According to the U.S. surgeon general’s office the mouth is a mirror of health or disease and could work as a sentinel to warn about potential threats to our well-being. But are we really acquainted with what’s going on in our oral cavity and the factors jeopardizing our oral health? Let’s explore what’s behind our 32-teeth smile. 

Each one of our teeth is embedded firmly in our gums.  Under each tooth there is the alveolar bone and the periodontal ligament. The latter creates a soft bearing that prevents bone and tooth from rubbing.  In addition, our mouth is populated by six billion bacteria that live with us our entire life and that are essential for the health of our oral cavity,  but that could also be dangerous if our oral hygiene is poor. Streptococcus oralis, Streptococcus sanguis, Streptococcus mutans, Actinomyces  naeslundii, Actinomyces odontolyticus, Veillonella parvula and Fusobacterium nucleatum are some of the most common bacteria species living on our teeth and gums and are the main components of a sort of film called dental plaque, which forms when bacteria in our mouth mix with sugary or starchy foods.

Dental plaque can be removed by brushing and flossing, but if it’s allowed to accumulate it can get harden and get into mouth niches like the gingival sulcus (the space between your teeth and your gums) or the periodontal space, where your toothbrush or dental floss can’t reach.

The progressive spreading of dental plaque allows some species to become more numerous than others, resulting in gum inflammation, also known as gingivitis. If untreated,  gingivitis could result in periodontitis or gum disease. According to the WHO, gum disease is the 12th most prevalent condition around the world. The risk factors connected with the development of gum inflammation are smoking, drug use, stress, malnourishment and incorrect or insufficient oral care. Each of these behaviors are dangerous because they can either exacerbate the inflammation, undermine mouth equilibrium or worsen the functioning of the immune system. Keep the following warning signs in mind to evaluate the health of your gums: 

-red, swollen or bleeding gums

– bad breath

– sensitive teeth (to hot/cold food and beverages)

– pain while chewing

– tooth mobility

Periodontitis can lead to gum abscesses, loss of teeth and the potential risk of developing systemic complications. It has been demonstrated that subjects affected by periodontal disease have a risk of myocardial infarction 28% higher than people with healthy gums.

a man touching his heart, with red highlight of heart attack, heart failure and others heart disease
Periodontal disease increases the risk of myocardial infarction by 28%.

In fact, the DNA of periodontal bacteria has been found in atherosclerotic plaque specimens. But what is the link between periodontitis and cardiovascular diseases? One potential explanation is that bacterial biofilms (dental plaque) cause the surplus of microorganisms to enter the bloodstream, allowing them to stay in the blood vessels or to get into different tissues and/or organs. Another hypothesis consists in an inflammatory state triggered by periodontitis that activates the immune system. This activation leads to proteins depositing in the blood vessels which, together with damage provoked by free radicals and immune cells, leads to the formation of plaque which occludes the vessel. At the same time inflammation around the plaque is pushed to rupture by microorganisms circulating in the bloodstream putting people in danger of thrombosis or myocardial disfuncion. It has also been demonstrated in experiments conducted on mice that one of the bacteria living in the mouth, P. gingivalis, is able to induce platelet aggregation and occlude vessels leading to embolism. A Chinese study underlines how the gum plaque bacteria byproducts and bacteria themselves have been detected in patients’ trombi and in atherosclerotic plaque fragments. This complex evidence and explanations should be taken as a warning to take better care of our oral hygiene: brushing our teeth after every meal, quitting smoking, stop using drugs, trying to manage stress, eating less sugary food and beverages and scheduling periodic professional plaque removal. 

Still not convinced these actions could protect you from cardiovascular disease?    

In a Japanese study, infrequent toothbrushing increased the incidence of risk factors for cardiovascular disease, while a Korean research study found an association between caries and heart problems. Daily toothbrushing resulted in a 20% lower risk of myocardial infarction. See? Good habits bear fruit!