Brush and floss — your heart may thank you

In case you need a little encouragement to keep up with brushing and flossing, consider this: Good dental habits might be another way to help reduce your risk of heart disease.

Several studies in recent years have identified a connection between heart disease and periodontal disease — infection and inflammation of the gums. People with poor oral health appear more likely to have heart disease.

While no cause-and-effect relationship has been proved, Thomas Hill, MD, a cardiologist at Trinity Health Muskegon, and part of the Cardiovascular Network, sees no reason not to add good dental habits to the practices that make heart disease, the No. 1 cause of death, up to 80% preventable.

“I certainly don't want to say, ‘Well, as long as you take care of your teeth, you don't have to quit smoking, or you don’t have to exercise or eat right, or you don't have to manage your diabetes and hypertension,’” he said.

“However, when some studies say brushing and flossing your teeth can decrease your risk for a heart attack by 20%, that's what people in the financial arena would call a pretty good return on investment.”

A logical connection

The association between heart disease and oral health makes sense, Dr. Hill said, even though no direct cause has been proved yet.

“We know inflammation plays a big role in coronary disease and vascular disease,” Dr. Hill said. “Other factors that lead to increased inflammation — like autoimmune conditions, diabetes and obesity — lead to increased risk for heart disease.”

He explained that inflammation can be helpful when it causes the body’s immune system to fight infection. But other causes of chronic inflammation, such as rheumatoid arthritis or lupus, can be damaging.

For example, in the heart and arteries, inflammation can contribute to cholesterol deposits, leading to plaque buildup, making it more likely to rupture and cause a heart attack or stroke. And periodontal disease is another condition that causes chronic inflammation, Dr. Hill said.

“Just from an anecdotal standpoint, the younger people I see with heart attacks, it's not unusual that you see very poor dental health and a lot of periodontal disease,” he said. “But they often are smokers and have other issues as well. And that's kind of a complicating factor on whether there's truly a cause and effect.”

Oral health and overall health

The mouth is increasingly being understood as a gateway to overall health, with oral infections being associated with a host of other diseases, including diabetes, respiratory illness, cancers, pregnancy complications — even dementia.

Dr. Hill noted that periodontal disease also is associated with vascular disease that can cause heart attacks and strokes. And there is a strong connection to a less common condition, endocarditis, which is an infection on the heart valves, he said. This can happen when bacteria in the mouth gets into the bloodstream.

“We do know that long-term good dental health does decrease the risk of infections on the heart valves, particularly if you have an abnormal heart valve or an artificial valve,” he said.

With growing evidence of these connections, Dr. Hill says it’s a good idea for patients to let their physicians know if they have oral health problems. But it’s still critical to be aware of all the factors that already are proven to contribute to heart disease.

“At the very least, start looking at other risk factors that are clearly causative — things like elevated cholesterol, family history, smoking, diabetes, obesity, inactivity,” he said. “Be sure you're keeping those in check, as well as getting encouragement from another physician or healthcare provider to really work on the oral health.”

Learn more about cardiovascular care at Trinity Health Michigan.