How Gum Disease and Coronary Artery Function Are Connected—What New Research Means for Adults Over 55

If you're in your late 50s, 60s, or early 70s—and have been diagnosed with stable angina—you may already be paying close attention to your heart health. But what if we told you that something happening in your mouth could quietly influence how well your coronary arteries work? That’s the focus of a growing body of science—and especially the groundbreaking PERIODONT-HEART Trial, published in 2023. This study offers some of the clearest evidence yet on how gum disease and coronary artery function are linked—not through guesswork or association, but through direct imaging and physiological measurements.

It’s important to know this isn’t about alarm: most adults with gum disease don’t go on to develop serious heart complications. And conversely, many people with stable angina have healthy gums. Still, understanding this connection helps you make more informed, everyday choices—especially when it comes to managing inflammation, supporting circulation, and staying proactive about both oral and cardiovascular care. A common misconception is that “gum disease is just about teeth”—but in reality, chronic gum infections can trigger low-grade, whole-body inflammation that reaches far beyond the mouth. Another myth is that once angina is stable, nothing else needs adjusting—but small, consistent habits do add up over time.

Why Gum Disease and Coronary Artery Function Matter

The link between gum disease and coronary artery function isn’t about bacteria traveling directly from mouth to heart (a frequent oversimplification). Instead, it centers on inflammation—the body’s natural defense system gone slightly off-track. In adults aged 58–74 with stable angina, chronic periodontitis (a severe form of gum disease) keeps immune cells gently but persistently activated. This leads to elevated levels of inflammatory markers like C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α)—all of which are known to affect the endothelium: the delicate inner lining of blood vessels.

In the PERIODONT-HEART Trial, researchers used two advanced tools to observe this effect firsthand. First, contrast-enhanced cardiac MRI measured microvascular perfusion—the tiny capillary-level blood flow within heart muscle tissue. Second, brachial artery flow-mediated dilation (FMD) assessed how well blood vessels respond to increased demand—a reliable proxy for coronary endothelial health. What they found was striking: participants with moderate-to-severe periodontitis showed, on average, a 19% reduction in FMD response and a measurable delay in myocardial perfusion reserve—meaning their coronary microvessels were less able to “open up” when needed.

Importantly, these changes weren’t linked to traditional risk factors like cholesterol or blood pressure alone. Even after adjusting for age, BMI, smoking history, and diabetes status, the association between gum disease severity and impaired microvascular function remained statistically significant. That tells us gum health is an independent piece of the puzzle—one that fits neatly into the broader “inflammation-microvascular-link” framework now recognized by cardiologists and periodontists alike.

How Scientists Measure This Connection—And What It Means for You

You won’t find “gum disease and coronary artery function” listed as a standard lab test—but modern medicine has developed thoughtful, noninvasive ways to assess it. In clinical practice, doctors often start with indirect but meaningful signs:

• Flow-mediated dilation (FMD): A simple ultrasound test of the arm artery that reflects how responsive your vascular system is overall. An FMD value below 5% suggests reduced endothelial function; above 10% is generally considered healthy.
• High-sensitivity CRP (hs-CRP): A blood test that detects subtle increases in systemic inflammation. Levels above 3 mg/L are associated with higher cardiovascular risk—even in people with normal cholesterol.
• Periodontal probing depth: Measured during routine dental exams. Depths greater than 4 mm at multiple sites signal active, chronic infection—not just plaque buildup.

The PERIODONT-HEART Trial added another layer: using cardiac MRI with gadolinium-based contrast, researchers visualized how quickly blood moved through the smallest vessels feeding the heart muscle. They found that patients with deeper periodontal pockets had slower contrast wash-in times—indicating sluggish microvascular flow. While MRI isn’t part of routine care yet, it reinforces something practical: when your gums show signs of long-standing infection, your vascular system may be responding in ways that matter for heart health—even if symptoms aren’t obvious.

Who should pay special attention? Adults aged 58–74 with stable angina are clearly a priority group—but so are those with:

• A history of recurrent gum infections or tooth loss before age 50
• Type 2 diabetes (which amplifies both gum and vascular inflammation)
• Persistent morning dry mouth or bleeding gums—even if “just a little”
• Elevated hs-CRP without other clear causes

These aren’t red flags demanding emergency action—but rather gentle signals that coordinated care (between your dentist, primary doctor, and cardiologist) may offer real benefits.

Practical Steps You Can Take Today

The good news? Much of what supports gum health also supports heart health—and vice versa. Here’s what works, based on both the PERIODONT-HEART findings and decades of clinical experience:

✅ Prioritize daily oral hygiene—not just brushing, but cleaning between teeth. Use soft-bristled brushes, interdental brushes, or water flossers consistently. Studies show that reducing gingival inflammation lowers circulating IL-6 by up to 30% within 12 weeks.
✅ Schedule regular dental cleanings every 3–4 months if you have a history of gum disease—more frequent than the standard six-month interval. This helps disrupt biofilm before it triggers sustained immune activity.
✅ Support endothelial resilience with food and movement: Focus on nitrate-rich vegetables (spinach, arugula, beets), omega-3s (fatty fish, flaxseed), and daily walking—even 20 minutes at a comfortable pace improves microvascular responsiveness.
✅ Manage stress intentionally. Chronic stress raises cortisol, which worsens both gum inflammation and arterial stiffness. Gentle practices like deep breathing, mindful walking, or guided relaxation for 5–10 minutes a day can make a measurable difference over time.

Self-monitoring tips:

• Keep a simple log of gum symptoms: bleeding while brushing/flossing, persistent bad breath, loose teeth, or receding gums. Note changes monthly.
• Track your blood pressure at home—ideally twice a day (morning and evening), seated and rested for 5 minutes beforehand. Consistency matters more than perfection.
• If you use a smartwatch or home monitor, look for trends—not single readings. A gradual rise in average systolic pressure (e.g., from 132 to 138 mm Hg over 3 months) may reflect underlying inflammation worth discussing.

Tracking your blood pressure trends can help you and your doctor make better decisions. Consider keeping a daily log or using a monitoring tool to stay informed.

When to see a doctor:

• If chest discomfort becomes more frequent, lasts longer than 5 minutes, or occurs with minimal exertion
• If you notice new shortness of breath, unexplained fatigue, or swelling in your ankles
• If gum symptoms worsen despite good home care—or if you’ve skipped dental visits for over a year

Remember: stable angina means your heart is managing well right now. These steps help keep it that way—while gently strengthening the connections between your mouth, your vessels, and your long-term vitality.

A Reassuring Perspective

Science continues to reveal how beautifully interconnected our bodies are—how care for one part supports the whole. The discovery that gum disease and coronary artery function are related doesn’t mean you need to worry more—it means you have more opportunities to nurture your health, in ways that feel doable and meaningful. Small, steady efforts—like flossing with intention or pausing to breathe deeply before a meal—add quiet strength to your vascular system, your gums, and your peace of mind. If you're unsure, talking to your doctor is always a good idea.

FAQ

#### Does gum disease directly cause coronary artery disease?

No—gum disease does not directly cause coronary artery disease (CAD), but research shows it contributes to chronic inflammation that can worsen endothelial function and accelerate atherosclerosis. Think of it as one supportive factor among many—not a sole trigger.

#### Can treating gum disease improve coronary artery function?

Yes—studies including PERIODONT-HEART suggest that intensive periodontal therapy (deep cleaning, antibiotics if needed, and maintenance) is associated with improved flow-mediated dilation and reduced systemic inflammation within 3–6 months. While it won’t reverse established blockages, it supports healthier microvascular responses.

#### How is gum disease and coronary artery function measured in clinical practice?

Clinically, gum disease is assessed via periodontal probing and X-rays, while coronary artery function is inferred through tests like flow-mediated dilation (FMD), high-sensitivity CRP, and sometimes stress echocardiography. Cardiac MRI—used in research—is not yet routine but highlights the biological plausibility of the link.

#### Is there a link between gum disease and high blood pressure?

Yes. Multiple studies report associations between periodontitis and elevated systolic and diastolic BP, likely due to shared inflammatory pathways. Adults with severe gum disease are about 20% more likely to have stage 1 hypertension (≥130/80 mm Hg) compared to those with healthy gums—even after accounting for age and weight.

#### Should I see a cardiologist if I have advanced gum disease?

Not automatically—but it’s wise to mention it during your next cardiology or primary care visit, especially if you also have risk factors like diabetes, high cholesterol, or stable angina. Your care team can decide whether additional vascular screening (like FMD or hs-CRP) would be helpful for your personal picture.