Dr. Christopher Kosenske prepares to extract Betsy Torres Ortiz’s tooth at Penn State Health St. Joseph Medical Center’s dental clinic.
Will going to the dentist eliminate the need to go to the heart surgeon?
February 7, 2024
Medical science has a lot to say about how what we put in our mouths affects our cardiovascular health. Fatty and sugary foods, tobacco and alcohol have been on most wanted posters in cardiologists’ offices for decades now.
But what about the mouth itself?
“There’s definitely an association,” says Dr. Andrew Waxler, a cardiologist at Berks Cardiology, a Penn State Health Group. In fact, people with untreated dental infections are 2.7 times more likely to develop cardiovascular disease, such as coronary artery disease, than people with healthy mouths, according to a 2016 study in the Journal of Dental Research.
But the exact relationship between oral health and heart health remains a mystery.
Heart valve connections
Scientists have known about the link between oral health and certain types of heart disease for some time, Waxler said.
“We’ve known for years that people who have infections in their mouths, such as tooth decay or other problems, are at higher risk for a condition called endocarditis,” he says, “which is another way of saying infection of the heart valves.”
The valves are tiny plugs in the heart that allow blood to flow between the ventricles without backing up. An infection can cause a variety of symptoms, including shortness of breath and chest pain, and can be life-threatening. Mild cases of endocarditis can be treated with intravenous antibiotics, but in some cases surgery may be required.
Can a toothache become infected?
“You can get strep from your mouth, which can get into your bloodstream, travel down and attach to the valve and cause an infection,” Waxler says.
Can dental problems cause a heart attack?
Modern medicine has discovered that people with dental problems are at significantly higher risk of developing problems with their arteries as well as heart valves. There appears to be a link between infections in the mouth and hardening of the highways that carry oxygen-rich blood to vital organs.
Atherosclerosis is the buildup of fatty substances inside the walls of blood vessels, clogging them and eventually causing a heart attack.
Incidentally, the material that blocks arteries is called plaque, but it’s a completely different kind of material than what gets on your teeth and causes cavities, Waxler said. Eating lots of sugary foods can lead to heart disease, but it’s not the number one risk factor for heart disease, Waxler said.
So what’s the connection between tooth decay and clogged arteries? Doctors aren’t sure yet, but they have some theories, Waxler says.
Theory 1: Bacteria Bacteria that infect the gums and teeth (often streptococcus but can be other types) can find their way into the bloodstream and the walls of arteries.
Autopsies of people who died of heart attacks have found DNA from various types of oral bacteria in the walls of their blood vessels.
Theory 2: Inflammation. For example, if you have a chronic infection in your gums, related chronic inflammation may appear elsewhere.
Research over the past 30 years has shown that people with high levels of inflammation in the body are more likely to suffer heart attacks and strokes. It’s believed that an infection in the mouth triggers an inflammatory response in the body. In response, the immune system becomes overly aggressive, and the inflammation caused by that response leads to hardening of the arteries.
“To me, this actually makes more sense than bacteria,” Waxler said.
Theory 3: It was a coincidence. People who neglect their teeth are more likely to have bad habits that lead to heart disease. In this case, the artery problems have nothing to do with bacteria or inflammation at all. The connection between dental health and heart health is that people with severe dental problems are likely to smoke or eat unhealthy foods.
What you can do
“If I decided to go to the dentist every three months and have the most beautiful mouth in the world, would that be good for my heart?” Waxler asked. “I don’t think anybody knows the answer to that.”
Doctors are sure about the big five: diabetes, smoking, high cholesterol, high blood pressure, and a family history of heart disease are all risk factors for heart disease. If you want to prevent heart disease, there are a few other causes to consider before worrying about your teeth.
What would Waxler say to a patient who worries that their teeth might one day rip their heart out?
“I would recommend going to the dentist at least once a year, ideally once every six months,” Waxler says. “Brush your teeth, floss your teeth. There’s a direct correlation. I don’t know why, but it can’t hurt, right?”
Waxler can be heard discussing these health issues on the Berks County Medical Association radio show, “Health Talk.” WEEU-AM830The show airs on the first Wednesday of every month at 6pm.
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