Many people have heard that brushing teeth and flossing daily are best practices to protect their smiles, but good oral hygiene could have impacts that do far more than keep teeth clean. In fact, recent research postulates that these habits could also keep the heart healthy.

Scientists have found that periodontitis, the gum disease that irreversibly disrupts bone and causes tooth loss, is correlated with an increased risk of cardiovascular conditions. Some researchers hypothesize causal connections between bacterial infection and immune system inflammation. Conversely, other scientists question the cause-and-effect link and instead attribute the correlation to factors such as genetics and lifestyle.

Mechanistic studies suggest that dental infections could contribute to atherosclerotic cardiovascular disease (ASCVD), the leading cause of death worldwide. ASCVD is caused by plaque buildup, which is fat and cholesterol hardening on artery walls. The precise mechanism is unclear; however, bacteria that contribute to periodontitis have also been detected in these plaques, with Porphyromonas gingivalis being one of these notable bacteria. This bacterium has been found to penetrate human tissues and cause disruptions in the endothelium, which is the thin layer of cells that line the inner surface of the cardiovascular system, leading to cardiovascular disease.

As immunology becomes intertwined with oral hygiene, evidence suggests that oral health is not just a dental problem, but a critical component to holistic health and disease prevention.

A more robust theory postulated is that the connection appears to be related to chronic inflammation: the bacteria in the mouth can cause immune responses that target the gum tissue, damaging it and triggering inflammation in blood vessels, which can contribute to ASCVD. These immune responses exacerbate periodontal disease and aid the development of ASCVD. As immunology becomes intertwined with oral hygiene, evidence suggests that oral health is not just a dental problem, but a critical component to holistic health and disease prevention.

While current research can hypothesize connections between periodontitis and cardiovascular disease backed with evidence, other studies found that the two diseases are linked by common risk factors rather than causal identities. A study published in 2018 analyzed data from almost one million people and nearly 65,000 with coronary heart disease. The researchers found that there was a moderate correlation between poor oral health and coronary heart disease. However, after accounting for patient smoking status, the connection between tooth loss (a key marker of poor oral health) and cardiovascular disease dwindled. The researchers conclude that the relationship is likely correlational rather than a direct causal link because poor oral health and coronary heart disease risk appear to be explained by confounding cigarette smoking.

Although the association between oral health and cardiovascular disease has room for investigation, the evidence to date underscores the importance of maintaining good oral hygiene as part of a comprehensive approach to one’s health. Regular dental care and limiting tobacco consumption are good practices that support not only oral well-being but also potentially cardiovascular health. Even without causality definitively established, promoting healthy oral practices represents an evidence-based strategy that can contribute to chronic disease prevention on a larger scale.