How Oral Health Affects Overall Health: the Heart of the Matter (part 1)

Mar 3, 2018

It is well-known that your oral health affects your overall health . But did you know that dental health has correlations to heart disease, Alzheimer’s Disease, and diabetes? In this series of blog posts, we’ll be delving into how oral health is linked to such extreme health conditions and what you can do about it.

How are Oral Health and Heart Disease Related?

Throughout the past few decades, much scientific research has been conducted to find the correlation between dental health and cardiovascular disease. There is currently no conclusive evidence that oral health specifically causes heart disease (or stroke) but they are definitely related and there have been several theories proposed.

Periodontitis and Loss of Teeth

Two studies in 2006 and 2010 collected information from over 3,000 participants. They found that the more severe periodontal disease was in a middle-aged patient, the more likely they would suffer hypertension (i.e. high blood pressure). However, a far more alarming finding was that a person who had fewer than 10 teeth remaining is seven times more likely to die of coronary disease than a person with more than 25 teeth. There is a direct correlation (but not necessarily causation) between oral health and cardiovascular disease.

Bacteria in Blood Vessels

Periodontal disease is gum inflammation caused by bacterial infection. When these periodontal bacteria (or the products released by the bacteria) penetrate the bloodstream to reach other parts of your body (e.g. your heart or brain), they can damage the linings of blood vessels in that area. Professor Walter Loesche of the University of Michigan found that his patients suffering from coronary artery disease had elevated levels of certain types of periodontal bacteria which contained lipopolysaccharides (a toxin contributing to illness if released).

Further research in that same vein has suggested that lipopolysaccharides may also damage the cells that line blood vessels. A substance called the von Willebrand factor is released when these cells are damaged. The von Willebrand factor is elevated in people with periodontal disease. This confirms the correlation between periodontitis and coronary artery disease.

Prof. Loesche also investigated the inflammatory responses of periodontitis. White blood cells produce cytokines (protein-like signalling molecules) to combat periodontal disease. However, if the cytokines enter the bloodstream, this could allow monocytes (another type of white blood cell) to attach and then penetrate blood vessel walls. This initiates the accumulation of fatty deposits on vessel walls.

C-Reactive Protein and Inflammation

Another theory revolves around the presence of the C-reactive protein (CRP) which increases during whole-body inflammation. It is also an accurate indication/predictor of a person’s risk of a heart attack. Patients who have moderate to advanced periodontal disease also have high levels of CRP. Their CRP levels significantly reduced when their periodontitis was treated. This has led researchers at Harvard University to conclude advanced periodontal disease increases the risk of cardiovascular disease.

Ultimately, most theories boil down to the fact that the bacteria involved in periodontitis could enter the blood stream and travel to the heart, causing inflammation and damage. This could lead to endocarditis (an infection of the inner lining of the heart), atherosclerosis (clogged arteries), other cardiovascular conditions, or a stroke.

The Bottom Line

There are a lot of contributing factors towards heart disease apart from oral health. Good dental hygiene will not necessarily prevent heart attack or stroke. Nor is there a direct causation link between periodontitis and heart disease. However, the research suggests that there is a correlation. Chronic gum disease is associated with an increased risk of developing heart disease or experiencing a stroke. So it is highly recommended you look after your dental health (especially if you are already at risk).

In part 2, we will be looking at how to identify periodontal disease and any preventative measures that can be taken.