'Five Minutes With Fialkow:' Is There a Link Between Gum Disease and Heart Disease?

Studies in recent years have shown possible links between gum disease and heart disease. Resource editors spoke about this with cardiologist Jonathan Fialkow, M.D., chief medical executive of Integrated Services and Precision Care, and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute.

RESOURCE: Thanks for your time, Dr. Fialkow. What are your thoughts – is there a link between gum disease and heart disease?

Dr. Fialkow: Gum disease is usually associated with bacterial infection of the gums. The bacteria may enter the bloodstream and cause inflammation of the arteries leading to heart disease. Also, the inflammation of the gums themselves may lead to other body-wide inflammatory factors that may affect the arteries. Lastly, gum disease can be associated with a diet and lifestyle which may also increase cardiac risk. So, in effect, the gum disease may contribute to heart disease and/or it could just be something we see more commonly in people already at risk for heart disease.

RESOURCE: Can you explain how what happens in the mouth can affect what happens in the heart? 

Dr. Fialkow: Coronary artery disease starts with something irritating or inflaming the inner layer of cells that separate our arteries from the blood flow. The bacteria in our gums can enter our blood stream and inflame those cells leading to coronary artery disease. There is also support now for the idea that ‘systemic inflammation’ meaning chronically inflamed parts of our body may increase inflammation elsewhere, like in our coronary arteries. So the bacteria AND the inflammation they cause may be the culprits. 

RESOURCE: Does this mean that anyone with periodontal disease is at risk for cardiovascular disease? 

Dr. Fialkow: Generally, yes, but the chronicity of the disease is important as well. Not everyone with gum disease has heart disease and not everyone with heart disease has gum disease. Also, factors like smoking, high sugar diet and other risky lifestyle factors may cause both. 

RESOURCE: Are dentists now taking a more active role in their patients’ heart health? If not, should they? 

Dr. Fialkow: I’ve been seeing more and more patients who have said their dentists have discussed heart disease with them when they assess their gums, which is positive. The more we can determine who is at risk for heart disease and the earlier, the better we can prevent heart attacks and deaths.

RESOURCE: Is it true that some people with heart disease need to take antibiotics prior to dental work or cleanings?

Dr. Fialkow: That is a separate issue. Certain people who have had mechanical heart valves or certain congenital heart problems are told to take antibiotics prior to deep dental cleanings as a “prophylaxis.” This is to decrease the risk of bacteria from entering the blood stream and attaching to areas of their heart and valves which can lead to a serious infection called endocarditis. 

RESOURCE: Does maintaining one’s oral health merit inclusion in “Life’s Essential Eight?” (“Life’s Necessary Nine,” perhaps?) 

Dr. Fialkow: In a way, yes, though there are many things we also know can increase heart disease besides the “Life’s Essential Eight.” Generally, if one establishes those health habits, the risk of gum disease will go down anyway. Look at dental hygiene and regular dental cleanings as important healthy lifestyle habits even beyond the cardiac risk.

RESOURCE: Chewing mastic gum has been shown to boost one’s cardiovascular health. What do we know about this and what are your thoughts?          

Dr. Fialkow: Mastic gum has been used in various cultures for thousands of years. It is thought to decrease inflammation and oxidation, another process harmful to our bodies. Small studies show it may lower cholesterol but those were done in healthy people. I think its benefits are, at best, very minimal and less impactful than the many other lifestyle improvement opportunities that one can take.

RESOURCE: Is there anything else you’d like to add on the subject or oral health and heart disease? 

Dr. Fialkow: Heart disease arises from combinations of a multiple of factors. We should not rely on any one thing to predict nor be the only treatment to improve. One should follow a healthy lifestyle, get regular prevention check-ups and seek medical advice if you notice anything out of the ordinary in your condition.

Cardiologist Jonathan Fialkow, M.D., chief medical executive of Integrated Services and Precision Care, and chief of cardiology at Baptist Health Miami Cardiac & Vascular Institute

Do You Know Your Coronary Calcium Score?  As part of Heart Month this February, many Baptist Health diagnostic imaging locations will be participating in our heart scan promotion. You may be eligible for a CT calcium scoring if you are 40-75 years old and meet certain cardiac risk factors. To learn more and request an appointment, visit BaptistHealth.net/HeartScan.