; i.e. periodontal infections are predominant among patients with heart diseases.
You should discuss your symptoms of gum disease and other risk factors of cardiovascular diseases with your dentist. It is highly recommended that a periodentist (dentist for periodontal diseases) evaluates oral health and treats any dental problem if exists.
- Periodontal infections and cardiovascular disease - (https://www.ada.org/~/media/ADA/Member%20Center/FIles/Perio_heart.ashx)
- Tooth abscess - (https://www.nlm.nih.gov/medlineplus/ency/article/001060.htm)
- Infective endocarditis - (http://www.heartfoundation.org.nz/know-the-facts/conditions/infective-endocarditis)
- Prasad Dhadse, Deepti Gattani, and Rohit Mishra The link between periodontal disease and cardiovascular disease: How far we have come in last two decades? J Indian Soc Periodontol. 2010 Jul-Sep; 14(3): 148–154. doi: 10.4103/0972-124X.75908 PMCID: PMC3100856
- Umeizudike KA1, Iwuala SO2, Ozoh OB2, Ayanbadejo PO1, Fasanmade OA2. Association between periodontal diseases and systemic illnesses: A survey among internal medicine residents in Nigeria. Saudi Dent J. 2016 Jan;28(1):24-30. doi: 10.1016/j.sdentj.2015.03.005. Epub 2015 Oct 23.
- Chen ZY1, Chiang CH, Huang CC, Chung CM, Chan WL, Huang PH, Lin SJ, Chen JW, Leu HB. The association of tooth scaling and decreased cardiovascular disease: a nationwide population-based study. Am J Med. 2012 Jun;125(6):568-75. doi: 10.1016/j.amjmed.2011.10.034. Epub 2012 Apr 4.
- Adult health - (http://www.mayoclinic.org/healthy-lifestyle/adult-health/expert-answers/heart-disease-prevention/faq-20057986)
Latest Publications and Research on Does Oral Health Affect Your Heart?
- [Research progress on the association between intestinal flora and hypertension]. - Published by PubMed
- [Feasibility of echocardiography-guided repeated intraventricular blood sampling in mice]. - Published by PubMed
- [The sex- and age-specific association between resting heart rate and hypertension in rural adult residents of Henan province]. - Published by PubMed
- [Analysis of sugammadex for antagonistic neuromuscular block in patients with radical resection of lung cancer under thoracoscope]. - Published by PubMed
- Oral Anticoagulant Treatment in Patients with Atrial Fibrillation and Cancer. - Published by PubMed
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