Heart disease is the leading cause of death in the United States, and, despite public opinion, it is just as deadly for women as it is for men. The illness was responsible for a staggering one in every four male deaths and one in every five female deaths in 2021, according to the U.S. Centers for Disease Control and Prevention. And yet, it is preventable 90 percent of the time with the right lifestyle choices, such as saying goodbye to cigarettes, eating a healthy diet, exercising regularly, reducing alcohol intake and keeping stress at bay.

Other powerful precautions relate to oral health. Left untreated, gum disease and sleep apnea have the potential to cause dire cardiovascular consequences. The good news is that treatments are available to decrease and often eradicate their threat. 

Gum Disease and the Heart

Although blood pressure and cholesterol are considered major risk factors for heart disease, there is another culprit that should not be ignored: inflammation. While arterial inflammation may be the vascular response to harmful assaults such as infections or injuries, it can also arise when there is an imbalance in the gut microbiome or inflammation of the gums—also known as periodontal disease. 

According to the National Institutes of Health, gum disease affects 47 percent of adults aged 30 or older and 70 percent of adults by age 65. Bleeding gums are telltale signs of gingivitis, which can promote the growth of disease-causing bacteria and produce substantial, body-wide inflammation.

A 2021 study published in Scientific Reports evaluated the effect that oral health problems had on all-cause, cardiovascular disease and respiratory mortality. Scientists followed almost 3,000 white and African American men and women aged 70 to 79, as well as just over 7,700 British men aged 40 to 59 for nine and 15 years, respectively. Researchers reported that periodontal disease was associated with increased cardiovascular mortality in the American group, a finding that was consistent with a similar study of older people in Taiwan. The scientists also noted that tooth loss and cumulative oral health problems correlated with higher all-cause mortality and higher respiratory mortality, while dry mouth appeared to be related to only all-cause mortality.

A 2012 study published in Kardiologia Polska of people with diabetes and periodontal disease showed that gum inflammation was highly correlated with increasing arterial plaque, as well as increases in markers of inflammation and blood pressure levels, suggesting a significant connection between periodontal disease and an increased risk of atherosclerosis. 

Another study published in 2013 in the Journal of the American Heart Association followed more than 400 subjects over three years and found that greater gum inflammation and higher growth of pathological bacterial species in the gums were strongly associated with increased growth of arterial plaque. The researchers concluded that an improvement in periodontal status was associated with less progression in carotid atherosclerosis, thereby emphasizing the importance of gum care as a possible preventive health measure. 

Preventing Gum Inflammation

In addition to a healthy diet, exercise and stress management, taking measures to improve dental hygiene will go a long way toward reducing the risk of heart disease. A dental hygienist can easily identify gingivitis and probe for deep gum pockets—an indication of periodontal disease—while a simple saliva test can determine the presence of disease-causing gum species. The following measures are recommended: 

• Brush teeth for two minutes twice daily, ideally with an electric toothbrush. 
• Floss and use a Waterpik every day.
• Visit the dental hygienist two to four times per year for a thorough cleaning. 
• Have the dentist measure gum-pocket depth to check for inflammation.
• Especially for those with gum disease, have saliva tested for bad bacteria at least annually.

Sleep Apnea

Considered and treated as an oral health issue, sleep apnea increases the risk for heart disease. According to the American Medical Association, approximately 30 million Americans experience sleep apnea, but only 6 million are diagnosed with the condition where breathing and air flow repeatedly stops and starts. People that suffer from this ailment are more likely to experience abnormal heart rhythms, hypertension, heart attacks, strokes and diabetes, the Mayo Clinic cautions.

Sleep apnea gradually worsens over time. As the airway increasingly fails to deliver air to the lungs, oxygen levels drop, causing adverse impacts on the heart and brain. Three factors decrease airflow: weight gain, aging and, for some people, genetics. When a person puts on extra weight, their neck thickens, diminishing the airway, and as we age, tissues in the neck become softer and sag. 

The symptoms for sleep apnea include excessive daytime sleepiness, loud snoring, noticeable stops in breathing at night, awakening with a dry mouth and morning headaches. These symptoms should prompt a discussion with a physician or dentist to schedule an overnight sleep test to confirm a diagnosis—either in a sleep laboratory or at home, depending on the degree of symptoms.

The mainstay of treatment for those with sleep apnea is a continuous positive airway pressure (CPAP) device worn over the nose or mouth to maintain pressure in the airway, keeping it open during sleep. Alternatively, a dentist can fit a patient with a mandibular device to help open the airway. The implement looks like a mouthguard that pushes the jaw forward to make the airway larger and improve airflow at night.

Another technique is to tape a patient’s mouth shut while sleeping to force breathing through the nose. Continuous nose breathing helps promote nitric oxide in the bloodstream, which induces the relaxation and dilation of blood vessels and airways. Duct tape or another household tape should not be used for this, as there are specially designed, hypoallergenic strips that are shaped to sit directly on the lips. Some have a small vent that allows for a little mouth breathing. In a small study published in JAMA Otolaryngology–Head & Neck Surgery, mouth taping led to significantly less snoring and fewer instances of lapsed breathing in 30 patients with mild sleep apnea.

After starting a chosen therapy, the overnight sleep test should be repeated to confirm that the airway is open and adequate oxygenation levels are being maintained. Additional tips to reduce sleep apnea include:

• Lose weight. According to the Sleep Foundation, a loss of 5 to 10 percent of total weight improves obstructive sleep apnea by 38 percent, and weight loss of more than 10 percent results in a nearly 49 percent improvement. 
• Avoid alcohol and sleeping medications before bedtime, which suppress breathing and cause the airway to sag.
• Change from back-sleeping to side-sleeping. More than 50 percent of people with sleep apnea find that their symptoms worsen when they sleep on their backs.

Steven Masley is a physician, nutritionist, trained chef, clinical professor at the University of South Florida, chief medical director of KnoWEwell and creator of health programs for public television. He is the author of The 30-Day Heart Tune-Up. Connect at drmasley.com.