Gum disease and the connection to heart disease


To me, this is one of the most surprising observations of recent years: Study after study shows that people with poor oral health, such as gum disease or tooth loss, are more likely to develop heart disease than the general population. cardiovascular disease such as disease or stroke.

Why are cardiovascular disease and poor oral health linked?

Many theories have been proposed, including:

  • The bacteria that infect the gums and cause gingivitis and periodontitis can also spread to blood vessels elsewhere in the body, causing inflammation and damage to them; microscopic blood clots, heart disease, and stroke may follow. Supporting this idea is the finding of remnants of oral bacteria within atherosclerotic blood vessels remote from the mouth. Then again, antibiotic treatment has not been proven to be effective in reducing cardiovascular risk.
  • It's not bacteria that cause the problem, but the body's immune response — inflammation — that triggers a cascade of damage to blood vessels throughout the body, including the heart and brain.
  • There may not be a direct link between gum disease and cardiovascular disease; there are 3 reasons why they may co-occurRD Factors such as smoking are risk factors for both conditions. Other potential “confounders” include poor access to health care and physical inactivity—perhaps people who don't have health insurance or don't take good care of their overall health are more likely to have poor oral health and heart disease.

A study published in 2018 is one of the largest to examine this issue. Researchers analyzed data from nearly 1 million people who experienced more than 65,000 cardiovascular events, including heart attacks, and found:

  • After accounting for age, there was a moderate association between tooth loss, a measure of poor oral health, and coronary heart disease.
  • The association between tooth loss and cardiovascular disease essentially disappeared when smoking status was taken into account

This study shows that poor oral health does not directly lead to cardiovascular disease. But if this is true, how do we explain other studies that have found an association even after accounting for smoking and other cardiovascular risk factors?

Rarely is a study able to definitively answer a question that researchers have pondered for decades. Therefore, we may need more research to resolve this issue.

But wait, there’s more!

The link between poor oral health and overall health may not be limited to cardiovascular disease. Research has linked periodontal disease, particularly due to Porphyromonas gingivalis infection, to rheumatoid arthritis. Additionally, a 2018 study found a link between this bacteria and pancreatic cancer risk. However, as with the link to heart disease, “association” does not equate to causation. More research is needed to clarify the significance of these observations.

bottom line

Whether the connection is direct, indirect, or coincidental, a healthy mouth and a regimen to keep it healthy, including not smoking and getting regular dental care, can help you keep your teeth. That’s why you do your best to prioritize your oral health. Perhaps it will also bring other benefits, although most of these are still in the speculative stage.

Awaiting more research on the link between oral health and overall health. Until then, keep brushing, flossing, and visiting your dentist.

Robert H. Shmerling, MD, is an associate professor of medicine at Harvard Medical School and clinical director of rheumatology at Beth Israel Deaconess Medical Center in Boston, where he teaches in the internal medicine residency program. He is also the Program Director of the Rheumatology Fellowship. He has been a rheumatologist for over 25 years.

Image source: © Zurijeta/Getty Images



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