Every month is heart month. We need constant reminders that cardiovascular disease is still the #1 cause of death in the Western world. Educating the public on the research showing that up to 80% of heart deaths are preventable by not smoking, eating a plant heavy diet, and obtaining regular fitness is always of importance. Although not a new concept, the link between oral care and heart care is stronger than ever. Indeed, when you brush and floss your teeth, you might consider it to be brushing and flossing your heart!
Scientific data linking heart and oral health has been coming from researchers in Korea and around the globe.
1) In a massive study published in late 2018, the National Health Screening Cohort (NHIS-HEALS), the only insurance provider in Korea, reported on an oral health screening program provided to participant. Data of 247,696 healthy adults were used for an analysis. During follow up of nearly 10 years, there were cardiovascular (CV) events in 14,893 study participants. The key findings of this data were that:
The self-reported questionnaires suggested that about 30% of participants had periodontal disease, 20% at least one dental caries, and 25% had lost one or more teeth.
Toothbrushing was done at least three times per day by 40% of participants, twice by 45% and once or less by 15%. Also, 26% of participants reported dental visits for professional cleaning at least once a year.
Survival curves time free of CV events showed that better oral health behaviors were associated with fewer CV events. The opposite was the case for different oral disease conditions in a dose-dependent manner.
In multivariable analysis, the number of missing teeth and dental caries were significantly associated with CV events.
Tooth brushing and professional cleaning were still significantly associated with CV events after adjustment. Brushing one more time a day was associated with a 9% lower risk of CV events and regular professional cleaning lowered the risk by 14%.
Frequent toothbrushing and regular professional cleaning were associated with better CV outcomes even in those with poor oral conditions. The benefit of tooth brushing was, however, more evident in the absence of periodontal disease and at a low number of dental caries. The benefit of tooth brushing showed no significant interaction with the number of teeth lost. Similarly, the benefit of professional cleaning was consistent in all oral conditions.
2) Poor oral hygiene can provoke transient bacteremia and systemic inflammation, a mediator of atrial fibrillation and heart failure. Therefore, Korean investigators published a study investigating the association of oral hygiene indicators with atrial fibrillation and heart failure risk. They included 161,286 subjects from the National Health Insurance System-Health Screening Cohort who had no missing data for demographics, past history, or laboratory findings.
During median follow-up of over 10 years, there were 4,911 (3%) cases of atrial fibrillation and 7,971 (5%) cases of heart failure (HF). In multivariate analysis after adjusting age, sex, socioeconomic status, regular exercise, alcohol consumption, body mass index, hypertension, diabetes, dyslipidemia, current smoking, renal disease, history of cancer, systolic blood pressure, blood and urine laboratory findings, frequent tooth brushing (≥3 times/day) was significantly associated with attenuated risk of atrial fibrillation (risk reduced 10%) and HF (risk reduced 12%). Professional dental cleaning was negatively, while number of missing teeth ≥22 was positively associated with risk of heart failure. The overall conclusion was that improved oral hygiene care was associated with decreased risk of atrial fibrillation and heart failure. Healthier oral hygiene by frequent tooth brushing and professional dental cleaning may reduce risk of atrial fibrillation and heart failure.
3) An international group of researchers published a provocative study linking oral health and the risk of Alzheimer’s Disease. Porphyromonas gingivalis (PG), the keystone pathogen in chronic periodontitis, was identified in the brain of Alzheimer’s disease patients. Oral PG infection in mice resulted in brain colonization and increased production of Aβ1–42, a component of amyloid plaques. The investigators commented that the bacteria were not causing Alzheimer´s alone, but the presence of these bacteria raise the risk for developing the disease substantially and are also implicated in a more rapid progression of the disease. They advised that regular oral hygiene was a protective strategy and that regular cleanings were advised. Furthermore, it is possible to measure the presence and quantity of PG in the mouth and take steps with a trained dental professional to minimize its growth.
Be sure not to smoke, schedule some exercise daily, and eat a plant diet of whole foods. In addition, consider your mouth as an extension of your cardiovascular system. Every time you remember to brush, floss, and water cleanse your teeth you have practiced a science based way to prevent heart disease, and perhaps, brain disease. The discipline of excellent oral health can be considered an act of brushing and flossing your heart and brain.