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April 2008 Issue

This photo shows healthy gums and the gums of someone with periodontal, or gum, disease. Research has shown gum disease can contribute to heart problems.
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Not Flossing Can Hurt Your Teeth—and Heart

By Katie Pence
Published April 2008

You’ve heard it from your dentist since your very first teeth cleaning and checkup: brush twice a day and don’t forget to floss.

But this advice may contribute more to your health than a mouth full of cavity-free teeth, according to cardiologists at UC.

Neal Weintraub, MD, chief of the cardiovascular disease division at UC, says there is research proving a connection between gum disease and cardiovascular disease.

“This information is relatively recent and less well established when compared with other known risk factors for heart disease such as high blood pressure and high cholesterol,” he says.

Gum, or periodontal, disease is a collection of inflammatory diseases affecting the tissues that surround and support the teeth.

Periodontal disease involves progressive loss of the bone around teeth which may lead to loosening and eventual loss of teeth if untreated. It is caused by bacteria that adhere to and grow on tooth surfaces, particularly in areas under the gum line.

Weintraub says that these bacteria can gain access to the bloodstream, triggering inflammation in the body.

“Like with any illness, your body starts to react,” says Weintraub. “When you get the flu, you get a fever, your white blood cell count goes up, etc. With periodontal disease, the level of local inflammation is much less severe and usually not high enough to cause systemic symptoms. 

“However, the chronic, low level of inflammation may be enough to bother the blood vessels and help trigger vascular disease.”

The low level of inflammation is sensed by white blood cells present in atherosclerotic, or hardened, blood vessels, which in turn produce a variety of factors that may worsen the disease process.

In addition, there is some evidence that periodontal bacteria
can attach to the fatty plaques in blood vessels, amplifying the inflammatory process, which can lead to heart attack or stroke. 

The latter mechanism is similar to periodontal bacteria attaching to heart valves, which can lead to a serious infection of the heart lining known as endocarditis.

Heart disease is caused by the thickening of the walls of the coronary arteries.

Weintraub says that patients with periodontal disease typically have elevated C-reactive protein (CRP) levels, an independent risk predictor of cardiovascular disease. CRP is a blood test that detects the level of inflammation in the body.

But Weintraub says it isn’t just bacteria in your mouth that can hurt your heart.

Simple illnesses such as a cold or the flu can significantly increase the risk of heart attacks and stroke in susceptible individuals.

“During the course of acute respiratory track infections in elderly patients, the risk of suffering a heart attack is up to four-fold higher than usual,” Weintraub says, noting that he encourages his patients to get an annual flu shot. 

In addition, he advises them to pay attention to suspicious symptoms that may signal heart disease, such as chest tightness or excessive shortness of breath, occurring during respiratory track infections.

He says that although the flu vaccine was not as effective this year, due to problems with formulation, people should not disregard its ability to prevent infection.

“The flu vaccine has and will continue to save many lives in the future,” he says. “There are many illnesses that may seem unrelated but that truly impact the function and health of the heart,” he says.

“The best resolution is to be aware of your health risks and to take the proper precautions to ensure healthy living.

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