Research out of Korea published December 1, 2019, in the European Journal of Preventive Cardiology found that toothbrushing three or more times a day was connected with a 10 percent lower risk of atrial fibrillation (a common irregular heartbeat condition) and a 12 percent lower risk of heart failure. “Healthier oral hygiene attained by frequent toothbrushing and professional dental cleaning may decrease risk of atrial fibrillation and heart failure,” wrote senior investigator Tae-Jin Song, MD, in the department of neurology at Ewha Womans University, Seoul, Korea, and collaborators. Investigators also noted that missing teeth was positively correlated with the risk of heart failure and afib. Tooth loss has been correlated in past research with coronary artery disease, according to the American Heart Association. For this research, Dr. Song and colleagues kept tabs on 161,286 participants in the Korean National Health Insurance System who were between ages 40 and 79 and had no history of atrial fibrillation or heart failure at study start. From routine medical examinations, scientists collected details on height, weight, laboratory tests, illnesses, lifestyle, oral health, and oral hygiene behaviors. After an average followup of 10.5 years, 4,911 (3 percent) of the subjects developed afib and 7,971 (almost 5 percent) developed heart failure.
How Bad Oral Health May Stoke Heart Troubles
The study authors suggested that a lack of toothbrushing and dental care may lead to bacteria entering the bloodstream, causing inflammation in the body that can be harmful to the heart. “It is well understood that increased inflammation leads to increased heart disease, including atrial fibrillation and heart failure,” says Satjit Bhusri, MD, a cardiologist at Lenox Hill Hospital in New York City, who did not work on this research. “The cause is due to an increase in certain markers in the blood that alter the inner lining of arteries and make the heart vulnerable to increased stress.” In an earlier study, published in the Journal of the American Heart Association, scientists at Columbia University’s Mailman School of Public Health observed that the thickness of artery walls worsened in individuals with gum disease. Both the American Heart Association and the American Dental Association have recognized that people with gum disease (periodontitis) have risk factors that may also damage their heart and blood vessels. According to a review published in 2014 in the International Journal of Dentistry, research has shown than smokers and people with diabetes have higher rates of periodontal disease, for example. Thomas J. Salinas, DDS, a prosthodontist with the Mayo Clinic in Rochester, Minnesota, adds that poor dental health also increases the risk of a bacterial infection in the bloodstream, which can affect the heart valves. “Oral health may be particularly important if you have artificial heart valves,” says Dr. Salinas, who was not involved in the study. “Artificial heart valves have a tendency to collect debris and are more prone to developing bacterial growth. Although of low incidence, it seems that bacteria inadvertently introduced into the bloodstream could be causative in a prosthetic heart valve becoming infected.” While this new report contributes to mounting research showing that poor oral health may be tied to poor heart health, bad toothbrushing habits have not been shown to cause these cardiovascular problems. Frequent brushing, however, helps eliminate bacteria living in the pockets between the teeth and gums (called subgingival biofilm), according to the study authors. “It is certainly too early to recommend toothbrushing for the prevention of atrial fibrillation and congestive heart failure,” write Pascal Meyre, MD,, in the division of cardiology at Basel University Hospital in Switzerland, and David Conen, MD, with the Population Health Research Institute at McMaster University in Hamilton, Ontario, Canada, in an accompanying editorial. “While the role of inflammation in the occurrence of cardiovascular disease is becoming more and more evident, intervention studies are needed to define strategies of public health importance.” The researchers recognize that the investigation is limited as an observational study conducted in one country. Much of the data was also self-reported, which can often be unreliable, according to Salinas. “For instance, a patient may self-report that they frequently brush several times a day when this is realistically lower,” he says. On the plus side, Song says, “We studied a large group over a long period, which adds strength to our findings.”
Good Practices for Oral and Heart Health
To avoid oral infections, the American Dental Association recommends brushing at least twice daily and flossing once a day. The organization also advises that individuals schedule regular checkups and professional dental cleanings with a dentist. To help prevent afib, heart failure, and other cardiovascular problems, the American Heart Association suggests exercising regularly; eating a diet low in salt, saturated fats, trans fats, and cholesterol; managing high blood pressure; avoiding excessive alcohol and caffeine; not smoking; controlling cholesterol; and maintaining a healthy weight. Dr. Bhusri indicates that people who pay close attention to their oral health may be more attentive to healthy lifestyle habits overall. “Lifestyle modifications, preventive care, and good surveillance — in any population — will lead to lower incidence of many chronic diseases, including atrial fibrillation and heart failure,” he says.
