They say that you can tell a lot by a person’s smile. Are you warm, sincere, comfortable, uncomfortable? The context of a smile can be an insightful nonverbal cue, but there’s more. Scientists also believe that our mouths are a good indicator of our general health — specifically, our heart health.
Studies show clear links between oral health and risk factors for heart disease.
In 2000, the first Surgeon General’s Report on oral health, Oral Health in America, not only explained the connection between oral health and heart health, but also emphasized that oral health extends beyond healthy teeth.
It has been estimated that around half of Americans have a mild to moderate form of gum disease, known as periodontitis (PD). This is when the accumulation of bacteria leads to inflammation of the connective tissue and bones that support the teeth. Chronic inflammation has been linked with increased risk of heart disease. This means we are left with a modifiable risk factor for heart health, and we are in a position to do something about it.
“The first stage of periodontal disease (gum disease) is gingivitis, indicated by bleeding gums,” explains Dr. David Roach, dentist and owner at Roach Family Dentistry in Nashville. “Untreated gingivitis exacerbates into periodontitis, a chronic inflammatory disease caused by the body’s immune response to plaque and calculus accumulation on teeth. Therefore, home hygiene practices that remove this dental plaque, along with frequent dental hygiene appointments, are vital to preventing this inflammatory process.”
“Research has shown connections between periodontal disease and a multitude of systemic conditions … cardiovascular disease, diabetes, arthritis, stroke, and adverse pregnancy outcomes,” adds Dr. Roach.
Periodontitis has also been linked to another type of inflammation that can lead to high blood pressure and the hardening and thickening of arteries due to plaque accumulation. In fact, several studies conducted between 2003 and 2018 showed that the prevalence of high blood pressure was higher in adults with a diagnosis of PD. Studies also showed that improvements in oral health led to improvements in blood pressure.
Another study published 11 years ago examined the effect of treating PD in diabetic patients. Diabetes is a chronic and major global health issue, and growing evidence has suggested that periodontal treatment may affect blood sugar in diabetic patients.
Ever felt a flutter in your chest? Yet another 2016 study concluded that there is an increased risk of atrial fibrillation or flutter in patients with PD. Systemic inflammation, such as bacteria and inflammatory components entering the bloodstream, increases the risk of developing this heart condition.
Dentists can be the first to detect bigger health issues.
The American Heart Association (AHA) has been researching the connection between oral and heart health through its Healthy Smiles, Healthy Hearts initiative, in collaboration with Delta Dental of California. They aimed to establish a standard of care that allows heart health screenings to be conducted in an oral healthcare setting.
They based this on statistical data from 2019. Overall, about 46% of Americans visit a dental care provider at least once a year. The most interesting finding, in terms of connecting oral and heart health, was that around 9% of the 2019 population had a dental visit, but no medical visit.
This presents oral health professionals with an opportunity and a duty not only to care for their patients, but also to introduce practices and standards for the early detection of related diseases. This is especially important when the visit may be the only time the patient encounters a health professional, or one of the two times the patient seeks medical attention in a year.
“The oral cavity can be one of the first presentations of an underlying health condition,” says Dr. Alex Miller of Miller Family Dentistry, also located in Nashville. “Something simple like acid reflux can, a lot of times, be noticed by a dentist due to changes in the surfaces of the teeth from increased acidity eroding the enamel away. Something more severe, like Leukemia, can present itself in how a person’s gums look.”
Why are so many of us neglecting our oral health?
With connections that are so well documented, why does oral health continue to be underrated? The answer is multifaceted. Many people find it easy to ignore oral problems, viewing bleeding gums or inflammation as minor issues.
Some oral problems do not cause immediate pain — cavities, for example, will only start to hurt once decay reaches the root of the tooth. The mouth is also less visible than, say, our skin, and few of us stand in front of a mirror examining our teeth and gums.
This (along with the fact that many feel scared or uncomfortable visiting the dentist) makes these visits fall lower down on the priority list. And specifically in the US, prohibitive or unknown costs can be a significant deterrent for those who don’t have dental insurance.
Focus on good dental hygiene habits.
So, what can we do? Unsurprisingly, good oral health habits are key.
“Staying away from consistent consumption of very sugary food and drinks and things with high acidity is the single biggest thing that I would say,” says Dr. Miller. “I’d rather you drink a large Coke in a short amount of time, then brush your teeth, rather than sipping on that same drink for hours throughout the day, essentially coating your teeth in sugar.”
Here are more rules of thumb to follow for optimal oral health:
- Brush your teeth twice daily for two minutes, including after your last meal, drink, or snack, and before bed. Never brush right after eating — wait at least twenty minutes.
- Use an electric toothbrush or brush your teeth in gentle, circular motions (not too soft, and not too hard!)
- Gently brush your tongue every time you brush your teeth (plaque can build on the tongue, too).
- Don’t use whitening toothpastes on a long-term basis if your teeth or gums are sensitive.
- Floss daily to remove food and plaque between the teeth — but choose the method that works best for your mouth. Some may prefer interdental brushes or a water flosser.
- Consider using a mouthwash, but don’t use it immediately after brushing, as it can remove beneficial ingredients from your toothpaste. Instead, use it at another time during the day after eating.
- Stay hydrated to prevent your mouth from getting dry. Chew sugar-free gum if you suffer from frequent dry mouth.
- Limit sugary and acidic foods. As you reduce sugar intake, you will also alter your mouth bacteria and microbiome.
- Visit your dentist at least once a year!
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