Is There a Relationship Between Gingivitis and Heart Disease?

When my patient Joe came for a check-up after a heart attack, I immediately noticed his bad breath and missing teeth. Because he feared the dentist, he missed many years of cleanings. I told him his bleeding gums and loose teeth may have contributed to his recent heart event.

If you focus on good oral hygiene and get regular professional cleanings, PD is very treatable

One of the key symptoms of Gingivitis is bleeding gums caused by inflammation and a low-grade infection. This generally helps dentists recognize the first signs of early periodontal disease (PD). If these symptoms go untreated, PD can progress to the bones that surround and support the teeth. In later stages, the gums will pull away from the teeth. Bone loss will then cause the teeth to become loose and eventually fall out. PD is exceedingly common. The Center for Disease Control reports that nearly half of adults age 30 or older have some form of periodontal disease. The good news is that if you focus on good oral hygiene and get regular professional cleanings, the disease is very treatable.

The Most Common Symptoms of PD

They include:

• Bad breath
• Red, swollen, tender or bleeding gums
• Tooth pain.

PD is more common in smokers, diabetics and older people. In fact, seventy percent of adults 65 or older have it. It’s also more common among people living in poverty.

PD and Heart Disease

A lot of research supports a connection between Periodontal Disease (PD) and heart disease:

• A study by researchers at Marshall Medical Research Foundation examined nearly 10,000 subjects over 17 years and found those subjects with PD had a 25% increase risk of heart disease.
•  Another 2007 meta-analysis by researchers at the University of Chicago that looked at 80,000 subjects also found that PD patients had a two-fold increase in heart disease.
•  A 2003 study in the journal of the American Heart Association found a correlation between PD, tooth loss and plaque accumulation and an increased risk for stroke and heart disease.
• Danish researchers found that people who had lost all their teeth due to PD had a 3-fold increased risk of stroke and 1.5 increased risk of heart disease.
• Unfortunately, removing the teeth in people with PD did not seem to help.

How Does PD Contribute to Heart Disease?

The current proposed mechanisms linking PD with Heart Disease are:

• Systemic inflammation: Inflammation in one area of the body can affect the whole body. This inflammation contributes to three things: blood vessel walls become more permeable, cholesterol becomes more sticky, (contributing to plaque growth) and platelets become more sticky (making a heart attack more likely).
• Direct invasion of the blood vessels by oral bacteria: the oral bacteria that get into the blood attack the lining of blood vessels. This causes inflammation and contributes in the ways mentioned above.

Does this Mean Everyone with PD is at High Risk for Heart Disease?

•  People with early PD who get effective treatment have a minimally-increased risk.
• If the disease has progressed to the point of losing teeth, as in this study done with veterans, severe PD is a more powerful predictor of heart disease than risk factors such as blood pressure, cholesterol level, diabetes and smoking.

Note: Even though periodontal disease is associated with heart disease and there are plausible mechanisms as to how it may contribute to heart disease, science has yet to fully endorse the connection.

How to Lower Your Risk of Heart Disease if You Have PD?

• Get effective treatment. This involves both good home care and special treatments to remove plaque by your dentist.
• Decrease your other risk factors that contribute to both conditions, especially Diabetes and tobacco use.
• Consider switching to a plant-based diet if you are not already following one. It has the proven benefits for reducing your risk of heart disease and is associated with less PD.
• Consider a large-scale lifestyle change to help your overall health, like Ornish Lifestyle Medicine.

By following a healthy lifestyle and practicing good oral care, you will have nicer teeth and lower your risk of Periodontal Disease, Diabetes and Heart Disease.