Research & Education

The Growing Connection Between Oral Microbiome and Cardiovascular Health

Complications related to oral health, such as periodontal disease, dental caries, and tooth loss, have been suggested to be associated with an increased risk of cardiovascular disease (CVD). Cardiovascular disease is the leading cause of death worldwide, while periodontal disease (PD) ranks as the sixth most common disease in humans. Both conditions share common risk factors, including smoking, poor oral hygiene, diabetes, obesity, stress, sedentary lifestyle, and advanced age. 

The connection between oral health and cardiovascular health:

Research suggests that PD can trigger the formation, maturation, and instability of atheroma in the arteries. Evidence from epidemiological studies shows a positive association between PD and coronary heart disease, cerebrovascular disease (stroke), and peripheral artery disease. Simple oral hygiene practices, such as brushing teeth, may potentially alter a person’s CVD risk. 

In a nationwide population-based cohort study in Korea (n = 247,696), researchers aimed to evaluate whether oral hygiene behavior could influence CVD associated with oral health status. The subjects were healthy adults aged 40 or older with no history of major cardiovascular events. After a 9.5-year median follow-up, it was concluded that the risk of cardiovascular events (including cardiovascular death, acute myocardial infarction, heart failure, and stroke) was higher when a subject was diagnosed with PD, a higher number of dental caries, or had a higher number of tooth loss. The researchers concluded that just one additional tooth-brushing episode per day was associated with a significantly lower (9%) risk of cardiovascular events after multivariable adjustment. Furthermore, regular dental visits (once a year or more) for professional cleaning reduced cardiovascular risk by 14%. 

These conclusions align with various other extensive studies. A cross-sectional study (n = 11,869) concluded that participants who brushed less than once a day had a higher incidence of atherosclerotic CVD events compared to those who brushed twice daily. Additionally, a retrospective, nationwide, population-based study in Taiwan (n = 511,630) observed consistent reductions in the incidence of ischemic stroke in those receiving dental prophylaxis and intensive treatment. 

Recent research suggests that poor oral health may negatively influence cardiovascular health in multiple ways: 

Clinical insights: 

It is advised that patients with PD or compromised oral health be educated on their potential increased risk for CVD. Similarly, those diagnosed with CVD should receive a thorough oral examination by a dental care professional

In addition to regularly brushing, flossing, and attending their annual dental examinations, patients must consider their nutritional status. Inadequate nutrition can be associated with PD, dental caries, and oral mucosal diseases. Conversely, compromised oral health, such as difficulty chewing or swallowing, may negatively influence a person’s daily food intake. This may result in suboptimal nutritional status, energy deficits, or malnutrition, which may increase the risk of chronic diseases like CVD. 

Encouraging a whole‐food diet emphasizing protein, vegetables, and antioxidant‐rich foods can support oral health. Additionally, reducing or eliminating soft drinks and refined sugar intake can be supportive. High sucrose intake, in particular, is associated with high plaque volume and gingivitis, and high sugar consumption, in general, has been associated with dental caries.

Explore more ways to promote oral health: 

Purified Silver for Oral Health 

MCT Oil and Periodontal Wellness 

The Latest on Probiotics and Periodontal Health 

Bromelain’s Unique Role in Oral Wellness 

By Danielle Moyer Male, MS, CNS, LDN