Is good dental hygiene beneficial for heart health?

Good Dental Hygiene is Beneficial for Heart Health

Yes, maintaining good dental hygiene is strongly beneficial for heart health. Multiple guidelines from major cardiovascular organizations emphasize that poor oral hygiene and periodontal diseases, rather than dental procedures themselves, are likely responsible for the vast majority of cases of infective endocarditis (IE) and other cardiovascular complications that originate in the mouth 1.

How Dental Health Affects Heart Health

Mechanisms linking oral health to cardiovascular disease:

• Poor oral hygiene leads to gingivitis and periodontitis, which can cause transient bacteremia (bacteria entering the bloodstream) during daily activities like brushing teeth, flossing, and chewing 1
• These frequent, low-grade bacteremias from daily activities occur much more often than those from dental procedures and may contribute to systemic inflammation 1
• Systemic inflammation is a known mediator of cardiovascular diseases including atrial fibrillation and heart failure 2

Evidence of cardiovascular risk from poor dental health:

• Periodontal disease, dental caries, and tooth loss are all associated with increased risk of cardiovascular events 3
• Patients with ≥15 missing teeth have a 37% higher risk of heart failure compared to those without missing teeth 4
• Poor oral hygiene is linked to elevated inflammatory markers including C-reactive protein (CRP), fibrinogen, and cellular adhesion molecules, which are implicated in cardiovascular disease 5

Benefits of Good Dental Hygiene Practices

Specific dental hygiene practices that reduce cardiovascular risk:

• Frequent tooth brushing (≥3 times/day) is associated with a 10% reduction in atrial fibrillation risk and a 12% reduction in heart failure risk 2
• Regular professional dental cleaning (at least once yearly) reduces cardiovascular event risk by 14% 3
• Professional dental cleaning is associated with a 7% reduction in heart failure risk 2
• Good oral hygiene practices can attenuate the cardiovascular risk originating from existing periodontal disease, dental caries, and tooth loss 3

Guidelines from major organizations:

• The American Heart Association (AHA) emphasizes that maintaining optimal oral health through daily activities is more important than antibiotic prophylaxis for dental procedures in reducing IE risk 1
• The European Society of Cardiology (ESC) states that good oral hygiene and regular dental review have an essential role in reducing the risk of IE 1
• Multiple guidelines highlight that poor oral hygiene and periodontal diseases are likely responsible for the majority of IE cases that originate in the mouth 1

Recommendations for Maintaining Oral Health

Daily oral hygiene practices:

• Brush teeth at least twice daily, ideally three times per day 2
• Use proper flossing techniques daily 1
• Focus on thorough cleaning to reduce plaque buildup 1

Professional dental care:

• Schedule regular dental check-ups at least once per year 3
• Undergo professional dental cleaning regularly 3, 2
• Address dental issues promptly to prevent progression of disease 1

Special considerations for high-risk patients:

• Patients with prosthetic heart valves, previous infective endocarditis, or certain congenital heart defects should be particularly vigilant about oral hygiene 1
• Patients with type 2 diabetes should pay special attention to oral health, as dental diseases and poor oral hygiene are important determinants of heart failure development in this population 4

Common Pitfalls and Caveats

• Many patients with severe cardiac conditions have inadequate oral health maintenance, with studies showing poor plaque and gingival index scores in over 30% and 50% of patients with rheumatic heart disease, respectively 6
• Daily bacteremia from routine activities like tooth brushing occurs far more frequently than bacteremia from dental procedures, making daily oral hygiene more important than antibiotic prophylaxis for preventing IE 1
• Focusing solely on antibiotic prophylaxis for dental procedures while neglecting daily oral hygiene is a common mistake that may increase cardiovascular risk 1
• Delaying treatment of dental issues can lead to more severe oral disease and potentially greater systemic inflammation 1

Good dental hygiene is an integral part of comprehensive cardiovascular health care and should be emphasized as a modifiable risk factor for heart disease 5, 3, 2.