Brush and Floss to Ward Off Stroke

Dental ills are linked with higher risk for cardiovascular problems such as stroke, heart failure and heart attack.

Regular visits to your dentist not only ensure healthy teeth and gums, but they may also help protect your brain. A recent study found a strong association between dental health and risk for stroke, a major cause of brain damage and cognitive decline. The research adds to an ongoing debate about whether careful care of teeth and gums can lower risk for cardiovascular disease.

“Accumulations of dental plaque, and bacteria and inflammation linked with gum disease are highly associated with cardiovascular disease,” says Maurizio Fava, MD, Executive Vice Chair of the Department of Psychia-try at MGH, “but whether there is a causal connection between inadequate dental hygiene and cardiovascular problems such as stroke is still up for debate. Nevertheless, in light of the many studies over the years that have linked poor oral health with a higher incidence of heart attack, heart failure, and stroke, it makes sense to avoid any problems by brushing, flossing, and getting regular dental checkups.”


Watch for these signs of gum disease, and see your dentist promptly if you encounter them:

  • Red, purple, or swollen gums
  • Tender or bleeding gums
  • Persistent bad breath
  • Shrinking of gums from around the tooth, with pockets of infection
  • Painful chewing; sensitive or loose teeth

Stroke Risk

A large study that followed more than 700,000 adults for a period of up to 10 years strongly linked the participants’ history of dental care and periodontal disease (gum disease) with their risk of ischemic stroke (stroke caused by a clot that blocks brain blood vessels). The research, published in the April 2013 issue of the journal Stroke, compared a group of participants diagnosed with gum disease to participants without disease. The participants with gum disease were divided into subgroups—those who received no treatment, those who received usual treatment, and those who received intensive treatment. The re-searchers found that participants with gum disease who received regular treatment had the lowest rate of ischemic stroke at 14 percent per year, while participants with no history of gum disease had an incidence of ischemic stroke of 32 percent per year. Participants who received intensive care for gum disease that included extraction or periodontal therapy—treatment that is associated with a slightly heightened, but temporary, increase in the risk for stroke and heart attack—had a higher rate of stroke (39 percent), and those who received no dental care at all had the highest rate per year at 48 percent.”

Common Risk Factors

“It’s unclear how periodontal disease and cardiovascular disease are related,” explains Dr. Fava. “It may be that the two conditions share common risk factors, such as smoking, increasing age, diabetes, high blood pressure, or systemic inflammation, or that poor cardiovascular health may aggravate dental problems.

“It may also be that bacteria from inflamed and diseased gums heighten the risk for cardiovascular events by lodging in fatty deposits along artery walls and increasing the accumulation of arterial plaques, or by entering the bloodstream and triggering an immune response that causes inflammation and narrowing of artery walls. Avoiding periodontal disease by taking good care of your teeth and gums helps reduce harmful inflammation in the body.

‘Whether or not good dental hygiene helps eliminate a potential risk factor for heart disease and stroke, it’s clear that it is an important part of ensuring overall health.”

Maintaining Oral Health

Periodontal disease can range from slight inflammation of the gums to severe disease that damages soft tissue and bone. Treatment may involve removing the tartar from teeth and eliminating rough spots on the tooth root that might attract bacteria. Surgical treatment may be suggested for serious periodontal disease. Medications may also be prescribed to control bacteria and slow the action of enzymes involved in gum dis-ease.

To keep your teeth and gums healthy, most experts advise that you:

• Brush your teeth at least twice a day with a fluoride toothpaste.
• Floss your teeth daily.
• Replace your toothbrush every two or three months to cut down on bacterial contamination lurking in frayed bristles.
• See your dentist regularly.
• Promptly seek treatment for swollen or bleeding gums, loose teeth, and other signs of periodontal dis-ease (see What You Can Do).
• Consult with your doctor about changing medications that reduce the flow of saliva in your mouth.
• If you have false teeth, clean them regularly to eliminate plaque and bacteria buildup

“In addition to caring for your teeth, reduce your stroke risk by paying attention to cardiovascular risk factors, such as high cholesterol, obesity, smoking, high blood pressure, and lack of exercise,” advises Dr. Fava.


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