Many people associate dental care above all with aesthetics. Clean teeth and fresh breath are seen as a sign of good hygiene – often nothing more is suspected behind it.
From a medical point of view, however, the oral cavity is a complex microbiological ecosystem and is in close exchange with the entire organism.
In recent years, more and more scientific studies and reports show that oral bacteria can influence systemic inflammatory processes, which in turn play a role in various chronic diseases – especially in cardiovascular diseases.
As a result, an area long underestimated is coming more into the focus of preventive medicine: the health of the gums.
How oral bacteria enter the bloodstream
Several hundred different bacterial species live in the mouth. In a healthy balance this normally poses no problem, and is probably even positive. Difficulties arise when disease-causing bacteria multiply strongly – for example in gum inflammation or periodontitis.
Inflamed gums are often characterised by small microscopic injuries. These allow bacteria as well as their metabolic products to enter the bloodstream. From there they can reach various organs – including the vessels of the cardiovascular system.
This mechanism is one of the reasons why periodontitis is today increasingly regarded as a systemic inflammatory disease.
The role of chronic inflammation
A central mechanism by which oral bacteria can act on the body is the activation of the immune system.
Certain bacterial components – for example lipopolysaccharides – are recognised by the immune system. So-called Toll-like receptors play an important role here. These belong to the innate immune system and recognise typical structures of pathogens.
When this mechanism is activated, the body triggers an inflammatory reaction and produces pro-inflammatory messengers such as interleukin-1, interleukin-6 or tumour necrosis factor-α.
When such processes remain active over a longer period, they can lead to chronic low-grade inflammation – a condition regarded today as an important risk factor for many chronic diseases.
Oral bacteria and the development of arteriosclerosis
The development of arteriosclerosis – that is, the narrowing and hardening of arteries – is a complex biological process in which inflammation plays a central role.
Researchers discuss several interconnected mechanisms by which oral bacteria could influence this process. If bacterial components from the oral cavity enter the bloodstream, they can trigger immune reactions in the vessel walls. Via so-called Toll-like receptors, inflammatory signalling pathways are activated, whereby pro-inflammatory messengers such as cytokines are released.
These inflammatory reactions can in turn trigger changes in the cells of the vessel wall. Particularly relevant here are the smooth muscle cells of the arteries. Under certain conditions – for example on contact with bacterial components – these cells can begin to produce inflammatory signals. This promotes the deposition of lipids and other substances in the vessel wall – a central step in the formation of atherosclerotic plaques.
In addition, several studies have been able to detect DNA and components of typical periodontitis bacteria in atherosclerotic plaques. This evidence does not prove that these microorganisms alone cause arteriosclerosis, but it supports the hypothesis that bacterial processes from the oral cavity contribute to inflammation of the vessel wall and can thus be involved in the development or progression of the disease.
From today's perspective, it is therefore less a single isolated mechanism than an interplay of several processes: microbial influence, immune reaction and chronic vascular inflammation. This interplay can contribute to the development and progression of arteriosclerosis.
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Which oral bacteria are particularly in focus
Among the numerous bacteria in the oral cavity, it is above all Porphyromonas gingivalis that stands at the centre of research. This bacterium is regarded as a so-called "keystone pathogen" in periodontitis and can influence the composition of the entire microbial ecosystem in the mouth.
Besides P. gingivalis, other typical periodontitis pathogens are also studied, such as Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Fusobacterium nucleatum or Prevotella intermedia.
Many of these bacteria produce substances that can trigger or intensify inflammatory reactions. Studies have also been able to show that a higher bacterial load in the oral cavity can be linked to elevated inflammatory markers in the blood – a factor in turn associated with cardiovascular diseases.
Why oral health can also be relevant for the brain
The effects of oral bacteria are studied not only in connection with cardiovascular diseases. Possible connections to neurodegenerative diseases are also increasingly in the focus of research.
Some studies have, for example, been able to detect so-called spirochetes – a group of spiral-shaped bacteria – in the brains of Alzheimer's patients. In addition, connections with neuroinflammatory processes have been observed for certain oral bacteria.
Furthermore, some researchers discuss an indirect connection: when chronic inflammatory processes contribute to the development of arteriosclerosis, this can also impair the blood supply to the brain. Long-term reduced or suboptimal brain perfusion is likewise regarded as a possible factor in cognitive decline and certain forms of dementia.
Research into these connections is still ongoing. Nevertheless, it is becoming increasingly clear how closely oral health, vascular health and brain function can be linked.
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Oral health as part of prevention
Against this background, a simple principle gains importance:
Healthy teeth and healthy gums are important not only for the mouth, but for the entire body.
Among the most important preventive measures are:
- regular and thorough tooth brushing
- cleaning the spaces between the teeth
- professional dental cleanings
- early treatment of gum inflammation
- regular dental check-ups
Even seemingly small symptoms such as bleeding gums should be taken seriously, as they are often an early sign of inflammation.
The good news is: many of the processes described can be influenced. Both gum inflammation and many risk factors for cardiovascular diseases can, to a certain extent, be influenced and treated preventively. Besides good oral hygiene, general lifestyle factors also play an important role. These include, for example, a balanced diet, sufficient physical activity, a stable blood sugar metabolism, sufficient sleep as well as refraining from smoking. These factors can reduce inflammatory processes in the body and at the same time positively influence both vascular health and oral health.
Conclusion
The oral cavity is an important component of our immune system and is in constant exchange with the entire body.
When disease-causing bacteria gain the upper hand in the oral cavity, they can not only cause local inflammation, but also influence systemic processes – among others in the cardiovascular system.
Research increasingly suggests that oral bacteria and heart health are more closely linked than was long assumed.
At the same time, it is encouraging that both gum inflammation and many risk factors for cardiovascular diseases can be treated and, to a certain extent, prevented. Good oral hygiene, a balanced diet, regular physical activity and refraining from smoking can help to reduce inflammatory processes in the body and to positively influence both vascular and oral health.
