Why Flossing and Good Teeth Hygiene are Important for Heart Health

We’ve all heard the guidance from our dentists: brush twice a day, and floss daily. But how many of us actually follow their advice, especially when it comes to flossing?

According to a national survey, only a third of people floss every day, and just as many admit to never flossing. 

Unfortunately, an increasing amount of research suggests that our flossing habits—or lack thereof—could be affecting not only our dental health, but our heart health, too. Let’s take a look at how oral and heart health are related, and the role flossing plays in keeping your heart in good shape.

What’s the Connection Between Oral Health and Heart Health?

Your mouth is home to a lot of bacteria. It’s a gross reality, but it’s not something to worry about if you’re otherwise healthy and have good oral hygiene habits. Regular brushing and flossing helps prevent bacteria from attaching to your gums and teeth, where it can colonize and spread to other parts of your body, including your heart. Left unchecked, this can lead to periodontal disease, also known as gum disease. 

Gum disease usually starts out as gingivitis, which is characterized by sensitive, swollen gums that may bleed fairly easily. Gingivitis is the mildest form of gum disease. It’s also reversible, if you take efforts to improve your brushing and flossing habits. A deep cleaning with a dentist can also remove any plaque that has built up.

Things become a problem when gum disease transitions from gingivitis to periodontitis, which is non-reversible. Periodontitis is a chronic infection of the gums characterized by severely inflamed, bleeding, and receding gums—which provide an open doorway for bacteria to step into your bloodstream. Once there, the bacteria can trigger inflammation in your blood vessels and contribute to the formation of arterial plaque—a major risk factor for heart disease, stroke, and atrial fibrillation (AFib), an irregular heart rhythm that can lead to stroke and heart failure.

“Atrial fibrillation significantly increases the risk for strokes as the heart does not fully contract, which can cause small blood clots to occur in the ventricle of the heart,” says Jessica Meisner, NP, a nurse practitioner based in North Carolina and board certified in Family Medicine. “A stroke can occur when these blood clots leave the heart and get stuck in the blood vessels of the heart.” Studies have found that those who have periodontitis were over 30% more likely to develop AFib. 

“Recent studies have shown that people who have dental plaque disease have an increased risk of cardiovascular disease,” says Kyauna Sanders, MD, a physician based in New Jersey who is board certified in Internal Medicine. For example, people with periodontitis are much more likely to experience a major cardiovascular event, including heart attack, stroke, or death.

This type of chronic inflammation remodels the actual blood vessels, and weakens the vessels we need to get oxygen to the heart muscle and the body, says Dr. Sanders. “Even without periodontal disease, micro bacteria can get in the bloodstream, but with more plaque, you get more bacteria and more risk of it getting into your bloodstream and the arteries.”

Why Is Flossing Important for Heart Health?

Brushing twice a day is important, but research shows that it only removes between 42–60% of the plaque on your teeth. Flossing, on the other hand, can remove up to 80%. That’s why flossing plays such a critical role in protecting your mouth and your heart.

Flossing gets in between the areas of the teeth where food residue can settle. “When food settles, the bacteria can, too, and inflammation and plaque can occur,” says Dr. Sanders. “You just can’t get into all the cracks and crevices with the bristles on a toothbrush, and those are areas where bacteria can enter and go below the gumline. Flossing is recommended to reach those areas and get a deeper clean than brushing can provide.”

By removing the plaque your toothbrush can’t reach, flossing reduces inflammation in your gums, breaks up the bacteria that can lead to gum disease, and keeps your gums healthy—further reducing the chance of infection and inflammation that can lead to heart problems.

In one study, researchers followed over 6,200 people for 25 years. They found that those who flossed at least once a week had:

• 22% lower risk of ischemic stroke, the most common type of stroke
• 44% lower risk of cardioembolic stroke, a stroke caused by a blood clot from the heart
• 12% lower risk of developing AFib

Without regular flossing and removal of the bacteria, it can grow larger in number and lead to gum disease, says Dr. Sanders. “Bacteria from gum disease can enter the bloodstream and potentially contribute to heart inflammation and scarring, which can disrupt the heart’s electrical signals and increase the risk of AFib.”

6 Oral Health Tips to Protect Your Heart

If the research tells us anything, it’s that we could all benefit from a little more flossing. But other aspects of oral hygiene can also be beneficial for heart health. For example, studies have found that:

• People who underwent dental scaling (a specialized deep cleaning recommended for those with gum disease) at least yearly were significantly less likely to develop AFib.
• People who brushed their teeth at least 3 times daily were 10% less likely to develop AFib and 12% less likely to experience heart failure.
• People who regularly saw their dentist were about 12% less likely to develop AFib.

Ready for a one-two punch of oral and heart health? Follow these tips.

1. Brush twice a day, for at least 2 minutes

While dentists recommend brushing for at least 2 minutes, the average person only brushes for 45 seconds. If you think you may fall in that category, set a timer for yourself when you brush, or listen to a song that’s at least 2 minutes long. Studies show that brushing for the full 2 minutes removes 26% more plaque than a mere 45 seconds.  

2. Floss once a day, before brushing if possible

Flossing in addition to brushing has shown to be more effective at reducing plaque and preventing gingivitis than brushing alone. The important thing is to be consistent with your flossing, but if you’re looking for extra credit: floss at night, before you brush your teeth. Doing it in this order helps break up the plaque between your teeth, which then makes it easier to wash it away in your saliva when you rinse. 

If you’re not thrilled by the idea of using traditional floss, try using a floss holder. Research shows that using one of these can help people make flossing a more regular habit. 

3. See your dentist twice a year

The American Dental Association recommends getting a dental checkup twice a year. With their professional tools and expertise, a dental cleaning can get deeper than flossing and brushing, says Dr. Sanders.

4. Limit sugary foods and drinks

Eating healthier and limiting your sugar intake is a good idea generally. But when it comes to oral health, specifically, sugar feeds bacteria, which is why enjoying a lot of it can lead to cavities. 

“Sugar is like fuel for bacteria,” says Dr. Sanders. “The more bacteria thrive off this fuel, the more tartar builds up, and then plaque, which leads to gingivitis and, if not checked, irreversible damage of periodontal disease. The resulting chronic inflammation can damage the tissues and bones that support teeth, leading to decay and tooth loss.” That’s why it’s important to have a good diet and limit junk foods, sticky or gummy candies, and soda, she says.

5. Stay hydrated

Add this to your list of reasons to drink 8 glasses of water a day: “A dry mouth is a bad environment for wounds to occur, and it worsens the healing process,” says Dr. Sanders. 

Dry mouth is also linked to an increased number of oral bacteria. This is why it’s so important to swish around your mouth with water after you brush your teeth.

6. Quit smoking

If you’re a smoker, you may already know that tobacco can stain and yellow your teeth. But tobacco can also negatively affect your gums, eat away at your tooth enamel, and increase your risk of oral cancer. It can also increase the amount of bacteria in your mouth.

Smoking increases risk of gum and dental disease in a few ways, says Dr. Sanders. For example, smoking: 

1. Compromises the immune system and ability to fight bacteria. 
2. Can cause dry mouth, increasing bacterial growth. 
3. Causes inflammation that interferes with wound healing and the effectiveness of dental and periodontal treatments.
4. Reduces blood flow to the gums, making them more prone to infection.
5. Increases bone loss, decay and tissue damage.

“Smoking dries out the mouth and is an inflammatory trigger, so people who smoke are more likely to have bacterial overgrowth causing oral wounds and lesions, scarring, and decay,” says Dr. Sanders. “This inflammation can compromise the integrity of wound healing. Beneficial dental care such as brushing, flossing, and dental procedures can cause microscopic cuts, wounds, and abrasions.” When a person’s wound healing is compromised, as can happen with smoking, it’s tougher for these beneficial dental habits to help.

The Bottom Line: Flossing Is Good for Your Heart

While more studies are needed, a growing body of research suggests a link between gum disease and heart health. While your teeth may look clean after you brush them, hopefully by now you realize there’s a lot more hiding between the lines (er, your gums). 

So if flossing has been an afterthought—or something you only do the week before your dentist appointment—consider this your friendly reminder to step up your flossing game. 

And the next time you see your dentist or primary care provider, ask them how your oral health should fit into your overall health plan. 

How K Health Can Help

Is it time for a checkup on your heart health? You can visit a primary care provider online.

With the K Health app, you can check your symptoms, explore conditions and treatments, and if needed, text with a healthcare provider in minutes. 

K Health’s AI-powered app is based on 20 years of clinical data.