Gum Disease, Heart Attack, and Stroke: How Are They Related

While anyone can be at risk for having a stroke, specific risk factors make some people more likely than others to have one. Studies suggest that gum disease may be one of these risk factors.

A stroke is a cardiovascular event that can cause permanent changes in a person’s motor function, cognitive ability, and general ability to live an independent life. It happens when the blood supply to part of your brain is interrupted due to a blood clot or a leak.

Medical professionals estimate that 1 in 4 people will have a stroke at some point in their life.

Maintain good oral hygiene both before and after a stroke to minimize your risk of further problems.

How Are Oral Health and Stroke Linked?

Over the years, researchers have consistently found a link between gum disease (specifically periodontitis, the most advanced form of gum disease) and stroke. Current estimates suggest that having gum disease makes you two to three times more likely to have a stroke than a person with healthy gums.

Researchers have not reached any decisive conclusions about how the relationship between these two factors works. They do not know if gum disease causes strokes, if there is a common underlying factor that makes a person more susceptible to both conditions, or anything else about what might be linking the two. 

Their best guess is that the long-term inflammation caused by gum disease burdens the body’s immune system and contributes to heart problems like stroke.

How are Oral Health & Heart Attacks Linked?

Similar to the available research linking strokes to gum disease, many studies have found a connection between heart attacks and gum disease. While there is much more research to be done to uncover the depth and inner workings of this connection, for now, it appears to be related to inflammation. 

To understand this, consider the cause of gum disease (periodontitis). It is the buildup of plaque and bacteria, which causes infection and inflammation in the gums. This inflammation triggers an immune response that can cause more damage to gums, feeding into a dangerous cycle of inflammation and damage. Eventually, gums and even bone are affected. 

These unhealthy oral bacteria can spread to other parts of the body, including the heart, through the bloodstream and respiratory tract. It can then cause and influence inflammation in these parts of the body, and it can contribute to chronic inflammation. 

Experts see a particular cardiovascular risk for patients who have gum disease and any of the following problems:

• Heart valve problems
• High cholesterol
• Blood vessel problems or inflammation
• Heart valve disease
• Bloodstream infections
• Artificial heart valves

How to Prevent Gum Disease 

Avoiding gum disease is a good idea for your oral health and heart health. You can prevent gum disease by doing the following: 

• Brush your teeth at least twice a day for at least two minutes each time.
• Floss your teeth at least once a day. Take care to slide the floss all the way down the tooth each time to clean under the gumline on each tooth.
• Eat a diet that is low in carbohydrates to avoid feeding the bacteria in your mouth.
• Avoid snacking outside of meals.
• Use mouthwash periodically throughout the day.
• Do not smoke or chew tobacco.
• Visit your dentist for cleanings at least once every 6 months.

If you already have early-stage gum disease (gingivitis), these tips can help you to reverse your condition and recover your oral health.

Oral Health Complications After a Stroke 

People who have had a stroke often face many oral health challenges during their recovery. They usually experience some lasting sensory and motor functioning difficulties, including these: 

• Muscle weakness 
• Lack of coordination, especially with fine motor movements 
• Paralysis of the tongue and mouth 
• Lack of sensation in the mouth 

These problems can make it difficult to brush properly or even hold a toothbrush. They may also make it difficult to recognize that there are leftover food particles in the mouth that should be brushed away.

Some patients experience significant cognitive issues after a stroke. They may be easily confused or disoriented, making it difficult for them to maintain an oral hygiene routine or even to recognize objects like a toothbrush or their dentures.

Many people who have had a stroke develop anxiety and depression, which can impact their motivation to care for their oral health. Even if they are physically able to brush and floss on their own, they may not be able to muster up the energy to do it.

Finally, many stroke patients are prescribed several medications during their recovery to help improve their functioning and reduce their chances of having another stroke. Xerostomia (or dry mouth) is a common side effect of these medications. This condition robs people of the protective effects of their saliva and significantly increases their risk of gum disease and cavities.

Tips for Good Oral Hygiene After a Stroke

If you or your loved one has had a stroke, you will need to adapt your oral hygiene routine in response. Here are some things you can do to make oral hygiene easier after a stroke:

• Create a structured environment for oral hygiene activities. Use the same sink in the same bathroom or kitchen every time you brush. Keep the toothbrush, floss, and other oral hygiene aids out on the counter to show what that space is for.  
• Use an electric toothbrush instead of a manual one. Electric brushes are easier to hold, don't require as much motor coordination to use, and provide superior cleaning that helps to keep gum disease under control.
• Consider using floss picks or a water flosser instead of string floss. These tools may be easier for stroke patients to hold and maneuver.
• Consider supplementing good oral hygiene practices with a chlorhexidine rinse. This can help to reduce gum swelling and improve overall oral health.

Acknowledge when help is needed. The vast majority of people who have had a stroke require help from another person to complete their oral hygiene routine. It may be necessary to have another person take over some oral hygiene tasks to keep the stroke patient’s oral health in check.

References

Stroke – Symptoms and Causes. (February 2021). Mayo Clinic.

Guidelines for the Oral Healthcare of Stroke Survivors. (2010). British Society of Gerodontology.

A New Management Approach for Dental Treatment After a Cerebrovascular Event: A Comparative Retrospective Study. (June 2010). Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics.

Stroke and Oral Health. (September 2008). Vital.

Periodontitis as a Risk Factor for Stroke: A Systematic Review and Meta-Analysis. (November 2019). Vascular Health and Risk Management.

Gum Disease and Heart Disease: The Common Thread. (February 2021). Harvard Health Publishing.

The Link Between Gum Disease and Heart Disease. Penn Medicine. 

Tackling Inflammation to Fight Age-Related Ailments. The New York Times. 

Gum Disease. (March 2020). HealthLink BC.

Stroke. (August 2017). College of Dental Hygienists of Ontario.