The heart of the problem


  Posted by: The Probe      6th May 2020

Much research has been conducted over the years into the risk factors for diseases relating to the heart. The biggest risk factors for cardiovascular disease (CVD) are high systolic blood pressure, diet, high cholesterol and diabetes.[i] While dental professionals can help to influence some of these areas, they will have the greatest impact on patients’ heart health by improving their oral health. A clear link has been drawn between periodontitis and cardiovascular health,[ii] making it another important risk factor for people to be aware of.

A closer look at the risk factors

The relationship between blood pressure – otherwise known as hypertension – and CVD has long been evidenced.[iii],[iv] It is one of the most common risk factors for CVD and it becomes more prominent with age.[v] Studies have also shown systolic blood pressure (SBP) to be a more accurate predictor of hypertension than diastolic blood pressure. This makes SBP an important consideration in the fight against CVD with today’s aging population. The good news is that the reduction of systolic blood pressure can significantly decrease the risk of CVD at the same time.[vi]

It is a similar story with diet, as this can substantially impact CVD risk.[vii] Eating the wrong foods and in the wrong quantities can increase the chance of developing high SBP, high cholesterol and diabetes, hence increasing the risk of CVD. People should therefore be advised to consume a diet rich in vegetables, fruits and wholegrain starchy foods, with some milk and dairy products, meat, fish, eggs and beans. Foods high in sugar, salt and fat should be minimised wherever possible.[viii]

As mentioned, a poor diet can lead to high cholesterol, but so can little physical activity and excessive body fat. The build-up of fatty deposits in the arteries (atherosclerosis) mean the heart has to work harder to circulate blood, and so SBP increases. This demonstrates how many of the risk factors of CVD are so closely connected. Lowering cholesterol, and therefore risk of CVD, often involves smoking cessation, improvement of diet, increased exercise and decreased alcohol consumption.[ix]

The link between diabetes and CVD appears to be bi-directional. People with type 2 diabetes have a higher risk of CVD while the risk of CVD increases with high fasting plasma glucose levels, even before diabetes is diagnosed.[x] Blood glucose has even been proposed as a better predictor for CVD than cholesterol, as would have traditionally been preferred.[xi] Several mechanisms are believed to exist that link insulin resistance and CVD, including the role of insulin resistance in vascular function and hypertension.[xii]

The gateway to the body

In the dental profession, we regularly talk about the mouth as being ‘the gateway to the body’. This is just as important when it comes to heart health, as CVD is associated with poor oral health. In particular, periodontal disease has been studied in relation to the development of heart conditions to establish whether a causal relationship exists.

There are a few possible links between the two conditions. Firstly, periodontitis and CVD have similar risk factors. Secondly, it has been postulated that the systemic inflammation resulting from periodontal disease could accelerate inflammation of the blood vessels and therefore be a contributing cause of CVD.[xiii] This is supported by evidence found of similar DNA from bacteria in oral and arterial plaque. The defective epithelial barrier in periodontal pockets may offer a pathway of transmission for bacteria from the oral cavity into the bloodstream.[xiv] Another study independently associated moderate to severe periodontitis with nearly a 30% increased risk of a first Myocardial Infarction,[xv] supporting the concept of a direct link between periodontal disease and CVD.

Improving periodontal health is therefore an effective way of reducing risk of CVD. To be successful in this, patients require tailored oral hygiene advice from their dental team, as well as products that are clinically proven to reduce gingival diseases. Why not recommend the new improved Wisdom Clean Between Pro Rubber Interdental Brushes for those patients who need to improve their gingival health? This latest generation of innovative brushes features a uniquely curved profile and a broad thumbgrip for easy access around the mouth. The reinforced stem is strong, durable and flexible, and the brush-like filaments on the tip gently and effectively sweep away plaque for an easier, more efficient interdental clean every time.

Communication and education are vital

Approximately 7.4 million people are living with CVD in the UK right now. More than a quarter (28%) of all deaths in the UK are caused by this condition.[xvi] Improving the statistics requires continued development of treatments and early diagnosis. In turn, this means improving awareness of the disease and its risk factors among the general population.

Most people understand that a healthy diet and exercise contribute to heart health. However, fewer may appreciate the importance of their oral hygiene in the matter. This highlights the need for patient education and provides an opportunity for dental professionals to broaden the topics they discuss with their patients.


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[i] BHF Heart Statistics. 2019 Statistics Compendium (Tables). Chapter 5 – risk factors. [Accessed November 2019]

[ii] Dhadse P, Gattani D, Mishra R. The link between periodontal disease and cardiovascular disease: How far we have come in last two decades. J Indian Soc Periodontol. Jul-Sep 2010; 14(3): 148–154. doi: 10.4103/0972-124X.75908

[iii] Kannel WB, Gordon T, Schwartz MJ. Systolic versus diastolic blood pressure and the risk of coronary heart disease. Am J Cardiol. 1971;27:335–346

[iv] Borghi, C. , Dormi, A. , L’Italien, G. , Lapuerta, P. , Franklin, S. S., Collatina, S. and Gaddi, A. The Relationship Between Systolic Blood Pressure and Cardiovascular Risk—Results of the Brisighella Heart Study. The Journal of Clinical Hypertension. 2013;5: 47-52. doi:10.1111/j.1524-6175.2003.01222.x

[v] Wu CY, Hu HY, Chou YJ, Huang N, Chou YC, Li CP. High Blood Pressure and All-Cause and Cardiovascular Disease Mortalities in Community-Dwelling Older Adults. Medicine (Baltimore). 2015;94(47):e2160. doi:10.1097/MD.0000000000002160

[vi] Bundy JD, Li C, Stuchlik P et al. Systolic blood pressure reduction and riskof cardiovascular diseade and mortality. JAMA Cardiol. 2017;2(7):775-781. doi:10.1001/jamacardio.2017.1421

[vii] Anand SS, Hawkes C, de Souza RJ, et al. Food Consumption and its Impact on Cardiovascular Disease: Importance of Solutions Focused on the Globalized Food System: A Report From the Workshop Convened by the World Heart Federation. J Am Coll Cardiol. 2015;66(14):1590–1614. doi:10.1016/j.jacc.2015.07.050

[viii] BHF. Information & support. Healthy eating. [Accessed November 2019]

[ix] National institute for Health and care excellence. Lowering cholesterol to reduce the risk of coronary heart disease and stroke. Information for the public. July 2014.

[x] Einarson TR, Acs A, Ludwig C, Panton UH. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018; 17, 83 doi:10.1186/s12933-018-0728-6

[xi] Braun, J., Bopp, M. & Faeh, D. Blood glucose may be an alternative to cholesterol in CVD risk prediction charts. Cardiovasc Diabetol. 2013;12, 24 doi:10.1186/1475-2840-12-24

[xii] Ormazabal V, nair S, Elfeky O, Aguaya C, Salomon C, Zuniga FA. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol. 2018;17, 122 doi:10.1186/s12933-018-0762-4

[xiii] Barbro Kjellström, Lars Rydén, Björn Klinge & Anna Norhammar. Periodontal disease – important to consider in cardiovascular disease prevention. Expert Review of Cardiovascular Therapy. 2016;14:9, 987-989, DOI: 10.1080/14779072.2016.1202112

[xiv] Armingohar Z, Jørgensen JJ, Kristoffersen AK, Abesha-Belay E, Olsen I. Bacteria and bacterial DNA in atherosclerotic plaque and aneurysmal wall biopsies from patients with and without periodontitis. J Oral Microbiol. 2014;6:10.3402/jom.v6.23408. doi:10.3402/jom.v6.23408

[xv] Rydén L, Buhlin K, Ekstrand E, et al. Periodontitis increases the risk of a first myocardial infarction: a report from the PAROKRANK study. Circulation. 2016;133:576–583. 

[xvi] BHF. UK Factsheet. August 2019. [Accessed November 2019]

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