Can your teeth cause you to have a heart attack?
“What’s your secret?” I asked my 96 year old patient. “No secrets,” he said. “So what advice would you give to young folks who want to live a long life?” His answer: “Take care of your teeth!”
In the medical community, we believe heart attacks are caused by too much cholesterol. And there is a large body of evidence showing that reducing cholesterol reduces risk. If it’s just cholesterol, then the best treatment program is to get the cholesterol as low as possible. No need to worry about other risk factors. Yet there is also good evidence that other risk factors play an important role in heart disease.
For years, periodontists have been telling us that periodontal disease is associated with an increased risk for heart attacks (1). Most of these studies have been published in the dental and periodontal journals. Until recently, most doctors didn’t read the periodontal journals. Periodontists and dentists did.
How is it possible?
When bad germs (“unhealthy bacteria”) grow in the space between the gum and the teeth, inflammatory cells called Th17 cause even more severe inflammation in the gum (2). That severe inflammation increases the blood flow to the unhealthy gum tissues. So what happens to those germs when you chew your food? Because of the inflammation, its easy for those germs to get into the bloodstream. And once inside the bloodstream, some types of germs can get into the plaque inside the arteries.
Germs inside the plaque
Once they get inside the plaque, germs activate white blood cells, increasing inflammation, which makes artery plaque worse, causing blockage to build up. Over time, blockage gets worse until vulnerable plaque ruptures. When it ruptures, it’s like getting a laceration on the inside surface of the artery. What does the blood do when there is a laceration? It clots. We call that a thrombus. In the heart arteries, when the thrombus grows, it suddenly blocks off the heart artery, causing a heart attack. When that same process happens in the brain arteries, the clot or thrombus breaks off and travels downstream, where it lodges in a brain artery, suddenly blocking the blood flow and causing a stroke.
where’s the evidence?
Germs from the mouth can now be identified by their DNA. And those same germs growing in the mouth have been identified in the plaque which is scrapped out of the carotid arteries during a procedure called carotid artery endarterectomy (3).
Using the same DNA identification technology, bad germs from the mouth have been found in the clots causing a heart attack when those clots were sucked out of the heart arteries and sent for testing (4). They’ve also been identified in other arterial structures and in plaque. (5-8)
Is that enough evidence? The American Heart Association reviewed the evidence (which is graded by letter, A being the most reliable level of proof), and found level A evidence that periodontal disease is independently associated with arterial disease. (9, 10)
Do you have periodontal disease?
Periodontal disease is dangerous. See a dentist and take care of your teeth. Consider getting tested. Our unique heart health screening program is designed to ask the question, “What’s my risk of having a heart attack or stroke?” Our 3 month artery disease trending program called Ask the Arteries is designed for those who already know they have high risk, to ask the question, “Are my arteries getting better? Or worse?”
Reyes, Periodontal Bacterial Invasion and infection: contribution to atherosclerotic pathology. J Periodonal 2013:84(4 suppl):S30-S50. Doi:10:1902/jop.2013.1340012
Dutzan N et al. A dysbiotic microbiome triggers Th17 cells to mediate oral mucosal immunopathology in mice and humans.Sci Trans Med. 2018 Oct 17. DOI: 10.1126/scitranslmed.aat0797
Morita, et al, Identification of periodontal bacteria from carotid artery plaque in chronic periodontitis patients, Journal of Oral and Maxillofacial Surgery, Medicine and Pathology: Oct 2014, Vol.26(4): 450-455, doi:10.1016/j.ajoms.2013.05.001
Figuero, et al., Detection of Periodontal Bacteria in Atheromatous Plaque by Nested Polymerase Chain Reaction, J Periodontology, Oct 2011, v82,#10, 1469-1477, DOI 10.1902/jop.2011.100719
Szulc, et al, Presence of Periodontopathic Bacteria DNA in Atheromatous Plaques from Coronary and Carotid Arteries, Biomed Res Int, 2015, 2015:825397, doi 10.1155/2015/825397, Epub 2015 Oct 4
Filho, Microbial diversity similarities in periodontal pockets and atheromatous plaques of cardiovascular disease patients, PLoS One, 2014 Oct 16;9(10):e109761, doi: 10.1371/journal.pone.0109761
Range, et al, Periodontal baceria in human carotid atherothrombosis as a potential trigger for neutrophil activation.Atherosclerosis. Published online http://dx.doi.org/10.1016/j.atherosclerosis.2014.07.034
Calandrini, et ql, Microbial composition of atherosclerotic plaques, Oral Diseases, v20, #3, pe128-e134, April 2014, DOI:10.1111/odi.12205
Lockhart, P.B., et al (2012) Periodontal disease and atherosclerotic vascular disease: does the evidence support an independent association? A scientific statement from the American Heart Association. Circulation, 125(20), 2520-2544
In order to recommend any form of therapy, physicians like to see evidence in the form of double blinded randomized controlled trials. These trials work best in scientific studies on pills, which lend themselves to placebo controls, so that neither the patients nor the doctors know who’s getting the real treatment. That’s what “double blinded” means. Those types of studies have been difficult to implement with surgical procedures, for example, because patients and doctors know who is and is not getting the treatment. A prospective randomized controlled trial to study the association between periodontal disease treatment and heart disease may never be done. .