Keep your teeth clean, keep your heart healthy

The purpose of toothbrushing is to clean our teeth. And we do achieve this goal when we perform this routine task 2 to 3 times a day. But what we don’t know is that during toothbrushing, we are also introducing bacteria into our bloodstream, probably through breaks and cuts in our gums.

A recent article in the journal Circulation reported that good dental hygiene is important in the prevention of heart valve infection.

The researchers studied 290 dental patients and measured bacteremia, which is the number of bacteria released into the bloodstream during performance of 3 different dental activities, as follows:

• Toothbrushing
• Single tooth extraction plus antibiotic (amoxicillin)
• Single tooth extraction plus placebo.

The results showed that bacteremia is highest in the patients who underwent extraction plus placebo. This is really not surprising. What is surprising – and troubling – is the high incidence of bacteremia during tooth brushing – with values which are too close to extraction measurements for comfort. In addition, the bacteria can persist in the blood for as long as an hour after the extraction or tooth brushing.

“This suggests that bacteria get into the bloodstream hundreds of times a year, not only from tooth brushing, but also from other routine daily activities like chewing food,”

according to Peter Lockhart, lead author of the study.

In additional to bacteremia measurements, the researchers also looked for the presence of bacterial species which are linked to infective endocarditis (IE) which is “a rare but life-threatening infection of the lining of the heart or heart valve that can occur when bacteria enter the bloodstream.” It has been previously reported that introduction of bacteria during dental procedures is linked to the development of IE.

From the blood samples of the dental patients analyzed, the incidence of IE-related bacteremia is as follows:

• 23% in the tooth-brushing group
• 33% in the extraction plus antibiotic group
• 60% for the extraction-placebo group

Now this doesn’t mean to say that we should stop brushing our teeth altogether. In fact, poor oral hygiene can actually increase the risks because it can cause chronic mouth infections such as gum disease and tooth decay. These infections in turn heighten the risk for IE. What we should probably do is to make sure that our toothbrushes are cleaned properly and cleaned regularly.

The antibiotic amoxicillin used in the study seems to have a prophylactic effect but did not fully prevent bacteremia.

The American Heart Association recommends the use of preventive antibiotics during dental procedures for patients at the highest risk for IE, namely patients described below:

patients with a prosthetic cardiac valve or prosthetic material used for cardiac valve repair;

previous endocarditis;

cardiac transplantation recipients who develop cardiac valve abnormalities;

congenital heart disease for unrepaired cyanotic congenital heart disease, including palliative shunts and conduits; completely repaired congenital heart defect with prosthetic material or device, during the first six months after the procedure; or repaired congenital heart disease with persisting leaks or abnormal flow at the site or adjacent to the site of a prosthetic patch or prosthetic device.