The jury’s still out, but studies are pointing to a link between gum disease and the state of your heart

Portrait of Tammy Strobel

The jury’s still out, but studies are pointing to a link between gum disease and the state of your heart

The past few years have seen considerable hype on the connection between gum health and heart disease. Many scientific studies have shown significant correlations, but not everyone is convinced. Here’s what you should know.

The research

In 2016, a Swedish study examined 805 patients under the age of 75 who had suffered their first acute myocardial infarction (AMI), also known as a heart attack. The study also examined 805 matched controls who had no history of heart problems. Gum disease was more common in patients who had had a heart attack than in the control group. In fact, the study concluded that there was a 49 per cent increased risk of AMI among the patients with periodontitis (gum disease). Even after the researchers made adjustments for other variables, such as smoking, the risk remained significantly higher at 29 per cent.

While statistics like these may have you heading straight to your dentist in the hope of fixing your heart, it’s not as simple as that. In 2017, Chinese researchers looked at 22 research studies into the link between gum disease and heart disease. Across the 22 studies, results from a total of 129,630 participants were analysed.

The expert viewpoint

While the research showed gum disease is associated with an increased risk of future heart disease, a causative relationship between the two could not be established.

Dr Fritz Heitz, President of the Australian Society of Periodontology, agrees. Dr Heitz argues that just because there are statistical correlations between the two diseases, it does not mean periodontitis causes heart disease or vice versa. Neither does it mean that fixing one disease will fix the other.

“Going to your dentist or a periodontist won’t fix your heart problems,” says Dr Heitz.

The commonalities

Singapore dentist Dr Hemalatha Nathan says that while research may show an association between gum disease and heart disease, the nature of the link is not clear – besides the fact that they have shared symptoms. “It has also been established that a similar anti-inflammatory response occurs in CVD (cardiovascular disease) where some of the raised markers seen in the blood are similar to the ones that occur when one has periodontal disease,” she says. “These raised markers, which form part of the immune response of the individual may end up causing harm to various parts of the body in their effort to protect the host. Therefore, both these disease conditions seem to display a similar inflammatory response and the raised markers for one disease may also bring on the onset or progression of the other disease,” she says.

The trigger and response

Some scientists say the two diseases are caused by the same bacteria, and that the bacteria which leads to inflammation in the gums can enter the bloodstream and move to parts of the circulatory system.

“Periodontal disease is now believed to be the result of the response of the body (host) to the onslaught of bad bacteria or bacterial products (toxins) found in plaque (a biofilm that tends to coat and grow on oral structures like the teeth, tongue or even dentures if present),” says Dr Nathan.

This is when the “host’s” immune system takes charge. It increases the blood flow to the affected areas in the mouth in a bid to raise the level of antibacterial markers to fight the infection, says Dr Nathan. “This inflammatory response could also result in a disruption in the integrity of the tissues supporting the teeth, allowing the bacteria and bacterial products to directly enter the blood stream and affect other organs in the body.”

Supporting this idea is the discovery of oral bacteria in the fatty deposits of some people with atherosclerosis.

The safety measures

So while experts like Dr Heitz say going to a periodontist won’t fix your heart problems, some studies show that periodontal therapy can reduce the amount of markers of systemic inflammation. A consensus report in the American Journal of Cardiology added that those with moderate to severe periodontitis should be told of a possible increased risk of cardiovascular disease.

Besides, the two diseases have similar risk factors such as age, smoking, obesity, diabetes, nutrition and diet, and exercise, says Dr Nathan. So it is imperative that patients reveal their full medical history to their oral healthcare practitioner and go for regular check-ups so that preventive measures can be put into place. She also emphasises that physicians and oral health care practitioners should communicate with each other when necessary.

While there is no definitive study showing a casual relationship between the two diseases, it’s crucial to prevent gum disease for no other reason than to prevent tooth loss.