Inflammation in the body often starts in the mouth: gums, heart and blood sugar

Plaque that is not removed with a toothbrush causes gum inflammation within two to three weeks. Left untreated, it smoulders for years and becomes a source of chronic inflammation for the whole body. Large studies link periodontitis to a higher risk of cardiovascular events and poorer control of diabetes. I explain what has been proven, what is not yet known and what to do about it.

How plaque turns into inflammation

Plaque is a biofilm: a colony of bacteria that builds up on the teeth near the gum line every day. A toothbrush and floss break it up. If that does not happen, the bacteria multiply, and the gums respond with inflammation: they turn red, swell and bleed.

This link was shown as early as 1965. In the classic study by Löe, Theilade and Jensen, dental students with healthy gums stopped brushing, and all of them developed gingivitis within 10–21 days. When they resumed oral hygiene, the gums settled. Periodontology still rests on this finding: gum inflammation starts with plaque, and in its early stage it is reversible.

If plaque and calculus stay for months, the inflammation goes deeper — into the ligaments and bone that hold the tooth. This is how periodontitis develops: periodontal pockets form, the bone is gradually lost, and over time the teeth begin to loosen.

Why inflammation in the mouth concerns the whole body

In periodontitis the gums around the teeth are a constantly inflamed surface through which bacteria and inflammatory substances enter the bloodstream. During chewing or brushing, people with inflamed gums get bacteria briefly in their blood more often than people with healthy gums.

The body responds with low-grade systemic inflammation. Researchers regard this as the main bridge between the mouth and cardiovascular disease, diabetes and other chronic conditions.

An important caveat: periodontitis is not the only cause of these diseases, and science cannot yet honestly say that it “causes” a heart attack. But it is a source of inflammation that is easy to influence: it can be seen at an examination, and it can be treated.

Heart and blood vessels: what large studies show

In 2023 PLOS ONE published a meta-analysis by Guo and colleagues. The researchers pooled 39 cohorts with more than 4.3 million people in total. People with periodontal disease had a 24% higher risk of major cardiovascular events (relative risk 1.24) and 31% higher all-cause mortality (1.31) than people with healthy gums.

The European Federation of Periodontology and the World Heart Federation reached a similar conclusion. In their joint 2020 consensus they stated that there is significant evidence of an independent association between severe periodontitis and cardiovascular disease.

What this means without exaggeration: the link is consistently repeated across countries and groups of people, although there is no direct proof yet that treating the gums by itself prevents heart attacks. Healthy gums are therefore part of prevention, alongside controlling blood pressure and cholesterol. They cannot replace it.

Diabetes: a two-way link

Diabetes makes the gums worse: with high blood sugar the inflammation is stronger and healing is slower. It works the other way too — inflamed gums make blood sugar harder to control.

Here there is already evidence on the effect of treatment. A 2022 Cochrane review found that in people with diabetes and periodontitis, gum treatment lowered glycated haemoglobin (HbA1c) by an average of 0.43 percentage points after 3–4 months. The authors rated the certainty of this evidence as moderate.

If you have diabetes, tell your periodontist, and tell your endocrinologist about the state of your gums. Both doctors are working on the same problem.

What helps put out the inflammation

• Brush twice a day with a fluoride toothpaste, paying attention to the gum line.
• Clean between your teeth every day with interdental brushes or floss: a toothbrush does not reach there, and that is where inflammation most often begins.
• Treat blood on the toothbrush as a signal to book an examination. Brushing more gently does not help in this case.
• Have professional hygiene: calculus cannot be removed at home.
• Have your gums checked at every examination with the PSR test.

Smokers should know that smoking masks bleeding, so the gums can look calmer than they really are. That makes regular checks with a periodontist all the more important.

How we check gums at Houston

Our periodontist Anna Vasylenko does the PSR test — a quick gum screening — at the consultation and before every professional hygiene visit. Within a few minutes it shows which areas are healthy, where there is bleeding or calculus, and where pockets have already formed. There is no separate fee for the test: the consultation costs UAH 690, professional hygiene from UAH 2,300.

If the test shows pockets, we draw up a full periodontal chart and a treatment plan, and if needed take an X-ray at our Houston 3D diagnostic centre. If you have diabetes or cardiovascular disease, we take it into account in the plan.

Book via TelegramCall +38 067 478 88 78

Sources

• Löe H., Theilade E., Jensen S.B. Experimental gingivitis in man. Journal of Periodontology, 1965. doi.org/10.1902/jop.1965.36.3.177
• Guo X., Li X., Liao C., Feng X., He T. Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality: a meta-analysis of prospective studies. PLOS ONE, 2023. doi.org/10.1371/journal.pone.0290545
• Sanz M. et al. Periodontitis and cardiovascular diseases: consensus report (EFP and World Heart Federation). Global Heart, 2020. doi.org/10.5334/gh.400
• Simpson T.C. et al. Treatment of periodontitis for glycaemic control in people with diabetes mellitus. Cochrane Database of Systematic Reviews, 2022. doi.org/10.1002/14651858.CD004714.pub4

Frequently asked questions

Anna Vasylenko

Deputy head doctor · periodontist

22 years in practice (graduated from Dnipro Medical University in 1999). An evidence-based approach to hygiene and to treating the gums and periodontitis.

All articles by this doctor →Clinic on Instagram ↗