Today is World Oral Health Day (March 20), so it’s the perfect time to talk about the importance of good oral hygiene and its impact on our overall health — which might be more significant than we realise.
If you think the worst that could happen if you didn’t take care of your oral health are cavities and the occasional toothache — you might need to think again.
Research has shown a link between people who have poor oral health (such as gum disease or tooth loss) and higher rates of cardiovascular problems such as a heart attack or stroke than people with good oral health, according to Harvard Health.
But how and why do these two seemingly unrelated body parts affect each other?
A study by the American Journal of Medicine noted that gum disease can potentially lead to “deteriorating cardiovascular health due to chronic systemic inflammatory disease”.
Dr Nora Heng, dental specialist in periodontics (gum health) at Raffles Dental, tells AsiaOne: “Poor gum health is often caused by bacterial infection. It can contribute to heart disease as bacteria from severe gum infections can enter the bloodstream and potentially cause inflammation in the heart.”
Dr Chee Hoe Kiat, senior consultant for the periodontics unit at National Dental Centre Singapore (NDS), echoes this sentiment, stating that “research has shown that people with gum disease have a higher risk of developing heart disease”.
“Scientists believe that inflammation caused by periodontal disease (or gum disease) may be responsible for the association,” he added.
What causes gum disease?
Also known as periodontal disease, gum disease is a chronic inflammatory disease of the gums.
“Gum disease is primarily caused by plaque buildup, which is caused by bacteria and can lead to gum infections,” shared Dr Heng.
While gum disease can happen to everyone, she stated that certain groups of people are more at risk — such as diabetics, smokers, pregnant women, those with poor oral hygiene and the elderly.
But just because you don’t belong in the “high risk” group doesn’t mean that gum disease is unlikely.
According to Dr Chee, 90 per cent of Singaporean adults are affected by some form of gum disease, varying in severity.
“There is also a lack of awareness surrounding preventive dental care, with 68.9 per cent unaware that regular dental check-ups help prevent gum disease and maintain overall oral health. This knowledge gap suggests a critical need for improved public education on oral hygiene practices and the importance of routine dental visits,” he urged.
Dr Heng added that gum disease is prevalent not just in Singapore, but also across the globe.
Citing the 2010 Global Burden Disease Study, she noted that severe gum disease is the sixth most prevalent disease in the world.
“Periodontal diseases are very common and is a significant global health concern,” the periodontist highlighted.
The link between gum health and other conditions
But does having gum disease or poor gum health in general mean that heart disease is inevitable?
Before you start to panic, it’s not a full-on cause-and-effect situation.
“Poor gum health does not guarantee imminent heart disease, but it can increase the risk factors. This is especially so for people already dealing with cardiovascular problems,” stated Dr Heng.
Dr Chee also acknowledged that “although there is an association between periodontal and cardiovascular diseases which has been well characterised, the causal relation is yet to be established”.
Besides poor gum health, there are other factors that play a role in the development of heart disease.
“While there’s an association between the two conditions, many factors influence heart health, including genetics, lifestyle, diet and exercise,” the senior consultant said.
Speaking to AsiaOne, Dr Jacinta Lu, head of the Division of Periodontics at the National University Centre for Oral Health Singapore, agreed that other factors may play a bigger role.
Referencing a report by the joint American Academy of Periodontology and the European Federation of Periodontology workshop, she stated that while periodontitis is recognised as a risk factor for cardiovascular disease, “there are many other risk factors like smoking, diet [and] lack of exercise that have a stronger link to cardiovascular diseases”.
However, this does mean that those with pre-existing conditions should take extra care.
“For people with existing heart conditions, poor gum health can exacerbate inflammation and potentially worsen their heart condition,” Dr Heng warned.
Additionally, gum disease can also be a warning sign of some other health conditions.
“Beyond heart disease, poor gum health can signal various underlying conditions, from diabetes and respiratory problems to rheumatoid arthritis. In particular, severe gum disease may be a sign of unrecognised diabetes in an individual who may not be aware,” Dr Chee stated.
According to the specialist, a recent study published in November 2024 by the NDS revealed that “1,074 participants who did not report to have any diabetes or prediabetes when they first joined the study” showed that “6.1 per cent and 7.7 per cent of the participants were identified to have type two diabetes and prediabetes”.
Dr Lu also noted that symptoms of poor gum health “can be an oral sign of untreated or uncontrolled diabetes”.
“For patients presenting with these oral symptoms, especially those with a family history of diabetes or gestational diabetes, it is recommended they undergo a blood sugar test to determine if they have underlying diabetes,” she advised.
Protecting gum and heart health
At the end of the day, while gum disease does not necessarily determine your heart health, there is still a substantial link that shouldn’t be ignored (plus, it’s never a bad idea to stay on top of your health).
In fact, according to the specialists, improving your gum health can potentially help reduce the risk of heart disease by lowering overall inflammation.
“Improving gum health reduces inflammation, which in turn lowers the overall inflammatory burden on the body, including the heart,” the Dr Heng stated.
Similarly, Dr Chee stated that the improvement or prevention of gum disease can reduce overall inflammation in the body, which in turn may help lower the risk of heart disease.
“Treatment of gum disease reduces the plaque bacterial load in the oral cavity, and maintaining good oral hygiene helps prevent harmful gum disease bacteria from entering the bloodstream and causing systemic inflammation that could affect heart health,” he explained.
So how exactly do you protect your gum health for a potentially healthier heart?
Most of us might think that brushing our teeth daily would suffice — but the experts begs to differ.
According to Dr Lu, brushing correctly twice a day is “essential but inadequate”.
This is because tooth brushing can only target the front, back, biting surfaces and along the gumline, but not necessarily all the spaces in between.
To tackle that problem, she suggests using dental floss or interdental brushes that can help to reach the spaces in between teeth where dental plaque and food debris usually accumulate.
On top of that, she also states that regular dental visits are “crucial for maintaining good oral health”.
“In addition to professional cleaning, monitoring any changes in dental health plays a key role in the early detection and prevention of issues like tooth decay and gum disease before they become more serious, ultimately helping to prevent tooth loss,” she said.
Also emphasising the importance of dental flossing, Dr Chee shared that a “simple yet effective change” that we can make to our daily dental routine is the practice of dental flossing.
“Many people brush regularly but skip flossing, which is crucial for removing plaque and food particles between teeth where brushing can’t reach.
This simple habit can significantly improve both gum and heart health, as according to a very recent preliminary study in the US, it was found that flossing teeth at least once a week may be linked to a lower risk of stroke caused by a blood clot blocking brain blood flow and irregular heartbeats,” he stated, referencing a study published in January this year by the Journal of American Dental Association.
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