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Preventing cardiovascular disease could start with good toothbrushing

Date: July 2021

Author: Natalie Bradley BDS Dip SCD MFDS RCSEd

The mouth is the gateway to the body and good toothbrushing could help reduce the risk of specific health conditions, such as cardiovascular disease. There is gathering evidence that periodontitis is a risk factor linked to diseases such as stroke and heart attacks.

What is cardiovascular disease and how is it linked to the mouth?

Cardiovascular diseases are a leading cause of death and disability. They include:

    1. Coronary heart disease - myocardial infarction (heart attack); angina.

    2. Ischemic cerebrovascular disease - stroke or mini-stroke (transient ischemic attack or TIA).

    3. Peripheral vascular disease - atherosclerosis.

Periodontitis has been shown to increase the risk of a first heart attack or stroke, independent of other known cardiovascular risk factors. The explanation regarded as the most likely for this relationship is that periodontal bacteria, together with their products, such as endotoxin from periodontal pockets enter the circulation and then cause an inflammatory response. According to the European Federation of Periodontists, part of this host response involves the production of mediators that promote arterial fatty lesions (atheroma) development. This elevates the risk of cardiovascular events. Bacteraemias following chewing, brushing or scaling occur in individuals with periodontal disease more commonly than in individuals with healthy mouths. After entering the blood stream, these bacteria can colonize atheromas, further elevating risk. Periodontal treatment reduces the overall level of inflammation (such as levels of C-reactive protein) within the circulation and reduces arterial blood pressure which can reduce risk of cardiovascular events.

How can we prevent periodontal disease?

It is important to assess every patient for their risk for periodontal disease which can inform your prevention messages, treatments and recall intervals. The American Academy of Periodontology lists the following as risk factors for periodontal disease:

  • Presence of plaque
  • Age - older people have higher rates of periodontitis
  • Smoking/tobacco use
  • Genetics - family history of periodontitis
  • Stress
  • Medications -- such as anti-depressants and certain heart medications which can affect oral health
  • Clenching or grinding teeth - speeds up rate at which periodontal tissues are destroyed
  • Other systemic diseases - such as cardiovascular disease or other inflammatory conditions
  • Poor nutrition and obesity

Individuals deemed to be at high risk for periodontal disease should receive intensive oral hygiene advice that includes emphasizing the positive effects of overall health in improving their oral health - including a lower risk for cardiovascular disease. This can include recommendation of Chlorhexidine mouthwash to help reduce plaque and gingivitis, as well as Zinc Citrate 2% toothpaste to help protect periodontal tissues against bacteria associated with gingivitis and progression of periodontal disease.