Brushes, not strokes

Cleaning your teeth to prevent heart attacks sounds like a medical intervention promoted by quacks on weird websites or in the less reliable pages of the tabloid press. However, there does appear to be a relationship between poor dental hygiene and risk of cardiovascular disease. And it is a link that may even offer an insight into what causes heart disease.

In a recent research paper published by the British Medical Journal (one that formed part of the Scottish Health Survey), 12,000 people were asked how often they brushed their teeth. Almost five per cent said “never” or “rarely”. These respondents were found to be 1.7 times more likely to have had a heart attack than regular brushers, when they were followed up over the course of eight years. A 2009 meta-analysis, looking at all the various studies in the field, indicated that people with periodontal disease also had higher rates of cardiovascular disease than people without it.

The research is muddied somewhat by several factors. People with cardiovascular disease are often smokers, and smoking is a cause of gum inflammation and heart disease. Association is not causation: perhaps people who don’t brush their teeth are also physically inactive or overweight (as the Scottish study also found). These researchers did correct for many – but not all – of these factors, but there does seem to be a weight of evidence linking teeth and the heart that needs now to be explained.

So, what could be happening? It wasn’t so long ago that doctors pooh-poohed the idea that bacteria cause stomach ulcers. But in 2005, two Australian doctors, Barry Marshall and Robin Warren, picked up the Nobel Prize for Medicine for demonstrating that bacteria known as Helicobacter pylori was indeed to blame. To prove it, Marshall and Warren infected themselves with the bug.

It’s long been known that people with cardiovascular disease tend to have higher levels of CRP (c-reactive protein), which rises in response to infection or inflammation. So, could bacteria play a more important role in heart disease than doctors have acknowledged? One bug, porphyromonas gingivalis, lives in the mouth but can also be found in the walls of arteries which are in danger of rupture.

There will need to be more studies. There have been trials to see whether administering antibiotics during heart attacks will improve outcomes, but writing as one who has issues with the preventative (over) medication we use to try to prevent heart attacks and strokes, I’d rather like it if toothbrushes were put to greater use.

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