People with gum disease (also known as periodontal disease) have two to three times the risk of

having a heart attack, stroke, or other serious cardiovascular event. But there may not be a direct
connection. Many people with heart disease have healthy gums, and not everyone with gum
disease develops heart problems. Shared risk factors, such as smoking or an unhealthy diet, may
explain the association. Still there's a growing suspicion that gum disease may be an independent
risk factor for heart disease.

Previous studies have found a link between heart disease and periodontal disease – a condition
marked by gum infection, gum inflammation and tooth damage. The new study, being presented
Saturday at the American Heart Association's Scientific Sessions meeting in Chicago, looked at
whether a person's tooth-brushing habits were associated with their risk of having or dying from
a heart attack, heart failure or stroke.

Researchers asked 682 people about their tooth-brushing behavior. After adjusting for various
factors, they found that those who said they brushed less than twice a day for less than two
minutes had a three-fold increased risk compared to those who said they brushed at least twice a
day for at least two minutes.

A separate study published last month in the AHA journal Hypertension found that gum disease
appears to worsen blood pressure and interferes with medications to treat hypertension.

Left untreated, gingivitis can turn into periodontal disease. The gums become loose around the
root of the tooth, creating a gum pocket that gradually deepens. Eventually, the infection and
inflammation can cause the tooth to loosen and possibly fall out.

Inflammation, or swelling. Scientists know that it leads to hardened arteries, also called
atherosclerosis. That's a condition that makes it hard for blood to flow to your heart. It puts you at
greater risk for heart attack and stroke.

Inflammation is also a sure sign of gum disease. Sore, swollen gums are the main symptom. There
are two main types: gingivitis, which causes red, painful, tender gums, and periodontitis, which leads
to infected pockets of germy pus. That's the type that raises the worry for heart problems. It allows
bacteria and other toxins to spread below the gum line.

Your gums are very vascular, meaning they're full of blood vessels. And, your mouth is full of
bacteria. If you disrupt the gum layer even a little bit, you're going to get bacteria in your
bloodstream, which can go anywhere and trigger inflammation throughout the body. Inflammation is
one of the main things that cause damage to blood vessels, including those of the heart.

The biochemically and antigenically diverse group of organisms classified as viridans

streptococci, as well as other non-groupable streptococci of the oral and gastrointestinal cavities
and urogenital tract, include important etiologic agents of bacterial endocarditis. Dental
manipulation and dental disease with the associated transient bacteremia are the most common
predisposing factors in bacterial endocarditis, especially if heart valves have been damaged by
previous rheumatic fever or by congenital cyanotic heart disease. S mutans and S sanguis are
odontopathogens responsible for the formation of dental plaque, the dense adhesive microbial
mass that colonizes teeth and is linked to caries and other human oral disease. S mutans is the
more cariogenic of the two species, and its virulence is directly related to its ability to synthesize
glucan from fermentable carbohydrates as well as to modify glucan in promoting increased
adhesiveness. In the absence of gum disease, there is significantly less of these bacteria in the heart.

Resources:

https://www.ncbi.nlm.nih.gov/books/NBK7611/

https://www.health.harvard.edu/heart-health/gum-disease-and-heart-disease-the-common-thread

https://www.webmd.com/heart-disease/features/periodontal-disease-heart-health#1

https://www.perio.org/consumer/gum-disease-and-heart-disease

https://www.heart.org/en/news/2018/11/07/bad-tooth-brushing-habits-tied-to-higher-heart-risk