From Barcclay's Heartycare Oral Health and Heart Disease:How Dental Health Affects Cardiovascular Conditions By Nieske Zabriskie, ND
Surprisingly, one of the most important risk factors for heart disease occurs in an area of the body we don’t often connect with cardiovascular health: the mouth. Yet, numerous studies have shown the correlation between poor oral health and heart disease.
Both poor oral health and heart disease are common conditions in America. According to the American Heart Association, 36.3 percent (1 in 2.8) of deaths in 2004 were caused by cardiovascular disease.1 In elderly populations, poor dental health is also associated with all-cause mortality.2 The National Health and Nutrition Examination Survey (NHANES) 1999-2002 investigated the oral health of the U.S. population. This study found that 41 percent of children aged 2-11, 50 percent of children aged 12–15 years, and 68 percent of adolescents aged 16–19 years had tooth decay in their primary teeth. Also, the prevalence of decay in adults showed that 87 percent of individuals ages 20-39 and 95 percent ages 40-59 had decay in the coronal surface of the permanent teeth. This study demonstrated another alarming fact: 25 percent of adults over age 60 had lost all of their teeth.3 Due to the prevalence of these conditions, the correlation between oral health and heart disease is
significant as oral health may be a possible avenue of intervention to decrease cardiovascular mortality.
Some researchers have suggested that oral infections may produce inflammatory markers, which could contribute to the pathology of coronary heart disease (CHD). Studies indicate that serum inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fibrinogen levels are significantly higher in individuals with CHD. CHD patients also have showed an increased prevalence of gingivitis and diseased supporting tissue, less natural teeth, and increased loss of all teeth compared to individuals without CHD.4
Chronic periodontitis also is an independent risk factor for coronary artery disease. In fact, studies show that the severity of periodontitis is directly correlated to the severity of the coronary heart disease.5 Additional research indicated that in individuals with coronary atherosclerotic heart disease (CAD), 84.44 percent had periodontal disease compared to only 22.5 percent in individuals without coronary heart disease. Furthermore, periodontal disease was associated with elevated inflammatory markers and is a higher risk factor for CAD than elevated low-density lipoprotein cholesterol (LDL) and pulse pressure.6
Evidence also indicates that cumulative incident tooth loss is significantly related to the prevalence of peripheral artery disease (PAD,) particularly in men with periodontal disease.7 Additionally, research has shown that periodontal disease is significantly associated with hypertension and risk for myocardial infarction (heart attack) in middle aged individuals. This study further demonstrates that the number of periodontal diseased pockets is significantly associated with hypertension at any age. Also, a low number of natural teeth is correlated with increased risk of myocardial infarction.8
Natural Support for Oral Health and Heart Disease
Xylitol is a 5-carbon sugar alcohol found in most fruits and vegetables and can be used as a sugar substitute. Commercially produced xylitol is often extracted from birch and other hardwoods. Most sugars are hydrolyzed by amylase providing a substrate for oral bacteria. These bacteria lower the pH of the saliva and plaque initiating tooth demineralization and decay. Xylitol, unlike most other sugars, has been shown to be beneficial for oral health and decrease dental caries. Xylitol intake has been shown to decrease the amount of plaque and the amount and virulence of the bacteria streptococci mutans in both plaque and saliva.9
Streptococci mutans is often transmitted from mothers to their children shortly after birth. Studies have shown that mothers who chew xylitol gum decrease the risk of transmission of these bacteria to their children. In fact, this study demonstrated that at two years of age, only 9.7 percent of children whose mothers began chewing xylitol gum when the children were 3 months of age had streptococci mutans. In children whose mothers were treated with fluoride varnish, a significant 48.5 percent had streptococci mutans.10 Additionally, researchers have demonstrated that even 5 years after the discontinuation of a xylitol chewing gum study, the children who were in the xylitol group still had 59 percent lower risk of dental caries compared to the group of children not given xylitol gum. Also, this study showed that teeth that erupted within one year of the discontinuation of the study had a long-term decreased risk of dental caries of 93 percent, suggesting that children should
chew xylitol gum or consume other forms of xylitol regularly beginning one year prior to permanent dentition eruption.11
Because xylitol is a low-glycemic, natural sugar substitute, its incorporation in the diet can also play a role in supporting healthy blood sugar levels. The link between diabetes and an increased risk of heart disease is well-established, indicating that xylitol can improve cardiovascular health on a number of levels.
Vaccinium macrocarpon (Cranberry)
Cranberry is frequently used medicinally to treat urinary tract infections because of its ability to inhibit particular strains of bacteria from adhering to the bladder wall. This evidence led researchers to investigate whether cranberries could also inhibit adhering of plaque bacteria in the mouth. Research indicates that cranberry juice inhibits colonization on the tooth surface by the bacteria streptococci, and thus may decrease the development of dental plaque.12 An additional study showed that a component of cranberries decreased coaggregates formed by oral bacteria. This causes a decrease in oral micro-flora and suggests a possible treatment to improve oral hygiene.13 In addition, cranberry supplementation has been shown to increase the beneficial high-density lipoprotein cholesterol (HDL.) Low HDL is an independent risk factor for cardiovascular disease.14 Thus, cranberry intake may have a dual role: increasing both oral health and cardiovascular protection.
Coenzyme Q10 (CoQ10)
CoQ10 is a compound found in virtually every cell in the body. CoQ10 is a potent antioxidant and is required for the synthesis of cellular energy. Supplementation with CoQ10 has been shown to benefit both cardiovascular disease and oral health. Evidence indicates that individuals with periodontal disease have decreased gingival tissue levels of CoQ10 compared to individuals without periodontal disease.15 Research has shown that topical application of CoQ10 significantly improved periodontitis in adults as the sole treatment as well as adjunctive therapy.16 CoQ10 has been shown to be helpful for numerous cardiovascular diseases as well, such as hypertension, ischemic heart disease, and congestive heart failure.17
Folic acid is a water-soluble B vitamin required in the diet. According to the National Health and Nutritional Examination Survey (NHANES) 2001-2002, low serum folic acid levels are an independent risk factor for periodontal disease in elderly adults.18 Additional studies indicate that folate mouthwash significantly improved gingival health in pregnant women.19 Low folic acid levels are also associated with increased levels of homocysteine, a risk factor for atherosclerosis, stroke, and heart disease.20
The association of poor oral health and heart disease is well established and the link between poor oral hygiene and heart disease may be due to an increase in inflammation. Use of xylitol as a sugar substitute as well as supplementation with cranberry, CoQ10, and folic acid can decrease risk factors associated with both poor oral health and heart disease. Therefore, correcting poor oral health issues is a potential avenue to decrease the overwhelming prevalence of cardiovascular disease.
1. American Heart Association. Cardiovascular disease statistics. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4478. Accessed on April 7, 2007.
2. Meurman JH, Hamalainen P. Oral health and morbidity--implications of oral infections on the elderly. Gerodontology. 2006 Mar;23(1):3-16.
3. Surveillance for Dental Caries, Dental Sealants, Tooth Retention, Edentulism and Enamel Fluorosis—United States, 1988–1994 and 1999–2002. Available at: http://www.cdc.gov/oralhealth/factsheets/nhanes_findings.htm. Accessed on: April 7, 2007.
4. Meurman JH, Janket SJ, Qvarnstrom M, Nuutinen P. Dental infections and serum inflammatory markers in patients with and without severe heart disease. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003 Dec;96(6):695