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It’s no secret that exercise and a healthy diet are both crucial to lowering the risk of heart disease — the leading cause of death for both women and men nationwide. But a new study out from the European Journal of Preventive Cardiology offers an additional recommendation for those who are struggling to adopt a new lifestyle: Be better about brushing your teeth.
The concept stems from research published Tuesday by the European Society of Cardiology, which analyzed the dental hygiene of over 160,000 individuals in Korea. The participants, all above age 40, were chosen from Korea’s National Health Insurance System-Health Screening Cohort, a program that gathers medical information about individuals — including height, weight, medical conditions and lifestyle questionnaires — in order to study the causes and treatments of disease.
For this particular study, the researchers chose individuals who had no previous history of heart issues, including atrial fibrillation (irregular heartbeat), heart failure or other cardiac diseases. After a median follow-up of 10.5 years, the researchers calculated how many of the individuals had experienced one of the heart complications, then compared that to the overall dental hygiene of the individual. Dental hygiene was measured through a variety of factors, including frequency of teeth brushing, presence of gum diseases, number of dental cleanings and amount of missing teeth.
After comparing the data, the researchers found that “improved oral hygiene care” was “associated with decreased risk of atrial fibrillation and heart failure.” Based on this result, they suggested that individuals pay close attention to the status of their teeth. “Healthier oral hygiene by frequent tooth brushing and professional dental cleaning may reduce the risk of atrial fibrillation and heart failure,” they write.
The research builds on a study out of Japan of over 600 people, presented at an American Heart Association (AHA) meeting in November 2018. In it, researchers found a potential link between heart disease and periodontal disease, or dental diseases. Periodontal diseases include gingivitis (inflammation of the gums) and periodontitis (inflammation of the tissues surrounding the bones in the mouth).
The study’s conclusion, captured by the American Heart Association, found that the individuals who brushed less than twice a day for under two minutes had a “three-fold increased risk” of heart failure, heart attack and stroke than those who brushed at least twice a day for at least two minutes.
While Tuesday’s study, and the AHA’s in 2018, seem to point to a clear connection between oral hygiene and heart health, researchers are still determining if this is the case. And if it is, why? Theories abound.
For some experts, it’s all about inflammation. Hatice Hasturk, DDS, PhD, a dental specialist at the oral health nonprofit the Forsyth Institute, says poor dental hygiene can cause a systematic reaction in the body that’s damaging to major organs. “Periodontal disease increases the body’s burden of inflammation,” Hasturk told Harvard University, which is affiliated with Forsyth.
Another popular train of thought, captured by Robert H. Shmerling, MD, associate professor of medicine at Harvard Medical School, is that the bacteria from gum diseases like gingivitis can also travel to “blood vessels elsewhere in the body.” There, Shmerling writes, bacteria may cause “tiny blood clots” that can lead to heart failure and stroke. “Supporting this idea is the finding of remnants of oral bacteria within atherosclerotic blood vessels far from the mouth.” Shmerling notes that a potential hole in this theory is the fact that antibiotics have not shown promise in reducing the risk of heart disease.
One final theory, floated by Ann Bolger, MD, a professor emeritus of medicine at the University of California, San Francisco, as well as a cardiologist, suggests that good dental hygiene may simply be indicative of the person’s overall habits. “It is possible that people who are very attentive to their dental health are also very attentive to other aspects of their health,” Bolger told the AHA last November. This may extend to their decision whether or not to smoke cigarettes for example, which remains one of the most “preventable causes of heart disease.”
Overall, Bolger say it’s important to not form a causal link between the two, but instead to view it as a “good reminder” that the mouth is “an important part of a person’s entire health.”
On that note: the Mayo Clinic, among others, recommends brushing your teeth twice a day with fluoride toothpaste for at least two minutes, as well as flossing and using mouthwash. For more recommendations and information about dental hygiene, visit the American Dental Association.