You may have remember your mother’s constant reminders to brush your teeth. It is something that goes back to the appearance of your first tooth. There is good reason for that. The mouth carries more than 700 types of bacteria. These bacteria can escape your mouth, into the bloodstream, and land in the arteries of your heart.

Gum Disease

Gingivitis is an inflammation of the gums around the teeth. It is earliest and most treatable stage gum disease. It can be reveresed with professional dental care and good oral hygiene. If left untreated, gingivitis can rapidly and silently progress to periodontitis. Periodontitis is a more severe form of gum disease. Bacteria invade the gums, bones, and supporting tissues that surround the teeth. Over time, gums separate from teeth, pockets of bacteria form and deepen, and toxins destroy oral tissue. Because it is painless, most adults do not realize it until the damage has occurred.

Heart Disease

Atherosclerosis is the most common cause of coronary artery disease (CAD). CAD is the leading cause of death in the United States. Atherosclerosis is the narrowing of blood vessels due to a build up of a waxy substance, called plaque, on the walls of the blood vessels that supply the heart muscle with blood. Plaque makes it difficult for blood to flow, and slows or stops the delivery of nutrients and oxygen to the heart muscle. This blockage can lead to a heart attack. CAD is also a progressive disease. It may not be noticed until chest pain occurs.

The Connection

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 heart 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.

Recognizing and Treating Gum Disease

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, make an appointment with your dentist or periodontist. 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 prescribe 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 periodontitis.

Unfortunately, it is not known whether treating periodontitis will decrease your risk for CAD. While researchers determine if treatment can reduce the the 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.

Prevention

Improving your dental hygiene will help prevent periodontitis and may also reduce your risk of CAD 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 6 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.

Perio—American Academy of Periodontology http://www.perio.org

Public Health Agency of Canada http://www.phac-aspc.gc.ca

D’Aiuto F, Parkar M, et al. Periodontitis and atherogenesis: Causal association or simple coincidence? J Clin Periodontol. 2004;31(5):402-411.

Hung HC, Joshipura KJ, et al. The association between tooth loss and coronary heart disease in men and women. J Public Health Dent. 2004;64(4):209-215.

Ford PJ, Yamazaki K, et al. Cardiovascular and oral disease interactions: What is the evidence? Prim Dent Care. 2007;14:59-66.

Kimura K, Takase B. Significant associatin between periodontitis and cardiovascular risk. Circ J. 2014;78(4):837-838.

Periodontitis. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed
Updated October 20, 2014. Accessed April 14, 2015.

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