Your Heart and Your Teeth: The Cardiovascular Connection Every South African Should Know

South Africa has one of the highest rates of cardiovascular disease in the world. Heart attacks and strokes are among our leading causes of death — and most South Africans know the established risk factors: high blood pressure, high cholesterol, smoking, and a sedentary lifestyle.

What far fewer people know is that gum disease is independently associated with cardiovascular disease — and that treating gum disease may actually help protect your heart.

At Smilez Dental Surgery, we routinely discuss this connection with our patients, because understanding the mouth-heart relationship can quite literally save lives. This is not speculation or fringe medicine. It is supported by decades of epidemiological research and increasingly integrated into mainstream cardiology practice internationally.

The Science Behind the Connection

The mouth contains hundreds of species of bacteria. When gum disease is present, the gum tissue becomes inflamed, ulcerated, and chronically infected — creating an entry point for bacteria and their toxic by-products to enter the bloodstream.

Once in the bloodstream, oral bacteria can:

Travel to and colonise the inner lining of the heart (endocardium), potentially causing a condition called infective endocarditis — a serious and potentially life-threatening infection of the heart valves.

Contribute to the formation of atherosclerotic plaques in arterial walls. Multiple studies have found oral bacteria — particularly Streptococcus mutans and Porphyromonas gingivalis — within the arterial plaques of heart attack patients.

Trigger a systemic inflammatory response through the release of C-reactive protein (CRP) and other inflammatory markers. Chronic low-grade inflammation is now understood to be a central driver of cardiovascular disease, and gum disease produces exactly this type of sustained inflammatory state.

What the Research Shows

The body of evidence connecting gum disease and cardiovascular disease is substantial and growing.

A landmark study published in the British Medical Journal found that people who reported infrequent tooth brushing had a significantly higher risk of cardiovascular events, and higher blood levels of inflammatory markers, than those who brushed twice daily.

Research published in the European Journal of Preventive Cardiology demonstrated that patients who underwent regular professional dental cleaning had a significantly lower risk of heart attack and stroke compared to those who did not.

The American Heart Association has formally reviewed the evidence and while stopping short of calling the relationship causal — it is methodologically difficult to fully control for all confounding variables — it acknowledges that the association is consistent, biologically plausible, and clinically relevant.

A 2019 study involving nearly 161,000 participants in South Korea found that those who maintained better tooth-brushing habits had a measurably lower risk of atrial fibrillation and heart failure — suggesting the relationship holds across very different populations and healthcare systems.

Infective Endocarditis: The Most Direct Link

While atherosclerosis represents the gradual end of the heart-oral health relationship, infective endocarditis represents the acute one. This serious infection of the heart valves occurs when bacteria — most commonly oral bacteria — enter the bloodstream and colonise damaged or abnormal heart tissue.

Patients who have congenital heart defects, artificial heart valves, a history of rheumatic heart disease, or certain other cardiac conditions are at significantly elevated risk of infective endocarditis. For these patients, even a routine dental cleaning can theoretically provide an entry point for bacteria into the bloodstream.

This is why patients with these conditions are typically prescribed antibiotics before certain dental procedures — a practice called antibiotic prophylaxis. It is absolutely essential that patients in this risk category inform their dentist about their cardiac history before any appointment.

Periodontal Disease and Stroke

The connection between gum disease and stroke follows similar pathways to the heart disease relationship. Several studies have found that people with severe gum disease have a significantly elevated risk of ischaemic stroke (the most common type, caused by a blood clot blocking a brain artery).

The proposed mechanisms include both the direct effect of oral bacteria reaching the cerebral vasculature and the systemic inflammation that gum disease produces — which promotes clot formation and arterial damage throughout the vascular system, not only in the coronary arteries.

What This Means for Your Dental Care

This research has practical implications that go beyond oral health:

Treating gum disease is heart-protective behaviour. Patients with existing cardiovascular disease should be particularly diligent about their gum health — and their cardiologist and dentist should ideally communicate about their care.

If you have known heart disease, artificial heart valves, or a history of endocarditis, always inform your dentist before any treatment. This is not optional — it is medically critical.

Twice-daily brushing and daily flossing are not vanity habits. They reduce the bacterial load in the mouth, limit gum inflammation, and decrease the systemic inflammatory burden on the body — including the cardiovascular system.

Professional cleaning every six months removes the calcified bacterial deposits (tartar) that cannot be removed by brushing alone. For patients with existing cardiovascular disease or poorly controlled gum disease, more frequent professional cleans may be recommended.

The Bigger Picture: Your Mouth as a Window

Dentistry has traditionally been siloed from general medicine — a situation that is slowly changing as the evidence for systemic oral health connections accumulates. We look at the mouth not as a separate system but as a part of the whole person sitting in our chair.

When we identify severe, unexplained gum disease, we ask about blood glucose. When we see dry mouth and a worn dentition, we ask about medications and sleep quality. When we find significant periodontitis in a patient we know is at cardiovascular risk, we treat it with urgency — not just because of their gums, but because of their heart.

Taking care of your teeth is taking care of yourself. It has always been true. The science is simply making it increasingly impossible to ignore.

Ready to take control of your oral health? Contact Smilez Dental Surgery today at 013 692 8249 or visit us at Tasbetpark Center, 8 Boekenout Street, Shop no.3, Witbank. We're your partner in building a healthier, happier smile.