This is another column in a series about major risk factors for heart attacks. Dental disease is another one.

The main mouth-heart connection is the food people put in their mouths — heart healthy or not. But there are other connections.

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The mouth has a microbiome, just like the gut microbiome. In their book “Healthy Heart, Healthy Brain,” Bale and Doneen state that “your mouth is home to more than seven hundred species of bacteria, most of which are harmless or even beneficial.” During dental procedures, including cleaning, some of these bacteria enter the blood stream, which usually isn’t a problem except in people with prosthetic heart valves, in which case prophylactic antibiotics are indicated to prevent serious infection.

The real issue this column is meant to address is the relationship of tooth and gum disease to development of atherosclerosis, the cause of heart disease — and to the heart attack-causing rupture of atherosclerotic plaque. There are five species of harmful mouth bacteria. When these bad bacteria enter the bloodstream — which can happen just by chewing, brushing, and flossing — they can create inflammation, which contributes both to formation of artery plaque (not to be confused with dental plaque) and plaque rupture.

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The early stage of gum disease is called gingivitis, which can cause bleeding but is often asymptomatic. This condition can progress to periodontitis, which can result in slow, progressive destruction of bone that surrounds teeth. These dental problems are usually caused by harmful mouth bacteria. Factors that encourage these bad bacteria to flourish include: smoking, poor oral hygiene, stress, obesity, insulin resistance (prediabetes), and an unhealthy diet.

Bale and Doneen, who have established a relationship with the prestigious Johns Hopkins Medical School, published an article in Postgraduate Medical Journal explaining how the five harmful varieties of mouth bacteria cause heart disease: They make the inner lining of arteries more permeable and easier for LDL (bad cholesterol) particles to penetrate. They also make the inner layers of the arterial wall—where plaque forms — stickier, so LDL is more likely to get trapped there and create plaque.

Following are steps that people can take to insure optimal mouth and therefore ootimal arterial health:

• Have a discussion with your dentist about a plan to prevent, treat or reverse gum and tooth disease.
• Ask your dentist to screen for tooth and gum disease including x-rays to check for bone loss; and checking with a periodontal probe (healthy gum pockets are 1-3 mm in depth, deeper pockets are unhealthy).
• Especially if you have atherosclerosis, based on carotid IMT or coronary calcium score screening; or have had a cardiovascular event (heart attack or stroke); or have undergone stents or bypass procedures, ask for a saliva screen to check for the five high-risk bacteria.
• Brush after meals. At night floss using proper technique, and use a water pick.
• Bleeding gums is not normal: don’t ignore it, get it checked out.
• Get a dental cleaning at least twice a year — more often if recommended.
• The bacteria that cause tooth decay have also been linked to heart attacks, so avoid cavity-causing sugar, especially sugary drinks (which includes fruit juice) — which applies both to adults and children.

There are a few dental providers in the area who have particular interest in and knowledge about the mouth-heart connection, including Lauren Roper, DDS, of New Castle Dental, who has attended one of the Bale-Doneen Method preceptorships.

Dr. Feinsinger is a retired family physician with special interest in disease prevention and reversal through nutrition. Free services through Center For Prevention and The People’s Clinic include: one-hour consultations, shop-with-a-doc at Carbondale City Market, and cooking classes. Call 970-379-5718 for appointment, or email gfeinsinger@comcast.net