The Link Between Oral Hygiene and Cardiovascular Disease

Does periodontal disease increase the risk of cardiovascular disease?

Current evidence suggests: yes. In 2019, the Journal of Clinical Periodontology published a scientific consensus report on periodontitis and cardiovascular diseases (CVD). This report reviewed a large body of scientific evidence on the subject and concluded that patients with periodontal diseases also have a higher:

• Prevalence of subclinical cardiovascular disease
• Prevalence of coronary artery disease
• Risk of myocardial infarction and other coronary events
• Prevalence of cerebrovascular disease and risk of stroke
• Prevalence and incidence of Peripheral Artery Disease
• Risk of other CVDs or conditions (e.g. heart failure, atrial fibrillation)

How does periodontal disease affect risk for cardiovascular disease?

The 2019 consensus report and other recent studies have reviewed a great deal of research to determine and outline the probable mechanistic links between these two inflammatory diseases.

There are at least two mechanistic reasons why periodontal disease increases the risk of cardiovascular disease. These links are rooted in:

• Microbiology: There is significant evidence that oral bacterial species can enter patient blood circulation and cause bacteremia. A 2020 study found that the kind of bacteria found in patients with periodontal disease are also a contributing factor to the development of atherosclerosis when they enter a patient’s bloodstream.
• Immune response: Periodontitis causes immune responses that increase levels of inflammatory mediators throughout the body. The heightened presence of these inflammatory mediators may raise the risk of aberrant inflammation throughout the body, including in the cardiovascular system. 

What kind of oral hygiene practices can help lower my risk of CVD?

Scientists have tested which kinds of oral hygiene help lower the risk of cardiovascular disease extensively.

The Journal of Clinical Periodontology’s consensus report also outlined these findings, concluding that “consistent observational evidence suggests that several oral health interventions produced a reduction in the incidence of Atherosclerotic cardiovascular disease events.”

The oral health interventions that reduce the risk of cardiovascular disease that the Journal outlined include:

• Self-performed oral hygiene habits such as toothbrushing and interdental cleaning
• Dental prophylaxis
• Increased self‐reported dental visits
• Periodontal treatment

How will brushing my teeth lower my risk of cardiovascular disease?

Brushing teeth lowers the risk of cardiovascular disease by lowering the systemic burden on the subject’s inflammatory system, reducing the risk of inflammation in the cardiovascular system.

A study titled “Association between toothbrushing and cardiovascular risk factors: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2015 - 2017” published by researchers Moon et al in the BMC Oral Health Journal provides contemporary evidence for this interaction.

How did the study work?

Researchers conducted a cross-sectional survey of 13,761 adults aged 30 or older without a history of cardiovascular disease sourced from the Korean National Health and Nutritional Examination Survey.

Subjects were asked how frequently they brushed their teeth on average per day and could respond zero times, once, twice, or three times (or more).

Next, the researchers then compared the respondent’s conventional cardiovascular risk factors and inflammatory markers to how frequently they reported brushing.

What did the study find?

Respondents' estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk was calculated from the resulting survey data using cohort equations. Researchers found:

• A 13.7% 10-year ASCVD risk for participants who brushed no times or only once per day.
• A 9.1% risk for participants who brushed twice a day.
• A 7.3% chance for participants who brushed three times a day or more.

Can toothbrushing help lower my blood pressure?

Yes.

Brushing at least three times a day with an electric toothbrush has been found to help subjects reduce their risk of hypertension and maintain healthier blood pressure profiles.

A study called “Home oral hygiene is associated with blood pressure profiles: results of a nationwide survey in Italian pharmacies” conducted by Del Pinto et al., 2022 and published in the Journal of Clinical Periodontology in 2022 provides strong evidence of this interaction.

How did this study work?

Researchers conducted a nationwide survey of 4506 volunteers over the age of 18 in 733 Italian pharmacies (44.8% males, 66.1 ± 37.8 years).

These participants underwent standardised blood pressure measurements and answered a questionnaire on cardiovascular risk factors, oral health status, and their normal oral hygiene habits.

After collecting this data, researchers used multivariate logistic regression to analyse the association between the participant’s oral care habits and their blood pressure.

What did this study find?

Among the 4506 participants, 47.6% reported brushing three or more times per day; 23.4% of these participants said they used an electric toothbrush.

After their analysis was conducted, researchers found:

• 19% lower odds of hypertension for participants who brushed three or more times daily versus participants who brushed fewer than three times daily.
• 28% lower odds of hypertension for participants who brushed with an electric toothbrush versus those who brushed with a manual toothbrush.

Will practising healthy oral hygiene habits lower my risk of dying from cardiovascular disease over time?

Yes. It has been scientifically shown that practising healthy oral hygiene self-care (OHS) habits regularly will help lower a patient’s risk of cardiovascular mortality over time.

A study called “Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up” published by Janket et al in the British Dental Journal on February 3, 2023 provides strong, recent evidence of this interaction.

Disclosure: SUNSTAR provided lead researcher Sok-Ja Janket post hoc travel support to present the results of this study at the International Association for Dental Research (IADR) conference.

How did this study work?

Researchers conducted a prospective cohort study of 256 patients with coronary artery disease against a control study of 250 age and sex-matched participants with the mean age of 60. 

The association of OHS with CVD mortality was assessed using Cox regression analyses while adjusting for age, sex, smoking, dyslipidemia, diabetes, hypertension, and education.

What did this study find?

The study’s multivariable-adjusted models found a 51% reduction in the risk of CVD mortality associated with OHS. Even subjects with coronary artery disease at baseline demonstrated a marginally significant benefit from OHS.

Practising good oral hygiene habits is an important way to lower risk of cardiovascular disease

As these studies show, practising healthy oral hygiene habits is an important way your patients can help lower their risk of cardiovascular disease throughout their lives.

Tell your patients that it is in the best interest of their blood pressure and overall cardiovascular health to:

• Brush their teeth two to three times daily with a manual or better yet, an electric toothbrush
• Clean between teeth as well
• Schedule regular checkups with their dental professional

Citations

[1] Moon, MG., Kang, SH., Kim, SH. et al. Association between toothbrushing and cardiovascular risk factors: a cross-sectional study using Korean National Health and Nutrition Examination Survey 2015–2017. BMC Oral Health 24, 4 (2024). 

[2] Del Pinto, R., Pietropaoli, D., Grassi, G., Muiesan, M. L., Monaco, A., Cossolo, M., Procaccini, A., & Ferri, C. (2022). Home oral hygiene is associated with blood pressure profiles: Results of a nationwide survey in Italian pharmacies. Journal of Clinical Periodontology, 49(12), 1234–1243.

[3] Janket, SJ., Lee, C., Surakka, M. et al. Oral hygiene, mouthwash usage and cardiovascular mortality during 18.8 years of follow-up. Br Dent J (2023).