February 9, 2022
When I was growing up, my brothers and sisters and I would earn a $5 reward from my mom if we had no cavities after we went to the dentist. Her reasoning was that it cost her less to pay us $5 than to get cavities filled, and this created an incentive for us to brush and floss regularly. What we didn’t know at the time was that our efforts to earn money by taking care of our teeth were also leading to possible health benefits for our hearts.
Disease of your Teeth: Periodontal Disease (PD)
When plaque on your teeth extends to your gums, this can progress to what is known as periodontal disease (PD), causing infections and inflammation in your gums and the bones that surround and support your teeth. PD is seen in 47% of adults over the age of 30 and becomes even more common as we get older. It is more common in men than women and some additional risk factors for PD include smoking, diabetes, high blood pressure, obesity, poor oral hygiene, and compromised immune systems.
Relationship of PD to Heart Disease
Your risk for heart disease increases 3.5 times if you have PD, and your risk for acute cardiac events such as a heart attack increases 24-35%, even after taking into account other risk factors for heart disease. Specifically, PD increases your risk for heart attack 2-fold, as well as increases your risk for stroke and blocked arteries outside the heart (called peripheral arterial disease, or PAD). A large 2019 study of people over the age of 40 with no history of heart disease showed a higher risk of heart-related death, heart attack, stroke, and heart failure over more than nine years of follow-up in people with PD and a higher number of cavities, or tooth loss. Adding an additional tooth brushing a day was associated with a 9% reduction in heart events after accounting for other risk factors. Regular dental visits once or more a year for professional cleaning were also shown to reduce heart risk by 14%.
Dental Habits and Cardiovascular Risk
Your tooth brushing habits affect your cardiovascular risk. A study asked almost 700 people about their tooth-brushing behavior and found that people who brushed less than twice a day for less than two minutes tripled their risk of having or dying from a heart attack, heart failure, or stroke. An additional study showed that those who brushed three or more times daily had a 12% lower risk of heart failure and a 10% lower risk of atrial fibrillation (an irregular heartbeat).
How is Disease in your Teeth Related to Heart Disease?
The exact relationship between PD and heart disease is difficult to determine, but possible causes include the effects of bacteria, markers of inflammation, or immune mediators on the lining of blood vessels, which then result in increased plaque buildup in these vessels. This chronic plaque buildup in arteries can eventually lead to cardiac events. Because many of the risk factors and symptoms of PD and heart disease are similar, it is challenging to directly prove that PD causes heart disease, or whether similar processes and reactions in your body cause the two diseases.
Sometimes in medicine and in life, however, recommendations can be pretty straightforward when weighing the risks and benefits. If taking care of your teeth means reducing your heart disease risk, good oral hygiene makes sense in many ways.
As I reflect on my mom’s dental incentive for us growing up, I am not sure that she realized that we would often use our $5 to buy candy….
Dr. Elizabeth Holper is an Interventional Cardiologist at St. Peter’s Health and serves as the Medical Director of Inpatient Cardiology. She is board certified in Cardiovascular Disease and Interventional Cardiology.