Oral Hygiene and Heart Disease

Flossing for your heart

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While several studies have pointed to a link between poor oral hygiene and atherosclerosis, there is as yet no proof of a direct cause-and-effect relationship.

What Is The Evidence Of a Link Between Oral Health And Heart Disease?

Studies have been fairly consistent in finding that regular flossing and dental care is related to a lower risk of heart disease.

Flossing and periodic teeth cleaning by a dental professional (to remove the plaque that invariably forms on everyone's teeth) are vital in preventing periodontal disease — gingivitis or periodontitis — which is caused by a chronic bacterial infection of the gums.

It has been proposed that periodontal disease might worsen inflammation of the blood vessels, an important component of atherosclerosis. Certainly, people with gum disease are known, for instance, to have elevated levels of C-reactive protein (CRP), and high CRP levels have been strongly associated with an increased risk of coronary artery disease.

Further, it has been shown that people with periodontal disease also have elevated levels of lipoprotein-associated phospholipase A2, another significant marker for the inflammation that increases cardiac risk.

There is also evidence that when people who have active periodontal disease receive good dental care and improve their own oral hygiene, their vascular function improves. And one small study has even suggested that aggressive treatment of periodontal disease can potentially result in the partial reversal of vascular disease, as determined by the carotid intimal medial thickness test.

Finally, epidemiologists have found that, among patients who have diabetes, heart disease or stroke, those who receive treatment for periodontal disease end up with substantially reduced overall healthcare costs.

Interesting, But Circumstantial

These findings, while interesting and possibly significant, do not definitively prove a link between oral hygiene and the prevention of heart disease.

Perhaps, for instance, people who regularly see a dentist merely turn out to be the same people who take better care of themselves in general.

Proof that good oral hygiene is good for the heart would require long-term, randomized clinical trials demonstrating that the incidence of myocardial infarction (heart attacks), the need for bypass surgery or stents, or cardiac death is significantly reduced by good dental care.

Bottom Line

Maybe someday, if some organization is willing to put up the $100 million or so that such a study is likely to cost, such definitive evidence will be available.

In the meantime, however, it is known beyond a doubt that good oral hygiene produces several health benefits aside from a healthy heart. These benefits include a reduction in cavities, the preservation of your teeth, getting rid of halitosis, and (though this also has not yet been proven in formal randomized clinical trials), better sex.

It seems advisable, to this cardiologist, to strongly encourage good oral hygiene.


Mochari H, Grbic JT, Mosca L. Usefulness of self-reported periodontal disease to identify individuals with elevated inflammatory markers at risk of cardiovascular disease. Am J Cardiol 2008; 102:1509-1513.

Tonetti MS, D'Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007; 356:911-20.

Piconi S, Trabattoni D, Luraghi C et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. FASEB J 2008; DOI: 10.1096/fj.08-119578.

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