The Impression
STRAIGHT TALK
ON ORAL CARE

How Taking Care Of Your Teeth Could Help Your Heart

Wondering about the connection between oral health and heart disease? Here’s what you need to know.

Ariel Harris
Contributing Writer

When it’s time for Shaun Hinklein’s bi-annual dental check-up, he has to stop at the pharmacy the day before for a dose of antibiotics. That’s because Hinklein, 32, was born with pulmonary valve stenosis — a congenital heart defect that’s a narrowing or constriction of the pulmonary valve which reduces blood flow to the lungs, according to the American Heart Association. When Hinklein was just an infant, he had surgery to implant a patch of the valve, and at 25 he underwent a total valve replacement.

Thanks to the marvels of modern medicine, Hinklein enjoyed a happy, normal childhood (outside of the major surgeries, anyway). “My parents were really great at making sure I wasn’t a bubble boy,” Hinklein tells The Impression. “I played sports. I grew up in a suburb in New Jersey where you’re running around outside 24-7. It wasn’t that different.”

In fact, one of the only things that was a little distinct was the extra hassle before the dentist. “It’s really an annoying thing, because if you forget, there goes your appointment,” Hinklein says. But the course of antibiotics is nonetheless a crucial precaution because the gums, as he puts it, “are a mainline to your heart.” Which means that, for Hinklein, one little prick of the gums could become a serious heart infection known as endocarditis.

Interestingly, though, researchers are learning that this link between heart and mouth isn’t just an important thing for people with existing heart conditions to know about. It may also help explain a way to help prevent heart disease later on.

For years, scientists have observed a curious link between markers of poor oral health (most notably tooth loss and gum diseases) and onset of cardiovascular disease, including incidence of heart attacks. Study after study has found that people with gum disease are more likely to have cardiovascular disease. But there are many unanswered questions — and the link between your teeth and heart health isn’t straightforward. Ahead, everything you need to know about dental health and heart disease.

What scientists know about the link between oral health and heart disease

There are two main ways your oral health is connected to your heart health, and both have to do with your gums, Ed Shaheen, DDS, a dentist and orthodontist based in St. Louis, MO, tells The Impression. The first way is related to that “mainline” Hinklein told us about.

The human body is swarming with trillions of bacteria, and one of the hottest hotspots for these (often friendly) germs is your mouth. Right now, you may have up to 600 different species of microbes living on your teeth and gums. Normally, your immune system and regular brushing and flossing can keep these bacteria in check. But without proper oral care, these bacteria can lead to tooth decay and gum disease (also known as gingivitis, which you’ve definitely heard about in toothbrush commercials.)

The main symptom of gum disease is inflamed and bleeding gums. When this happens, all that bacteria in your mouth can find its way directly into the bloodstream via your gums. (This can also happen during office visits when your dentist manipulates your gums — hence Hinklein’s preventive antibiotics.) From there, these bacteria can make their way to the lining of your heart and become endocarditis.

For healthy people with strong immune systems and no prior heart complications, this only happens in the rarest of cases or when another illness has depressed your immune system. And for those who have a higher risk, precautionary measures like Hinklein’s preventive antibiotics and routine oral care can go a long way in preventing a dangerous infection. The other way your gums can affect your heart health is more complicated — but it’s arguably more important for most people to know about because it’s potentially a much more common concern.

The later stage of gum disease, when poor oral health has led the infection and inflammation to spread beyond your gums to the ligaments and bones around your teeth, is called periodontitis.

At this point, the disease is “non-reversible,” Christof Dörfer, DDS, President of the German Society for Periodontology, tells The Impression. The theory linking periodontitis to heart disease is that this chronic inflammation in your mouth can increase the level of inflammation in your whole body, including your heart and blood vessels, Dr. Shaheen says. Over time, this inflammation may contribute to the narrowing or hardening of your arteries, a hallmark of cardiovascular disease and a precursor to heart attacks and stroke.

Does this mean treating gum disease can prevent heart disease?

According to the Harvard Health Letter, people with periodontal disease may have between two to three times the risk of having a heart attack, stroke, or other serious cardiovascular event, compared to those with healthy gums. So does that mean taking care of your gums can prevent heart disease? Not exactly.

The cause of heart disease is multifactorial — diet, exercise and even genetics all play huge roles, too. So at this point, it’s too early to tell whether the link between dental hygiene and heart disease is a causal one. And as strong as the association is, researchers still urge caution.

“It may also be that both diseases are linked to the same risk factors,” Dr. Dörfer says. “Habits, mainly smoking, but also genetic risks are in common for both diseases.”

Still, because of the strong association, many researchers agree that it can’t hurt to take care of your oral health.

“It is a complex interrelationship between oral conditions and cardiovascular disease – at this stage we know there is a strong and consistent association but we cannot say that this is a causal link,” Richard G. Watt, PhD Professor of Dental Public Health at University College London, tells The Impression. “So I would say that to maintain good oral and [cardiovascular] health we all need to address the common risks.”

“Periodontitis is the silent disease,” Dr. Dorfer adds. “The more of the periodontium is destroyed by the disease, it becomes more difficult [to treat]. That means that the earlier you start with the preventive measures, as simple as brushing and flossing and seeing the dentist, the less likely it is that you experience periodontitis and the lower the risk that this chronic disease will have a negative impact on your general health.”

Can tooth decay cause heart problems?

When you take a look at the research, one of the most consistent predictors of heart disease is tooth loss. On face value, this makes it seem like tooth decay, which starts with smaller dental caries or cavities, may also be a risk factor for heart disease. But Dr. Watt explains that tooth decay is only indirectly related to heart issues in that the same overgrowth of bacteria that can happen without proper dental hygiene leads to both cavities and gum disease. In fact, the leading cause of tooth loss is periodontal disease.

“The association is most likely through a shared inflammatory process that links periodontal disease and CVD,” Dr. Watt says. “So dental caries is not so relevant here.”

What's the bottom line on the teeth and heart connection?

As we've seen, it's not quite a straight line. But what we do know is that taking steps to care for your teeth will pay off for your gums, which may (or may not) pay serious dividends for your heart. Add that to the long list of benefits of proper oral hygiene.

“Taking care of your oral health first is a benefit in itself and it keeps your quality of life high. It maintains your ability to chew properly and, therefore, to use all the positive ingredients of your healthy food,” Dr. Dorfer says.  “Healthy and beautiful teeth also give you self-confidence.”

Even investing in straightening your teeth can impact your general oral health by making it easier to floss, which is known to help prevent plaque build-up that leads to gum disease and tooth loss, adds Dr. Shaheen.

The bottom line: Caring about your teeth isn’t just about vanity. Be sure to follow the American Dental Association’s recommendations to see your dentist regularly, and keep up with brushing (twice a day) and flossing (once a day).

Shaun Hinklein, phone interview, 4/18/2019
American Heart Association, heart.org Health Topics: Pulmonary Valve Stenosis, visited 4/20/19
American Heart Association, heart.org Health Topics: Invective Endocardities, visited 4/22/2019
Tooth Loss and Cardiovascular Disease Mortality Risk – Results from the Scottish Health Survey, Richard G. Watt*, Georgios Tsakos, Cesar de Oliveira, Mark Hamer, PLoS One, 2012
Oral health and cardiovascular disease risk in a cohort of periodontitis patients. Holmlund, Lampa, Lind, Atherosclerosis, 2017
Periodontal disease and stroke: a meta-analysis of cohort studies. Lafon, Pereira B, Dufour T, Rigouby V, Giroud M, Béjot Y, Tubert-Jeannin S. Eur J Neurol. 2014
Evidence summary: the relationship between oral and cardiovascular disease. Dietrich T, Webb I, Stenhouse L, Pattni A, Ready D, Wanyonyi KL, White S, Gallagher J. Br Dent J. 2017.
Ed Shaheen, DDS, email interview 4/21/2019
The Human Oral Microbiome. Floyd E. Dewhirst, Tuste Chen, Jacques Izard, Bruce J. Paster, Anne C. R. Tanner, Wen-Han Yu, Abirami Lakshmanan, William G. Wade. Journal of Bacteriology
Christof Dörfer, DDS, President of the German Society for Periodontology, email interview 4/20/2019
Periodontitis as a Risk Factor of Atherosclerosis. Jirina Bartova, Pavla Sommerova, Yelena Lyuya-Mi, Jaroslav Mysak, Jarmila Prochazkova, Jana Duskova, Tatjana Janatova, and Stepan Podzimek. Journal of Immunology Research 2014
Harvard Health Letter. Gum disease and heart disease the common thread. Accessed 4/20/2019.
Richard G. Watt, PhD, email interview 4/25/2019.
American Dental Association press release. Accessed 4/21/2019.