Clean teeth protect your heart
17 February 2005
by BUPA's Health information team
Taking good care of your teeth and gums could prevent you from having a
stroke or heart attack, according to a study published in 8 February 2005
edition of the journal Circulation.1
What did the study find?
The study found a strong link between gum disease and narrowing of the
arteries (a process known as atherosclerosis), which can lead to heart
attacks and stroke.
What is gum disease?
Teeth are covered by sticky plaque, made up of food, bacteria and bacterial
waste products. If plaque is left on the teeth the gums become irritated and
may bleed when you brush. This early stage of gum disease is called
If gum disease is not treated, the gums may swell, forming a little pocket
around the tooth. Plaque collects in this and cannot be removed by a
toothbrush. When plaque is left on the teeth it may harden to form tartar
As time goes on the pockets get deeper, trap even more plaque and tartar and
may become infected. Over time gingivitis can develop into chronic (long
term) periodontitis, in which the jaw bone can become infected and damaged,
causing teeth to loosen or fall out.3
What is heart disease?
Atherosclerosis is when the arteries become narrow and damaged. It happens
when the arteries are clogged up with fatty deposits or the walls of the
arteries become inflamed.
This narrowing can happen in the arteries that supply blood to the heart,
depriving it of the oxygen and nutrients it needs to work normally. When the
blood flow through an artery is stopped, a heart attack can occur.4
Arteries supplying blood to the brain can also be affected by
atherosclerosis. If a blood clot becomes lodged in a narrowed artery, blood
flow to part of the brain may be stopped. This is called a stroke.
What did the researchers look for?
To measure whether or not gum disease is associated with an increased risk
of developing atherosclerosis, the researchers tested people for 11 bacteria
that cause gum disease.
They also tested each person for three factors that point to the development
- the thickness of the walls of the
carotid artery, a major blood vessel in the neck that carries blood from
the heart to the brain (the thickness of the wall is a measure of how
clogged up the artery is)
- the number of white blood cells in
the blood (raised levels are associated with increased risk of
- the amount of a protein, called
C-reactive protein, in the blood (this protein is found in higher levels
when there is inflammation of the blood vessels and is a good indicator
that atherosclerosis may develop in the future)6
What did the researchers find?
The study looked at 657 people who had no history of heart attack or stroke.
It found that those people who had higher levels of the 11 types of bacteria
that cause gum disease also had:
- increased carotid artery wall
- raised white blood cell levels
However, the researchers found that
the level of bacteria that cause gum disease was not linked to levels of
C-reactive protein in the blood.1
The researchers also discovered that these links existed only for gum
disease causing bacteria and not for all the other bacteria that can live in
What does this mean?
The researchers suggest that the results mean that people who have gum
disease may be at a greater risk of developing atherosclerosis and heart
Although the study suggests a link between gum disease and heart disease, it
does not prove that gum disease actually causes heart disease.
Why might gum disease be linked to heart disease?
Studies in the past have suggested that the bacteria that cause gum disease
may increase the rate at which arteries become blocked.1
The researchers believe that bacteria can leave people's infected gums and
enter the bloodstream, activating the immune system (the body's defence
mechanism) and making their artery walls inflamed and narrowed.7
Another theory is that the bacteria enter the blood and attach themselves
directly to the fatty deposits that are already present in a person's
arteries, causing further narrowing.4
Could the increase in the risk of heart disease be due to a different
Other lifestyle factors are known to increase the risk of heart disease, and
they are often associated with poor dental health as well. For example:
- poor diet
- low income
Some experts do not believe that the
bacteria that cause gum disease are really responsible for increasing heart
disease risk. Instead, they argue that the gum disease is due to smoking,
poor diet or low income and that it is these factors that are also
increasing the heart disease risk.
In an attempt to answer this argument, the researchers in this study
adjusted their results to take the following factors into account:1
- body mass index
- blood pressure
- cholesterol levels
Even after they had adjusted their
results to remove the effects of all these factors, the researchers found
that the presence of gum disease causing bacteria was still associated with
an increased risk of heart disease.1
How can you prevent gum disease?
The best way to prevent gum disease is to maintain good oral hygiene. This
means brushing your teeth twice a day with a fluoride toothpaste and
regularly visiting your dentist or hygienist (see below).2
Brushing is the most effective way of removing plaque and preventing the
build up of bacteria. The following tips will help you to get the most out
of your brushing routine:3
- brush your teeth at least twice a
- use a fluoride toothpaste to
provide protection against decay
- use a toothbrush that's small
enough to reach all around your mouth, with soft or medium synthetic
- use a gentle circular action and
brush all the tooth surfaces thoroughly
For more on looking after your teeth,
please see our fact sheet:
Caring for your teeth
How often should you go to your dentist?
Even thorough brushing and flossing cannot remove every trace of plaque, so
your dentist needs to check your teeth regularly and remove any tartar build
up. Your dentist will advise you how often to visit.3
What are the signs that you have gum disease?
Normally, gums are pink and healthy looking. When you have gum disease your
gums may be red and swollen, although sometimes they may look normal.2
Sometimes the only sign of gum disease is bleeding gums when brushing. If
you find that your gums are bleeding when you brush, it is vital that you
clean them more thoroughly, not less. Make sure that you clean every surface
of the tooth and use dental floss or interdental brushes to clean in between
How is gum disease treated?
Gum disease treatment aims to remove plaque and make it as difficult as
possible for it to reform. With mild gum disease, more careful brushing and
flossing may cure the problem without need for further treatment.
However, once a hard layer of tartar has formed, you cannot remove it
yourself. Your dentist or hygienist needs to remove it with a specialist
scaling tool. He or she will also polish your teeth's surfaces to make it
harder for bacteria to attach themselves. Your dentist may recommend an
antiseptic mouthwash to control plaque levels in the short term but these
are not used for longer than one month.2
If the infection has developed into periodontitis and deep pockets have
formed that are affecting the support of the tooth, your dentist or
hygienist will need to clean these regularly. It may be necessary to visit
your dentist as often as every two months. Your dentist may also carry out
root planning (removal of infected base around the root).2
- Desvarieux M, Demmer RT, Rundek T
et al. Periodontal microbiota and carotid intima-media thickness: The oral
infections and vascular disease epidemiology study (INVEST). Circulation
- NHS Direct Online Health
Encyclopaedia: Gum disease.
- British Dental Association: Smile.
- American Academy of Periodontology.
Factsheet: Heart Disease and Stroke.
- Chong DL, Folsom AR, Nieto FJ et
al. White blood cell count and incidence of coronary heart disease and
ischemic stroke and mortality from cardiovascular disease in
African-American and white men and women: atherosclerosis risk in
communities study. Am J Epidemiol 2001;154(8):758-764.
- American Heart Association.
Inflammation, heart disease and stroke: the role of C-reactive protein.
- Columbia University press release:
Columbia study suggests brushing your teeth may reduce risk of stroke and