THE FACULTY OF HARVARD MEDICAL SCHOOL
Q: My dentist told me that seeing a periodontist for my gums might protect me from heart disease. How is this possible?
A: It's true that people with gum disease and tooth loss tend to have more heart disease than those with good oral health. Researchers are still trying to pin down the nature of this connection. So far, we don't know if improving your oral health will help you prevent a heart attack, but future studies may answer this question.
Two possible links between your mouth and your heart are bacteria and inflammation, the body's response to injury or irritation. Take gum disease, for example. Gum disease gets a foothold when the sticky, bacteria-laden film that forms on teeth (called plaque) extends into the sulcus, the shallow groove where gum meets tooth (see illustration). Toxins released by the bacteria irritate the surrounding tissue. The immune system responds to the infection and irritation. Inflammation follows. Plaque slowly hardens into calculus, which further inflames the gum. Eventually, some of the tissue and bone that supports the teeth can erode away. This is gum disease, also known as periodontitis.
People with heart disease develop blockages filled with cholesterol in the walls of their arteries. Inflammation causes these blockages to grow and rupture-- an event that triggers heart attacks and most strokes.
In people with gum disease, chewing and tooth brushing release bacteria into the bloodstream. Several species of bacteria that cause gum disease have sometimes been found in the fatty blockages in arteries. It is possible they contribute to the inflammatory damage that leads to heart disease.
Bacteria that inhabit the mouth could also cause trouble by releasing toxins that find their way into the bloodstream or artery walls. The immune system's response to these toxins could harm artery walls or make blood clot more easily. Inflammation in the mouth might "rev up" inflammation throughout the body. This could set the stage for heart problems.
Unfortunately, research in humans hasn't yet revealed clear connections between oral health and heart health. Several studies have shown a strong link between gum disease and the risk of heart attacks. But others turned up no connection at all. And even if the association is real, it doesn't necessarily mean that gum disease actually leads to heart problems. Instead, it's possible the two share common causes, such as advancing age, cigarette smoking, diabetes or low socioeconomic status.
Researchers at the Harvard Schools of Dental Medicine and Public Health have also suggested that gum disease and the resulting tooth loss may lead to poor eating habits. That, in turn, could contribute to heart-disease risk.
Treating gum disease usually involves scaling, a procedure that removes plaque and calculus above and below the gum line. In some cases, the dentist will surgically remove damaged gum tissue or prescribe antibiotics to reduce infection.
Does this treatment lower the risk of heart disease? Some small studies suggest yes, while other say no. A larger, longer trial could cut through the confusion. Tentative plans call for giving intensive periodontal treatment to 2,000 people with gum disease and heart disease, and standard treatment to another 2,000.
But in the meantime, take care of your teeth for your teeth's sake. Brush and floss every day and see your dentist at least twice a year for regular cleanings and oral exams. Get help if you have sore or receding gums, or if your gums bleed when you brush.
If you've already lost one or more teeth, talk with a nutritionist to find foods you can eat that are good for your overall health. All of these strategies will pay off for your oral health, and they just may benefit your heart-- and that should put some sparkle in your smile!
