Watch: How is gum disease linked to heart problems and diabetes?

Watch our animation to discover why brushing your teeth can help your cardiovascular system, and get answers to some common questions about oral health and heart conditions.

How do I prevent gum disease?

Brush your teeth, particularly after meals so you can more easily remove food debris and plaque trapped between your teeth and gums. Also brush your tongue; this will help get rid of bacteria too.

Change your toothbrush around every three months. Look out for the bristles starting to bend, as this is a good sign you need a new one. Stand the toothbrush upright and let it air-dry between each use, as this can help reduce the bacteria.  It doesn't matter whether you use an electric or manual toothbrush. They're both equally good, as long as you thoroughly brush all the surfaces of all your teeth for at least two minutes twice a day, and you use fluoride toothpaste. However, because of the rotating action of electric toothbrushes some people find it easier to clean their teeth thoroughly with them.

Flossing helps remove food particles and plaque between teeth and along the gum line, which your toothbrush can’t reach

Don't rinse with water immediately after brushing your teeth as it will wash away the concentrated fluoride in the remaining toothpaste, diluting it and reducing its preventative effects.

Floss at least once a day, using a different part of the floss for each tooth. It's best to floss before brushing your teeth. Take 12-18 inches (30-45 cm) of floss or dental tape, and grasp it so you have a couple of inches of floss taut between your hands. Slip the floss or dental tape between the teeth as far as it will go. Floss with 8-10 strokes, up and down between each tooth. This helps remove food particles and plaque between teeth and along the gum line, which your toothbrush can’t reach.

Mouthwash can help reduce plaque and can remove any remaining food particles that brushing and flossing missed. Use a mouthwash containing fluoride, but don’t use it after your brushing your teeth, as this can wash away the fluoride from your toothpaste. Instead choose another time to use mouthwash, such as after lunch, and don’t eat or drink for 30 minutes afterwards.

Attend regular dental check-ups, and speak to a dental hygienist who could help clean and remove any hardened plaque.

What’s the difference between gum disease, periodontitis, and gingivitis?

Gingivitis (gum inflammation) usually happens before periodontitis (gum disease). However, not all gingivitis progresses to periodontitis. Gingivitis can be treated so it doesn’t progress to periodontitis.

How do I know if I have gum disease?

The surest sign of gum disease is inflammation. Gingivitis can cause red, painful, and tender gums. Periodontitis can then develop, which can cause bad breath and affects the tissues that hold your teeth in place. If periodontitis isn’t treated your jaw bone may become damaged, and your teeth can become loose and eventually fall out.

Toothbrush toothpaste mouthwash and dental floss

Brushing regularly with fluoride toothpaste, flossing and using mouthwash can help prevent gum disease

Should I tell my dentist and hygienist if I have a heart condition?

Yes, and make sure that your dentist always has a list of all the medicines you take. It should include prescription drugs, over-the-counter medicines, vitamins, herbal pills and other nutritional supplements. Your list should include the name of each drug, the dosage, how often you take it and when your physician prescribed it. Put the date that you made the list at the top of the page. This will let the dentist know that it is a current list.

Will I need antibiotics before a dental procedure?

You may do, but this largely depends on your heart condition and the type of procedure. 

Infective endocarditis is a rare but serious disease caused by oral bacteria known as streptococci, which can cause unwanted clot formation on heart valves. It is difficult to treat and is associated with a high mortality rate. In the past, people at risk of endocarditis, such as those with heart valve problems, were often given antibiotics before dental procedures. There are also growing concerns around evidence that antibiotic resistance is due to inappropriate use of antibiotics.

The final decision will be based on the dentist's clinical judgement

The National Institute for Health and Care Excellence (NICE) recommend that dentists no longer routinely give antibiotics to protect against endocarditis in high risk patients. However, the final decision will be based on the dentist's clinical judgement, and where necessary the dentist will seek advice from cardiologists or physicians.

Regardless of whether or not you receive antibiotics prior to a dental procedure, people at risk of endocarditis should take extra care to maintain an excellent standard of oral hygiene, know the symptoms of endocarditis, and seek medical advice urgently if symptoms develop.

If I’m on warfarin do I need to be more careful brushing my teeth?

You can brush your teeth as normal but be aware of any blood on your toothbrush or when you spit the toothpaste out, and of bleeding gums. If you notice any of these things, seek medical attention. You're at greatest risk of bleeding in the first few weeks of starting treatment with warfarin and when you're unwell. Bleeding is the main side effect associated with warfarin, as it slows down the blood's normal clotting ability.

Your dose of warfarin may need to be lowered or stopped a few days before having an operation or dental work

Tell the dentist that you're taking warfarin. Make sure your dentist knows any other conditions that you have, and any other medication that you’re on. You can also show your dentist your INR record booklet.

In most cases your dentist will be able to carry out dental treatment as usual, but because of the risk of bleeding, your dose of warfarin may need to be lowered or stopped a few days before having an operation or dental work.

Do some drugs for heart and circulatory conditions damage your teeth and gums?

Calcium channel blockers (such as nifedipine, amlodipine, and verapamil) have been associated with an increase in the size of the gums or overgrown gums (gingival enlargement), but this is quite rare. You can prevent this by maintaining good oral hygiene. If you have gingival enlargement due to the medicines you’re taking, some symptoms include:

  • swollen and firm gums, but your gums do not feel tender when touched and aren’t bleeding
  • your gums look overgrown.  

Contact a dentist if you are on calcium channel blockers and spot the above symptoms.

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