It’s not just your smile that benefits from good oral health. By keeping your teeth and gums in good shape you could also be staving off heart disease, stroke and dementia, according to new evidence.
Researchers at the University of South Carolina are the latest to lay bare the risks of poor dental habits in a study that reveals an unhealthy mouth is associated with a 36 per cent greater likelihood of heart attacks and other cardiovascular problems. Reporting in the journal Neurology Open Access, the team also warned that people with both gum disease and cavities are at an 86 per cent greater risk of a stroke compared with those who have good dental habits.
Scientists are increasingly viewing the mouth as a gateway to serious disease. “When you have both tooth decay and gum disease, your mouth is constantly inflamed and full of harmful bacteria,” says Dr Saroash Shahid, a reader in dental anatomy at Queen Mary University of London. “These bacteria and the chemicals your body releases to fight them can leak into the bloodstream.” As blood vessels become less healthy, it increases the risk of clots forming and, in turn, your risk of stroke or heart disease. “When a particular bacteria called P. gingivalis enters the bloodstream, it can adhere to blood vessel walls,” says Dr Neil Sikka, director of dentistry at Bupa Dental Care. “That can lead to plaque build-up in the arteries, which accelerates the risk of heart disease.”
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The latest study monitored 5,986 adults in their fifties and sixties, none of whom had suffered a stroke when the investigation started, over 20 years. After accounting for variables such as age, body mass index and smoking, which all affect oral health, they found that those who visited their dentist regularly were 81 per cent less likely to have the gum disease and cavities tied to serious cardiovascular events, such as fatal heart disease and stroke, which cuts blood supply to the brain.
“This study reinforces the idea that taking care of your teeth and gums isn’t just about your smile; it could help protect your brain,” said Souvik Sen, a professor of neurology and lead author of the paper. “People with signs of gum disease or cavities should seek treatment not just to preserve their teeth, but potentially to reduce stroke risk.”
Taking good care of your teeth could even reduce your risk of dementia. A study in Neurology found gum disease and tooth loss were tied to shrinkage in the hippocampus, the part of the brain that plays a role in memory and Alzheimer’s disease. There’s evidence, too, that the delicate bacterial balance in the mouth, known as the oral microbiome, may be implicated in memory loss and dementia.
In a study of 115 midlifers published this year Anne Corbett, a professor of dementia research at the University of Exeter, found that certain types of bacteria in the mouth are associated with better memory, focus and attention, while others are linked to poor brain health and dementia. In future, she says, it could lead to the development of DIY tests to detect early signs that someone is at elevated risk of cognitive decline.
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“The potential for profiling dementia risk through at-home sampling is exciting,” Corbett says. “It is possible that the [oral] microbiome could form part of a battery of tests that would be used for this purpose.”
Oral hygiene — brushing twice a day and using floss or interdental brushes — remains the most important step, but thinking beyond that with steps that can improve our teeth and gums is increasingly considered a powerful way to protect against disease.
“People see their general health as separate from their oral health,” Sikka says. “They don’t see the mouth as connected to the body, yet the mouth-body connection is extremely strong.”
Here’s how you can improve the health of your mouth.
Make sure you get plenty of omega-3 fats in your diet
Omega-3 fats found in oily fish such as salmon have anti-inflammatory effects on the body
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We are all encouraged to eat more fatty fish for general health, but many of us don’t realise that the benefits of the essential healthy omega-3 oils they contain extend to improvements in our oral health.
“Omega-3 fats found in oily fish such as salmon, sardines and mackerel have anti-inflammatory effects on the body,” Shahid says. “Some studies show that when people with gum disease take omega-3s alongside dental treatment, their gums heal a little better.”
One recent investigation in the journal Scientific Reports suggested that combining omega-3 supplementation with regular exercise had a potent effect on lowering inflammation and helping the immune system to fight off chronic tooth root infections. It also helped to protect teeth from bone loss. The NHS recommends we eat at least one portion of oily fish a week. “Other good sources of omega-3 fats include flaxseed and walnuts,” Shahid says.
Take a daily beetroot shot and eat your leafy greens
Some beneficial oral bacteria are known to play a key role in turning nitrate to nitric oxide, which has been shown in numerous studies to relax and widen blood vessels and improve blood flow around the body, including to the brain. Research by Anni Vanhatalo, professor in the faculty of health and life sciences at the University of Exeter, and Corbett has shown that eating plenty of nitrate-rich foods, including beetroot, can help with that process.
In ongoing studies looking at the effects on oral health of taking a daily beetroot shot for 12 weeks Vanhatalo and Corbett have found that nitrate supplementation causes changes in mouth bacteria that are associated with healthier blood vessels and brain function as we age. They have also seen that levels of many harmful species of bacteria linked to inflammation decrease when beetroot shots are consumed.
“We have shown that chronic nitrate supplementation [with beetroot shots] increases the proportion of nitrite-producing oral bacteria,” Vanhatalo says. “This change is particularly beneficial in older people because as we age, our ability to produce nitric oxide via alternative pathways decreases.” Beetroot shots are one option, but leafy greens such as spinach, rocket and other salad leaves are also good sources of dietary nitrate. “We know that a nitrate-rich diet such as the Mediterranean diet or Dash diet is an effective intervention to reduce the proportion of potentially harmful oral bacteria,” Vanhatalo says.
Regularly exercise
Staying fit has benefits for your oral health, as a recent review in the Journal of Family Medicine and Primary Care demonstrated. Dental researchers looked at the effects of regular intense physical exercise — running, cycling, swimming and competitive sports — and found that the physically active “have lower levels of inflammatory biological markers, which is linked to better oral health”.
They also revealed that regular exercise has a positive effect on salivary antigens, substances in saliva that can trigger a positive immune response, as well as improved oral muscle strength.
“Exercise improves blood flow, lowers levels of inflammation in the body that exacerbate gum disease, and helps control conditions like diabetes and high blood pressure that can make gum problems worse,” Shahid says. “While a workout in the gym won’t clean your teeth, staying active supports the gums and tissues that keep them in place.”
• Read more expert advice on healthy living, fitness and wellbeing
Get plenty of fibre
Few of us get the recommended 30g of fibre a day that the NHS says we need for good health. We tend to think of fibre as improving our gut health and digestion, but its effects are far-reaching and by increasing our intake with more wholegrains, fruit and vegetables, we may inadvertently boost the health of our teeth and gums. A review by dental experts from Australia, New Zealand and India found that people who consumed 22-30g of fibre daily had less swelling of the gums, less plaque build-up and stronger tissues surrounding the teeth. It suggests “a fibre-rich daily diet may offer promise as a complementary approach for the prevention and management of periodontal diseases”, the researchers said.
Crunchy foods such as celery, raw carrots and peppers promote oral health not just because of the immune enhancing antioxidants they contain, but because they physically scrub the teeth as you chew them. Think of them as nature’s own interdental brushes, Sikka says. “All high-fibre foods act a bit like a natural cleanser as they rub against your teeth when you chew,” he says. “In addition, the chewing they require stimulates saliva production, which, in conjunction with good brushing and flossing habits, helps to remove plaque from the teeth.”
Eat cheese after a meal
Cheese helps to neutralise acid levels in the mouth
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Cheese is good news for your oral health. “It is not only rich in calcium and phosphorus, which strengthen your tooth enamel, but cheese also helps to neutralise acid levels in the mouth,” Sikka says.
Consuming a small piece of cheese after eating acidic foods or drinks — ultra-processed foods and fizzy drinks — can help to raise pH levels in the mouth, reducing levels of bacteria that over a long term can lead to decay.
In a small trial at Western Kentucky University researchers gave participants 28g of mild cheddar 60 seconds after they had sipped some cola. Tests showed that the cheese helped to “provide a protective shield around the teeth that fights the release of acids”, the researchers wrote. Cheese also increases the flow of saliva, preventing bacteria from sticking to tooth surfaces.
Consider a deep-cleaning treatment
Data from the latest Adult Oral Health Survey commissioned by the Department of Health and Social Care suggests that in England 19 per cent of adults and up to 28 per cent of those aged 55-64 said they had been told they had gum disease. Gum disease can be treated on the NHS — national guidelines include deep cleaning under local anaesthesia as part of the programme.
Dr Marco Orlandi, honorary associate professor at the UCL Eastman Dental Institute, recently published findings of a two-year clinical trial in the European Heart Journal that found that this type of deep cleaning can reduce the risk of developing cardiovascular disease by 10 per cent each year compared with those who underwent a routine scale and polish. By reducing the amount of gum inflammation and bacteria entering the bloodstream, the deep cleaning helped to slow the thickening of the carotid arteries, the blood vessels supplying oxygen to the brain, face and neck.
“Our trial did not include measures of cognitive function,” Orlandi says. “But it is plausible that arterial changes could support a modulation of the risk of neurodegenerative conditions such as dementia.”
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