Dr. Christopher Kosenske prepares to extract a tooth from Betsy Torres Ortiz in the dental office at Penn State St. Joseph Medical Center.
Could a visit to the dentist save you the trouble of a trip to a heart surgeon?
February 7, 2024
The medical community has a lot to say about how the food you put in your mouth affects cardiovascular health. Fatty and sugary foods, cigarettes and alcohol have appeared on wanted posters in cardiologists’ offices for decades.
But what about the mouth itself?
“There is definitely a link,” said Dr. Andrew Waxler, a cardiologist at Penn State Health Berks Cardiology. In fact, according to a 2016 study in the Journal of Dental Research, people with untreated dental infections were 2.7 times more likely to develop cardiovascular problems such as coronary artery disease than those with healthy mouths.
But the exact link between oral health and heart health remains a mystery.
heart valve connection
Waxler said scientists have long known about the link between oral health and a specific type of heart problem.
“We’ve known for years that people who have infections in their mouths, such as cavities and other problems, are at higher risk of developing endocarditis,” he said. “That’s a fancy way of saying a heart valve infection.”
These valves are tiny openings in the heart that help keep blood flowing between the ventricles without backing up. The infection causes a range of symptoms, such as shortness of breath and chest pain, and can be fatal. Mild endocarditis can be treated with intravenous antibiotics, but surgery may be needed in some cases.
Can you get it from a toothache?
“People can get strep from the mouth, which can enter the bloodstream and attach itself down to the valve and cause an infection,” Waxler said.
Can dental problems cause heart attacks?
The medical community has recently discovered that people with dental problems are at a significantly higher risk of not only developing heart valve problems, but also arterial problems. There is a link between oral infections and hardening of the highway system that carries oxygen-rich blood to vital organs.
Arteriosclerosis is the accumulation of fatty material in the walls of blood vessels, causing them to become clogged and ultimately leading to a heart attack.
By the way, the stuff that clogs arteries is called plaque, but it’s nothing like the stuff that coats teeth and causes cavities, Waxler says. Eating lots of sugary foods can still cause heart problems, but that’s not necessarily the case. He said the number one risk factor for heart disease is diabetes.
So what’s the connection between tooth decay and clogged arteries? Waxler said doctors aren’t sure yet, but they have theories.
Theory 1: Bacteria Bacteria that infect gums and teeth (usually Streptococcus but can be other species) can enter the bloodstream and artery walls.
Autopsies of people who died of heart disease revealed the presence of DNA from different species of oral bacteria in the walls of blood vessels.
Theory Two: Inflammation. When people develop chronic infections in areas such as their gums, associated chronic inflammation can develop elsewhere.
Over the past 30 years or so, research has shown that people with higher levels of inflammation in their bodies are more likely to suffer from heart disease and stroke. The idea is that when people get an infection in their mouth, it triggers an inflammatory response in the body. In reacting to it, the immune system can become overly aggressive, and arteriosclerosis is a result of the irritation caused by this response.
“This actually makes more sense to me than bacteria,” Waxler said.
Theory 3: It’s accidental. People who don’t take good care of their teeth are more likely to develop bad habits that lead to heart disease. In this case, any artery problems are not related to bacteria or inflammation. The connection between dental health and heart health is that people with severe dental problems may also smoke or eat foods that are bad for them.
what can you do
“If you decided to go to the dentist every three months and decided you were going to have the cleanest mouth in the world, would that help your heart?” Waxler asked. “I don’t know that anyone can actually find the answer.”
What doctors can determine is 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 many possible culprits you need to consider before worrying about your teeth.
What would Waxler say to a patient who was worried that his teeth might one day bite out his heart?
“I would tell them to go to the dentist at least once a year and preferably every six months,” Waxler said. “Brush your teeth. Floss your teeth. There’s a direct correlation. We don’t know why. But it can’t hurt you, right?”
You can listen to Waxler discuss health issues like this on the Berks County Medical Society’s radio show Health Talk WEEU-AM 830. The show airs on the first Wednesday of every month at 6 p.m.
The Medical Minute is a weekly health news feature produced by Penn State Health. Articles feature the expertise of faculty, physicians, and staff and are designed to provide timely, relevant health information of interest to a broad audience.
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