Is your oral health linked to cardiovascular disease?

Periodontitis, a serious gum disease, is associated with a higher risk of a range of cardiovascular conditions: ischaemic heart disease, stroke, heart failure, atrial fibrillation, and peripheral arterial disease. This link has been demonstrated in multiple systematic reviews and meta-analyses. It is an association; whether gum disease actually causes these conditions has not yet been established.

A large American population study with more than 21,000 participants found that people with periodontitis had a 21% higher chance of high blood pressure than people without gum disease. A clear dose-response effect was notable: the worse the overall oral health, the higher the likelihood of hypertension. In the group with the poorest oral health, that figure rose to a 48% higher chance compared with excellent oral health. Smoking and age strengthened the association.

The biological mechanism behind the link is reasonably well described. Inflammation in the gums triggers a body-wide inflammatory response, during which bacteria can also enter the bloodstream. This promotes the formation and growth of fatty deposits in the walls of blood vessels. The fact that elevated inflammatory markers are also found in more severe periodontitis fits this picture, although direct causality in humans has not yet been definitively established.

Treatment of gum disease, both surgical and non-surgical, can reduce inflammatory markers in the blood. There is also evidence that blood sugar regulation in diabetes patients improves after gum treatment. This suggests that the connection between the mouth and the body is not one-way traffic, and that improving oral health may have broader effects. The exact size of that benefit, however, still varies from study to study.

Outside the cardiovascular domain, a link has also been found between a disrupted oral microbiome (the bacterial community in the mouth) and diseases such as rheumatoid arthritis, Alzheimer's disease, and lung conditions. Studies also indicate that tooth loss may play a triggering role in cognitive decline. These are still early findings, without concrete risk figures, but they do confirm that oral health is not separate from the rest of your body.