Published on April 12, 2019

Can your toothbrush help you heart health?Can your toothbrush help you heart health?

How closely tied are your dental and heart health? Maybe closer than you think.

In a report published recently, the American Heart Association says that if you don’t practice good dental hygiene, you may have a higher risk of cardiac disease. Researchers questioned 682 people about their tooth brushing behavior. After adjusting for other factors, they discovered that those in the study who brushed their teeth for less than two minutes twice a day had a three-fold increase in risk compared to those who brushed for the allotted time.

The study’s lead researcher, Dr. Shogo Matsui, said the findings suggest “poor oral health, based on daily teeth-brushing behavior, is associated with” poorer heart health.

Reactions to this hypothesis have been mixed because different studies draw different conclusions. Some studies show that bad tooth brushing habits are linked to heart disease. Other studies show that the link is only present if another poor health habit, especially smoking, is also present.

Cardiologist Lawrence McAuliffe, MD, of Cape Cod Healthcare Cardiovascular Center in Hyannis said it is a question that goes back many years. There are two things people should consider when thinking about how their dental health may affect cardiovascular events, he said.

“The easy one is for patients who have valvular heart disease and, most specifically, those who have had valve replacement surgery and for some who have severe/critical aortic stenosis,” he said. “These are disorders of the valves that cause them to be less mobile than they should be and they build up with calcium and other plaques in nooks and crannies where, if bacteria landed, they could set up shop and then create an infection.”

In years past, cardiologists would tell all patients with various cardiac conditions to take antibiotics before going to the dentist. Those recommendations have changed to include only patients who have ever had an infection of their heart valve or who have a prosthesis in their heart like an aortic valve, a mitral valve or other hardware, he said. Those types of valves are foreign bodies where bacteria can land and cause problems.

Poor Company

“The more interesting question that was raised by the American Heart Association article is whether or not dental hygiene or lack thereof plays a role in the development of cardiovascular disease,” said Dr. McAuliffe. “In that case, you can’t connect the two dots directly, other than by asking the question what kind of company does poor oral hygiene travel with?”

For example, are people who neglect their teeth also not living a heart healthy lifestyle? Are they obese or do they smoke? The association between the dental health and heart health may be as simple as the fact that there are other comorbidities that go hand in hand with gingivitis, he said.

“One likely and plausible physiological thesis is that it’s all part of the generalized systematic inflammatory state,” he said. “We ask patients if they’ve ever had gout or rheumatoid arthritis because there does appear to be a systemic inflammatory condition that can also cause inflammation of blood vessels. Inflammation of blood vessels is what causes microscopic damage and then plaque damage and eventually you develop a narrowing of the vessel.”

Even though the studies are intriguing, cardiologists are not ready to add poor dental hygiene to their list of known cardiovascular risk factors quite yet. While there is an association, there is not cause and effect proof. That said, there are certainly compelling reasons to practice good oral hygiene that includes brushing your teeth twice a day for at least two minutes, flossing every day and regularly visiting the dentist. If you do those things, you will have a healthier mouth and probably a healthier body, according to Dr. McAuliffe.

“It’s not a direct relationship but enough of one to make sure that primary care doctors, internists and cardiologists think about it and ask their patients questions about their dental hygiene and emphasize good practices.”