For the last several years, there has been an active debate about the association between oral health and health in general, especially cardiovascular health. On the surface, it might seem a stretch to relate the two, but a closer look reveals not only a similarity in process for the diseases, but a plausible cause and effect relationship.
There is no argument that gum disease (gingivitis, or its more severe cousin, periodontitis) is an inflammatory disease. It is more likely to occur in people who are overweight, smokers, diabetics, those with high sugar intake and poor diet, and those with poor oral hygiene. Cardiovascular disease is also more common in all of these groups. This, of course, is not surprising as it is now well established that cardiovascular disease is also a disease of inflammation, with rough, inflamed lining of arterial walls leading to sticky spots for blockages to occur. 91% of patients with heart disease have some level of gum disease, compared to 66% of patients without heart disease. Is there an association between the two? Yes, but what researchers aren’t sure about is whether inflammation that is originating in the gums could actually be leading to inflammation that initiates poor cardiovascular health, and the ensuing greater risk for heart attack and stroke. In addition to the commonality of inflammation, some studies also show similar bacterial presence in both regions. A possible transfer of inflammatory by-products or bacteria could come from the bloodstream. Inflammation and infection of the fibrous tissue around the heart itself could also come from a shared fascia (lining) between the neck and the heart.
So, although plausible, we aren’t able to precisely blame bad oral hygiene on increased cardiovascular risk. What we do know is that good oral hygiene is important anyway. According to the CDC, advanced gum disease affects 4-12% of the adult U.S. population (1/2 of these cases involve smoking). One-fourth of U.S. adults over age 65 have lost all of their teeth, as weakened inflamed gums recede over time and can no longer support the root system for the teeth. In other words, we have ample reasons to support our oral health, and if we happen to decrease our chances for later cardiovascular disease, that’s even better. Furthermore, many other diseases have been at least linked to poor oral health, including endocarditis, low-birth weight and premature births, diabetes, osteoporosis, and Alzheimer’s. It is estimated that 40% of people with gum disease have some other chronic illness as well. Again, gum disease might just be a visible symptom of overall inflammation, or a culprit that leads to further disease.
Maintaining good oral health starts with the basics: brush at least twice daily, floss daily, eat a low sugar diet, and don’t smoke. Replace your toothbrush every month or so, and see your dentist regularly. If you have diabetes or pre-diabetes, seek treatment to control sugar levels, as high blood sugar itself leads to increased inflammation everywhere. Good mineral and fat intake is vital for the health of gums and teeth. A good multivitamin or multi-mineral is a good start, and increase vitamin A, D, E, and K with lots of good fats in your diet like olive oil, coconut oil, and avocados (all, of course, good for cardiovascular health as well). If you haven’t already done so, have your Vitamin D levels checked, regardless of how much sun you get, as low levels can lead to poor teeth and gum health. Some medications such as anti-depressants, decongestants, anti-histamines and some diseases themselves can cause dry mouth, which can accelerate gum disease. Be aware of this and speak with your doctor about possible prevention. Fish oil or omega-3s can decrease symptoms of dry mouth for some.
If you have gum disease now, a probiotic or “good bacteria” can be helpful in re-inoculating the mouth with proper flora. Rinsing without swallowing hydrogen peroxide can also decrease bacterial overgrowth around the gums. Drinking green and black tea can decrease some bacterial overgrowth, as can lavender and a handful of herbs which can be found in mouth rinses and toothpastes at natural food stores. Vitamins C and B6 can decrease gum disease and bleeding.
There is another debate in the natural medicine world about fluoride. Flouride in high amounts has been linked to disease and certain cancers. However, most research points to an exposure to high amounts of fluoride, which is probably not going to come from toothpaste that you are not swallowing. Flouride has been linked to decreases in gum disease, so I do recommend it in toothpaste especially if you struggle with your gum health. Do try to get toothpaste without lauryl sulfate (a lathering agent often found in toothpastes, soaps, and shampoos).
Of course, systemic measures to decrease overall inflammation are going to decrease your risk for gum disease and disease in general as well. Remember that nutritionally, a diet lower in animal product, especially red meat and dairy, and lower in simple sugars, is going to lead to less inflammation. Try to limit red meat to once or twice weekly, and dairy to once to twice daily. Keep your blood sugar balanced by greatly moderating intake of sodas, candies, and pastries, and when you do have sugars, including alcohol, make sure that you combine them with a food containing a protein or fiber so that you don’t have a blood-sugar spike after consuming them. A whole foods, low-processed diet is also going to help control blood sugar and decrease general inflammation. Fermented foods and yogurts can give you a daily dose of probiotic to keep your natural flora healthy. Leafy greens with oil and vinegar are the best way to provide absorbable calcium for the health of your teeth and bones.
We may never know whether the relationship between oral health and cardiovascular disease is just an association of commonalities or cause and effect. What we do know is that controlling health issues including bacterial overgrowth and inflammation can decrease the likelihood of both, along with many other diseases, so at the end of the day, I’m not sure it matters. Eat well, live well, and take care of your body, including your teeth and gums, for a long and healthy life.
Stay healthy & be well!
– Amy Whittington, NMD