When evaluating your risk of developing heart disease, your health care provider may assess your blood cholesterol and blood pressure levels, your activity level, your weight and your diet, among other factors. What if your doctor then followed up by asking how often you brush and floss your teeth? You'd expect that type of question at your visits to the dentist, sure, but at your family doctor? Studies are beginning to find that your teeth have a lot to say about your overall health.
Brushing and flossing at least twice every day is proven to help keep mouths healthy. Periodontal disease is inflammation and infection of the gums, tissues and ligaments that keep our teeth firmly in our mouths. It can be mild, in the form of gingivitis, or severe, manifesting as chronic periodontitis and tooth loss.
The most common cause of gum disease is plaque. When plaque, a sticky film of sugars, bacteria and mucus, is left to build up on teeth it can cause cavities, harden into tartar and create the perfect setting for gingivitis. In addition to plaque, there are personal and environmental pieces that factor in to the puzzle of who is at increased risk for developing gum disease, including smoking and tobacco usage, certain diseases such as diabetes, cancer and HIV, medications that cause dry mouth, female hormonal changes, such as puberty and menopause, and your genes.
Most people don't begin to notice symptoms of gum disease until they're in their 30s or 40s. Symptoms of gingivitis include tender, swollen, red or bleeding gums, sensitive teeth and -- this one may surprise you -- persistent bad breath. As the inflammation and infection become more severe, new symptoms such as receding gums, loose teeth, tooth loss and pain while chewing may arise. The inflammation and infection may affect your whole mouth or just a few teeth.
So are swollen gums really that big of a deal?
Yes, they are, and not just because they can lead to more damaging forms of gum disease and tooth loss. When it comes to predicting who is at increased risk for developing coronary artery disease, some common oral health maladies such as cavities, gingivitis and missing teeth rival cholesterol levels as indicators of the condition [source: Griffin]. Flossing, as it turns out, may help save you from having a heart attack.
The Periodontitis and Atherosclerosis Link
Let's look at the current predominant theory about the association between periodontal disease and coronary heart disease. In one word, the link boils down to this: Inflammation.
Inflammation happens when the immune system kicks in to fight off something foreign such as a virus or bacteria. It's supposed to do that, and it helps to keep us healthy. Sometimes, though, the immune system overreacts, and when this is chronic it can cause problems such as allergies, asthma, rheumatoid arthritis, and other autoinflammatory and autoimmune diseases. Inflammation may also be responsible for other chronic conditions, such as depression, cancer, diabetes and heart disease, among others.
Inflammation is linked to atherosclerosis, a form of heart disease characterized by a hardening of the arteries, but it remains unclear whether or not the inflammation is systemic (throughout the whole body) or local. Inflammation's role in periodontal disease is still unfolding, but studies have shown that when plaque isn't frequently removed from the surface of the teeth and the gumline, the bacteria in it releases toxins that cause infection and inflammation in the gums -- inflammation that can become chronic and systemic if not treated. Researchers have found that the same bacteria present in gum disease is also present in the fatty plaques that cause growth of blood vessel walls and harden carotid arteries, suggesting a link between the two diseases. According to the American Academy of Periodontology, research has also found that people with periodontal disease are almost twice as likely to have heart disease, when compared to people with healthy, firm, pink gums [source: Griffin].
Proper brushing and flossing in addition to semi-annual visits to the dentist are your best defense against developing gum disease. And while you can't know for sure if the bacteria responsible for your periodontal disease caused your atherosclerosis or vice versa, you can ask your doctor to test the level of inflammation present in your body. The body normally makes a protein called C-reactive protein (CRP) and the level of that protein increases if there is swelling anywhere in the body. The test is able to assess if CRP levels are higher-than-average in your blood, and while it isn't a diagnosis, it can be an indication that you need follow-up screenings.
More Great Links
- American Academy of Periodontology. "Periodontal Disease Fact Sheet." (Sept. 23, 2011) http://www.perio.org/consumer/disease_facts.htm
- Colgate. "Gingivitis." 2009. (Sept. 23, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Common-Concerns/Gum-Disease/article/Gingivitis.cvsp
- Griffin, R. Morgan. "Periodontal Disease and Heart Health." WebMD. 2005. (Sept. 23, 2011) http://www.webmd.com/heart-disease/features/periodontal-disease-heart-health
- MayoClinic.com. "C-reactive protein test." 2009. (Sept. 23, 2011) http://www.mayoclinic.com/health/c-reactive-protein/MY01018
- National Institute of Dental and Craniofacial Research. "Periodontal (Gum) Disease: Causes, Symptoms, and Treatments." 2010. (Sept. 23, 2011) http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm
- ScienceDaily. "Link Between Oral Infections and Cardiovascular Disease Morbidity Explained." 2009. (Sept. 23, 2011) http://www.sciencedaily.com/releases/2009/07/090709140822.htm
- U.S. National Library of Medicine. "Gingivitis." 2010. (Sept. 23, 2011) http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002051/
- U.S. News & World Report. "Gum Disease, Heart Disease Share a Genetic Link." 2011. (Sept. 23, 2011) http://health.usnews.com/health-news/family-health/heart/articles/2009/05/26/gum-disease-heart-disease-share-genetic-link
- Yamazaki, Kazuhisa; Tabeta, Koichi; and Takako Nakajima. "periodontitis as a Risk Factor for Atherosclerosis." Journal of Oral Biosciences. Vol. 53, no. 3. Pages 221-232. 2011. (Sept. 23, 2011) http://www.jstage.jst.go.jp/article/joralbiosci/53/3/53_221/_article