Tooth-brushing one’s way to a healthier heart

Earlier this week, I had the privilege to speak before members of the Philippine Dental Association (PDA), upon the invitation of my good dentist-friends—Doctors Cora Flores, who’s the current PDA president; Nannette Vergel de Dios and Agnes Claros.

My topic during the convention was about emerging scientific data linking poor oral or dental health with cardiovascular disease (CVD). It may seem a little far-fetched but indeed, accumulating research data are starting to point in that direction that people with poor oral health have a higher risk of developing CVD. This can possibly explain why the CVD-causing process, or the progressive narrowing of the arteries of the body, actually start even as early as the first decade of life, when dental caries can also be prevalent. This may serve as a good motivation to brush and floss one’s teeth more regularly.

Possible strong link

Medical and dental researchers are intrigued by this possible strong link between oral health and CVD, and they continue to investigate this relationship, which many dental experts say are not due to chance. Those with  bad teeth and gums have been shown to have a higher risk to develop heart attacks and strokes; and if they do, they’re likely to die more from these cardiovascular complications.

The hypothesis is that CVD and chronic periodontal problems share the same risk factors—diabetes, smoking, obesity and overall unhealthy lifestyle. They also share a similar mechanism—which is a slow, insidious inflammatory process which might be  caused by a common bacteria that has not been identified yet. Yes, atherosclerosis is believed to be an infectious process caused by bacteria.

It is now well established that atherosclerosis is an insidious inflammatory or swelling process involving the fine inner lining of the arteries called endothelium. The process is slow but progressive; and eventually, it occludes the arteries and causes heart attacks, strokes, leg gangrene and other serious complications of CVD.

A common inflammatory marker of CVD and those with significant periodontal disease is high-sensitivity C-reactive protein (hs-CRP), which one can now determine by a simple blood test which can be done in many modern medical centers in the country. Individuals with high hs-CRP are said to be at risk of developing a serious cardiovascular event like  heart attack, stroke and even sudden cardiac death.

Many lives have been saved, forewarned by an elevated hs-CRP; when they thought they were in the pink of health, they would realize they had uncontrolled, potentially life-threatening cardiovascular risk factors which made them  walking time bombs. Well, that’s another topic we can talk about in a later column.

There are some studies which would suggest that bacteria in the mouth that are involved in the development of periodontal disease can reach the bloodstream and cause an elevation in hs-CRP.

Whether there’s a causal relationship, or a common etiology for periodontal disease and CVD, the data are still insufficient to draw any definite conclusions. However, the data are already of such volume that we cannot ignore them anymore. There appears to be a direct linear relationship, such that the more severe the periodontal disease is, the more severe the CVD is likely to be.

Strong link

In a study done in a Scottish population, it has also been demonstrated that even a simple tooth-brushing behavior shows a strong link to the development of heart attacks and strokes. People surveyed with the poorest oral hygiene (those who rarely or never brushed) had the worst cardiovascular outcomes.

The data are getting stronger, but we still need more studies with more stringent research designs eliminating other possible confounding variables or risk factors which could also be contributory to the development of CVD or its complications.

From where we stand at the moment, though, it seems the smoke is getting too thick not to believe there’s fire underneath. It is quite clear that regardless of the relationship or lack of it between periodontal disease and CVD, maintaining optimal oral hygiene is an essential part of maintaining overall systemic health.