| Risk Factors
Mom's constant reminders to brush your teeth may be helping your heart. Good oral hygiene aids in preventing plaque build-up that characterizes both cardiac and gum diseases.
There is growing evidence that hardening of the arteries, or atherosclerosis, is somehow related to infection and inflammation.
The primary form of periodontal disease occurs when bacteria invade the gums, bones, and tissue that support the teeth. Many adults suffer from periodontal disease, but most do not realize it until substantial damage has already occurred. Often painless, gum disease progresses relentlessly. Gums separate from teeth, pockets form and deepen, and bacteria-produced toxins destroy tissue. While in its earliest stage, known as
gingivitis, professional dental care and good oral hygiene can reverse the damage.
For hundreds of years, people have recognized a connection between oral infections and systemic conditions. More recent investigations have found an association between gum disease and cardiovascular disease, low birth-weight babies, respiratory infections, and diabetes. One study found people with periodontal bone loss had twice the chance of fatal heart disease. The exact mechanism that increases cardiovascular risk remains murky, but experts believe bacteria from the chronic gum infection enter the bloodstream and cause white blood cells that fight infections to release inflammatory chemicals that create a build-up of fatty deposits and clots in the arteries. Studies have shown that chronic infections in other parts of the body can cause a similar response.
Improving your dental hygiene will help prevent periodontal disease and may also reduce your risk of coronary artery disease as a result.
To minimize your risk:
- Brush inner, outer, and chewing surfaces at least twice daily with a soft-bristled brush held at a 45° angle. Some people find electric brushes easier to use.
- Floss at least once daily, gently guiding the floss between teeth. While holding floss tight and curved around each tooth, slide the floss up and down. Use a clean section of floss for each tooth.
- Get a professional dental cleaning every six months, or more often if you are prone to plaque or gingivitis.
- Ask for an annual periodontal screening and assessment of the degree to which gum tissue has pulled away from teeth.
Several factors can place you at increased risk for periodontal disease.
Birth control pills, hormone replacement therapy, pregnancy, puberty, and menstrual cycles all raise estrogen levels. This can make your gums more sensitive and make it easier for gingivitis to form.
Some medicines create an overgrowth of gum tissue, especially in people with an existing gum condition. Bacteria can easily build up in the enlarged gums and start to destroy the tissues that support the teeth.
Smoking increases the risk of periodontal disease and can also reduce the effectiveness of treatment.
One study found that periodontal disease is more common in people who are obese. It may be because the body has a harder time fighting infection without proper nutrients.
- Increased Age
As we age, our risk for peridontal disease rises.
People with diabetes are at higher risk for developing gum disease.
- Other Illnesses
People with immune deficiencies, such as those with AIDS, are more likely to have problems with their gums.
Although slow-moving at first, gum disease will steadily become worse without treatment. Symptoms include:
- Gums pulling away from the teeth
- Swollen, red, or tender gums
- Gums that bleed with brushing or flossing
- Bad breath
- Loose or missing teeth
If you notice any of these symptoms, contact your dentist for a referral or call a periodontist directly.
In its earliest stages, good oral hygiene and frequent professional cleaning will clear up the condition. If not, a periodontist can remove plaque from below the gum line and smooth or plane the tooth root to enable the gum to reattach. With more advanced cases, surgery may be required to clean up the infected area and rebuild damaged bone.
Often, periodontists will add a course of antimicrobial therapy—pastes, gels, or polymers applied topically, or antibiotic pills to eliminate more aggressive bacteria. The specialists may also order Periostat, a pill that decreases the concentration of destructive enzymes called collagenases around the teeth and protects the tissue from additional damage. Treatment can prevent further deterioration associated with periodontal disease.
Unfortunately, it is not known whether treating periodontal disease will decrease your risk for coronary artery disease. While researchers determine if treatment can reduce the cardiac risk, professional care will minimize tooth loss. Tooth loss is clearly associated with risk of heart disease. The best bet for oral health remains prevention and minimizing periodontal risk factors.
D'Aiuto F, Parkar M, Andreou G, Brett PM, Ready D, Tonetti MS.
Periodontitis and atherogenesis: causal association or simple coincidence?
J Clin Periodontol. 2004;31(5):402-411.
Hung HC, Joshipura KJ, Colditz G, Manson JE, Rimm EB, Speizer FE, Willett WC. The association between tooth loss and coronary heart disease in men and women.
J Public Health Dent. 2004;64(4):209-215.
First evidence found of link between gum disease and high alcohol consumption, low dietary antioxidants. University at Buffalo School of Dental Medicine website. Available at:
http://www.buffalo.edu/news/releases/1999/03/3171.html. Published March 13, 1999. Accessed August 30, 2013.
Ford PJ, Yamazaki K, Seymour GJ:Cardiovascular and oral disease interactions: what is the evidence? Prim Dent Care. 2007;14:59-66.
Periodontal (gum) disease: causes, symptoms, and treatments. National Institute of Dental and Craniofacial Research website. Available at: http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/. Updated August 2012. Accessed August 30, 2013.
Periodontitis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated August 22, 2013. Accessed August 30, 2013.
UB researchers identify specific oral bacteria most likely to increase risk of heart attack. University at Buffalo School of Dental Medicine website. Available at:
http://www.buffalo.edu/news/releases/1999/03/3210.html. Published March 12, 1999. Accessed August 30, 2013.
Yeh ET: High-sensitivity C-reactive protein as a risk assessment tool for cardiovascular disease. Clin Cardiol. 2005; 28:408-12.
Last reviewed August 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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