Gum disease and the connection to heart disease

For me, it’s been one of the more surprising observations in recent
years: study after study has shown that people who have poor oral health
(such as gum disease or tooth loss) have higher rates of cardiovascular
problems such as heart attack or stroke than people with good oral
health.Why would cardiovascular disease and poor oral health be connected?A number of theories have been proposed, including:

The bacteria that infect the gums and cause gingivitis and
periodontitis also travel to blood vessels elsewhere in the body where
they cause blood vessel inflammation and damage; tiny blood clots, heart
attack and stroke may follow. Supporting this idea is the finding of
remnants of oral bacteria within atherosclerotic blood vessels far from
the mouth. Then again, antibiotic treatment has not proven effective at
reducing cardiovascular risk.Rather than bacteria causing the problem, it’s the body’s immune response – inflammation – that sets off a cascade of vascular damage throughout the body, including the heart and brain.There may be no direct connection between gum disease and
cardiovascular disease; the reason they may occur together is that there
is a 3^rd factor (such as smoking) that’s a risk factor for both conditions. Other potential “confounders” include genetic contributions to both disorders,
poor include poor access to healthcare and lack of exercise – perhaps
people without health insurance or who don’t take good care of their
overall health are more likely to have poor oral health and heart
disease.

A study published in 2018
is among the largest to look at this question. Researchers analyzed
data from nearly a million people who experienced more than 65,000
cardiovascular events (including heart attack) and found that:

After accounting for age, there was a moderate correlation
between tooth loss (a measure of poor oral health) and coronary heart
disease.When smoking status was considered, the connection between tooth loss and cardiovascular disease largely disappeared

This study suggests that poor oral health does not directly
cause cardiovascular disease. But if that’s true, how do we explain
other studies that found a connection even after accounting for smoking
and other cardiovascular risk factors?It’s rare that a single study definitively answers a question
that has been pondered by researchers for decades. So, we’ll probably
need additional studies to sort this out.But wait, there’s more!The connection between poor oral health and overall health may not be limited to cardiovascular disease. Studies
have linked periodontal disease (especially if due to infection with a
bacterium called porphyromonas gingivalis) and rheumatoid arthritis. In
addition, several studies have found a link between this same bacterium and risk of pancreatic cancer.
However, as in the case of the connection with heart disease, an
“association” is not the same as causation; we’ll need additional
research to figure out the importance of these observations.The bottom lineWhether the link is direct, indirect or coincidence, a
healthy mouth and a regimen to keep it that way (including not smoking,
and getting regular dental care) can help you keep your teeth. That’s
reason enough to do what you can to make oral health a priority. Perhaps
it will turn out to have other benefits though much of that remains
speculative.