oral health and heart

Evidence continues to mount that maintaining good oral hygiene is good for your heart.
It has been apparent for several years that consistent flossing and seeing your dentist regularly can help to prevent heart disease. Flossing and periodic teeth cleaning by a dental professional (to remove the plaque that invariably forms on everyone's teeth) are vital in preventing periodontal disease — gingivitis or periodontitis — which is caused by a chronic bacterial infection of the gums.
 
Periodontal disease can promote inflammation of the blood vessels, an important risk factor for atherosclerosis. People with gum disease are known, for instance, to have elevated levels of C-reactive protein (CRP), a marker for inflammation that is associated with an increased risk of coronary artery disease. More recently, it has been shown that people with periodontal disease also have elevated levels of lipoprotein-associated phospholipase A2, another significant marker for inflammation that increases cardiac risk.
 
Furthermore, there is evidence that when people who have active periodontal disease receive good dental care and improve their own oral hygiene, their vascular function improves. And one small study has even suggested that aggressive treatment of periodontal disease can potentially result in the partial reversal of vascular disease, as determined by the carotid intimal medial thickness test. (This, interestingly, was the same test that failed to improve with Vytorin therapy in the controversial ENHANCE trial, suggesting that simple oral hygiene may be able to accomplish something that even some expensive cholesterol drugs cannot.)
 
Of course, the link between oral hygiene and the prevention of heart disease has not yet been proven definitively with the sort of long-term, randomized clinical trials demanded by evidence-based medical purists. These trials, for instance, would demonstrate that the incidence of heart attacks and/or cardiac death is significantly reduced by good dental care. Perhaps in 10 or 15 years such evidence will be available (if somebody is willing to produce the $20 to $50 million that such a clinical trial would likely cost).
 
In the meantime, though, considering that good oral hygiene is known to produce several other benefits aside from a healthy heart (including the reduction in cavities, the preservation of teeth, the reduced risk of halitosis and — though this has not yet been proven in formal randomized clinical trials either — better sex), it seems advisable, to this cardiologist, for me to strongly recommend good oral hygiene to you.
_Sources:
Mochari H, Grbic JT, Mosca L. Usefulness of self-reported periodontal disease to identify individuals with elevated inflammatory markers at risk of cardiovascular disease. Am J Cardiol 2008; 102:1509-1513.
Tonetti MS, D'Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Engl J Med 2007; 356:911-20.
Piconi S, Trabattoni D, Luraghi C et al. Treatment of periodontal disease results in improvements in endothelial dysfunction and reduction of the carotid intima-media thickness. FASEB J 2008; DOI: 10.1096/fj.08-119578.