Gum Disease and the Connection to Heart Disease and Strokes

In 2016, Drs. Bradley Bale and Amy Doneen published an article proving that certain periodontal bacteria are a contributing cause to cardiovascular disease. This landmark study was published in the Postgraduate Medical Journal (PMJ) and is the first to identify a causal link of this kind.  Their study states that bacteria responsible for Periodontal Disease (gum diseases) can contribute to cardiovascular disease – the leading killer of Americans. Their research includes a scientific statement from the American Heart Association that provides level A evidence between Periodontal Disease and Heart disease.

Biological Basis for the Link

It is well documented in the literature that gram-negative anaerobic bacteria are the causative agents responsible for Periodontal Disease.  The bacterial pathogens identified are Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Tannerella forsythia (Tf), Treponema denticola (Td) or Fusobacterium nucleatum (Fn). These bacteria can initiate a series of inflammatory and immunologic host changes that ultimately lead to destructive effects, such as bone and tooth loss.1,2  

Prior to the destructive effects, bleeding of the gums is typically seen.  Bleeding gums are not normal. Bleeding is a sign of inflammation and a warning flag. Would you leave a bleeding wound on your arm day after day? Would you consider a little blood in your urine normal? No. When the gums bleed, the bacteria in the mouth are able to enter our blood stream and travel to other parts of our body. There are published studies on people who have died of a heart attack and found have similar gram negative oral bacteria in the clot that caused the heart attack. How do you think it got there?

Think about this: your skin is your barrier that protects you from all of the harmful things in the outside world. The gum tissues in our mouths act in the same manner. That barrier needs to have a tight seal in order to do its job.

What Do We Know

Periodontal bacteria can enter the bloodstream and travel to major organs (Figure 1), where it can begin new infections. The research suggests that this process may:3

  1. Contribute to the development of heart disease, the nation’s leading cause of death
  2. Increase the risk of stroke
  3. Increase a woman’s risk of having a preterm low birth-weight baby
  4. Pose a serious threat to people whose health is already compromised by diabetes, respiratory diseases, or osteoporosis

The significant findings that Periodontal Disease is a serious risk factor for many systemic diseases reflect a paradigm shift in the management of their patients. The traditional role of a dentist was from a “repair of damage” mode. Now the emphasis will be on “proactive” to prevent the disease from occurring. Dentists will be the first line of defense to provide an in depth evaluation of your periodontal status and share this information with physicians to provide a risk reduction treatment protocol that could potentially save your life.

Based upon the current research, it is clear than gum disease increases your risk of a heart  attack and stroke compared to people with good oral health. Contact your local periodontal partner at  Dr. Tassos Sfondouris  301-652-2300 for a complimentary consultation to evaluate the health status of your gums.

Figure 1: Periodontal Disease and Links to Other Systemic Conditions


1.Kunzel C, Lalla E, Albert D, et al. On the primary care frontlines: The role of the general practitioner in smoking-cessation activities and diabetes management. JADA. 2005;136:1144-53.

2. U.S. Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: 2000.

3. Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann. Periodontol. 1998;3: 251-6.