Is Gum Disease a Culprit Leading to Heart Disease?

If you ask most healthcare professionals how to avoid heart disease, chances are they will tell you to exercise, eat a healthy diet and lower your LDL cholesterol (with a statin if needed). At last count about 50 million Americans were taking a medicine such as atorvastatin, rosuvastatin or simvastatin to treat or prevent heart disease. Certainly high cholesterol and cardiovascular problems are linked. But could gum disease also be a culprit leading to heart disease?

Floss to Ward Off a Culprit Leading to Heart Disease:

We would be surprised if the usual advice on preventing heart disease included flossing your teeth regularly. That’s because it seems unrelated to the conventional idea that high cholesterol is the primary cause of heart disease.

Yet an analysis of data from the National Health and Nutrition Examination Survey (NHANES) shows that regular dental floss use may reduce the risk of atherosclerosis (Heart & Lung, May-June 2025).  People who reported flossing three or four days a week lowered their chance of a stroke, heart attack, angina or coronary artery disease by almost half.
That probably comes as a surprise to many cardiologists and primary care physicians. How could flossing make such a difference?

Periodontal Disease and Heart Trouble:

Decades ago, researchers had detected a link between gum disease and heart attacks (European Heart Journal, Dec. 1993, suppl.). Periodontal disease (gum infection) can trigger body-wide chronic inflammation. Cholesterol may not be the only factor clogging coronary arteries (atherosclerosis). Inflammation also contributes to the development of plaque in the lining of blood vessels (Current Pharmaceutical Design, 2012).

What Are Bacteria Doing in the Mouth?

Bacteria in the mouth may increase the risk of heart attacks. One study reported that germs such as Bacteroides, Sphingomonas and Serratia were more common in the mouth or blood of heart attack patients (Journal of Translational Medicine, July 16, 2025).

Another bad actor in the mouth is Porphyromonas gingivalis (Pg). This pathogen is associated with atherosclerosis and elevated heart attack risk (BMC Oral Health, Feb. 2, 2023).  The microbes spread throughout the body, burrow into the cells lining blood vessels and trigger an inflammatory reaction. Such a cascade of events leads to heart disease.

How Statins May Help:

Most cardiologists have focused on statins as preventive measures against heart disease because these drugs lower cholesterol. There may be another benefit from taking a statin, however. One way that statins may be reducing the risk of heart attacks is through an anti-inflammatory effect, including in the mouth (International Journal of Cardiology, Nov. 15, 2024). Maybe dentists should be prescribing statins to help treat gum disease and cardiologists should be referring their heart patients to periodontal experts.

What About Diet?

At least a decade ago, epidemiologists questioned the validity of standard dietary advice to avoid saturated fat for the sake of heart health. Over the last several decades, nutrition experts, dietitians and cardiologists have been warning Americans to cut back on sat fat found in meat, butter, cheese, whole milk and coconut. The theory was that saturated fat would raise cholesterol and clog arteries, leading to heart attacks and strokes. Hence the advice to eat a low-fat diet and take a statin.

Then a meta-analysis of 72 studies including more than 600,000 participants found that there was no association between saturated fat consumption and the risk of a fatal or non-fatal heart attack or heart disease (Annals of Internal Medicine, March 18, 2014). A blood fat marker for dairy fat consumption was inversely linked to a possible risk of heart disease. Should we conclude that fats from milk and dairy products might be protective rather than harmful?

Conversely, trans fats such as hydrogenated vegetable oils once promoted as heart healthy are actually the most clearly associated with coronary disease risk. This was the only significant association the meta-analysis found. This study made many nutrition experts uncomfortable because it challenged decades of dietary advice.

Butter Is Not the Only Culprit Leading to Heart Disease:

In fact, according to the meta-analysis, it may not be a culprit at all. This is not the first we heard of a change in position on saturated fat based on scientific evidence. An interventional cardiologist wrote in the BMJ in October, 2013, that “Saturated fat is not the major issue.” This was a controversial statement at the time, and probably remains so.

All this brings us back to flossing. Many people find flossing boring at best and annoying at worst. The benefit is fairly impressive, though. Dental floss is cheap and is not associated with severe side effects, yet people who floss are 24 to 32 percent less likely to suffer heart attacks, strokes or other cardiovascular complications.

Learn More:

Some of the guidelines to avoid heart disease don’t seem to have changed in years. One is what your grandmother told you: Eat your vegetables! This is the foundation for the evidence-backed DASH diet that lowers blood pressure and the Mediterranean diet that can reduce the risk of heart disease, stroke, dementia and diabetes. To learn more about how to follow such diets, you may be interested in our book,  The People’s Pharmacy Quick & Handy Home Remedies.

And if your grandmother didn’t urge you to brush your teeth and floss every day, she should have. It may be just as important as eating right.

Maybe it is time for cardiologists to prescribe flossing along with statins for patients at risk of heart disease. And dentists may want to refer their patients with gum disease to a cardiologist for a thorough workup.