By Erica Kilburn on Saturday, 12 October 2013
Category: Product Updates

Hearts and Minds: Protecting Patients from Heart Disease With Better Oral Hygiene

Cardiovascular disease (CVD) is one of the major health issues of the day and the principal cause of death for communities throughout Europe[i]. According to NHS statistics[ii], chronic heart disease affects more than 2.6 million UK residents - approximately 0.6 million more men than women – and accounts for over 88,000 deaths annually, primarily from heart attacks.

CVD is a generic term encompassing a number of diseases of the circulatory system and the four main forms are coronary heart disease (CHD), stroke, peripheral arterial disease and aortic disease. Nearly half of CVD-related deaths in the European Union (EU) are due to CHD, followed closely behind by instances of stroke[iii].

Considering the widespread devastation it is causing, it is interesting to note that cardiovascular disease is largely influenced by lifestyle; with contributory factors ranging from an individual’s weight, diet and levels of physical activity to smoking habits and even stress. In effect, cardiovascular disease is - to a degree - avoidable. Further to this, research is increasingly coming to light demonstrating another link that brings control or even prevention of the disease back to the individual – oral hygiene.

A Scottish health survey[iv] has indicated an increased risk of heart disease for individuals who don’t undertake an adequate, regular oral hygiene routine. Of nearly 12,000 participants in the eight-year study, those with the poorest oral hygiene (who rarely or never brushed their teeth) were found to be up to 70% more likely to develop heart disease than others who brushed their teeth twice a day. They also had increased frequency of markers of low grade systemic inflammation. The results suggested that poor oral hygiene might increase the risk of developing CVD by means of periodontal infection.

Another study[v], a collaboration between the University of Bristol, Ireland’s Royal College of Surgeons and the State University of New York, has looked into the association between oral bacteria and heart disease. In particular, the researchers found the oral bacterium Streptococcus gordonii to be a plausible agent for CVD. Chronic oral disease, such as periodontitis, provides a pathway for the bacteria to access the bloodstream, where they can interact with platelets and induce aggregation. The study found that the S. gordonii could contribute towards unwanted blood clotting and the development of infective endocarditis.

Although heart disease remains the biggest killer in the UK, there is some good news on the horizon. The rate of deaths from coronary heart disease has been slowly but surely declining for the past three decades throughout much of Northern and Western Europe; and mortality rate following stroke is also decreasing[vi]. Heart attack related deaths in England have cut in half since 2002[vii] while public health targets, including reducing premature death from CVD by 40% by 2010, have been met[viii].

Interestingly, oral hygiene habits and oral health in the UK have likewise shown improvement in recent years; with the latest Adult Dental Health Survey establishing that 75% of adults brush their teeth at least twice daily[ix]. However, much fewer numbers use adjunctive interdental cleaning methods - just 22% floss, for example - and this could account in part for the high instances of plaque[x] which was found in two out of every three adults.

Clearly, tooth brushing along with fluoride toothpaste - although an excellent start - is not enough and it falls to the dental profession to help patients to maintain their own oral health with encouragement and advice. Patient education divides into three main aspects: which oral hygiene products are best for the individual patient to use, how to use them, and why it is so important to do so.

Most patients are aware of string floss for cleaning the interproximal spaces, but few are keen to use it and they frequently cite a lack of time or claim they forget to floss. In the majority of cases, patients struggle to use string floss properly and are more liable to give up quickly. In addition to this, research has thrown considerable doubt on the effectiveness of string flossing on reducing interproximal caries[xi] or inflammation.[xii] Perhaps it is time to give other interdental cleaning techniques a higher profile?

One method of quickly and efficiently cleaning between the teeth and below the gumline is the oral irrigator, also known as the Water Flosser. Easy to use and suitable for most patients, including those with braces or restorations, the leading Water Flosser can reduce gingivitis[xiii] and bleeding[xiv] and can help to minimise probing pocket depth[xv]. In particular, the Waterpik® Water Flosser is superior to dental floss at reducing gingival bleeding,[xvi] inflammation,[xvii] and plaque[xviii] with multiple patients including orthodontics, implants, and mild to moderate periodontitis. In fact, evidence shows that the Waterpik® Water Flosser removes up to 99.9% of plaque biofilm from any treated area of the tooth in just three seconds.[xix]

Through sound education on both the risks associated with poor oral health and the right tools for effective oral hygiene, we can help patients to prevent or control oral disease and help minimise the risk of developing or exacerbating chronic systemic disorders.

For more information on Waterpik® Water Flossers please speak to your wholesaler or visit www.waterpik.co.uk. Waterpik® products are widely available in Boots stores and selected Lloyds Pharmacies.



[i] European Heart Network and European Society of Cardiology (2012) European cardiovascular disease statistics. P10. Available through: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002098 [Accessed 19th December 2012].

[ii] NHS website. Cardiovascular disease. Available through: http://www.nhs.uk/conditions/Cardiovascular-disease/Pages/Introduction.aspx [Accessed 19th December 2012].

[iii] European Heart Network and European Society of Cardiology (2012) European cardiovascular disease statistics. P10. Available through: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002098 [Accessed 19th December 2012].

[iv] De Oliveira C, Watt R, Hamer M (2010) Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey. BMJ. 340:c2451.

[v] Petersen HJ, Keane C, Jenkinson HF, Vickerman MM, Jesionowski A, Waterhouse JC, Cox D, Kerrigan SW (2010) Human Platelets Recognize a Novel Surface Protein, PadA, on Streptococcus gordonii through a Unique Interaction Involving Fibrinogen Receptor GPIIbIIIa. Infect Immun. January; 78(1) 413-422. Available through: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2798181/ [Accessed 23rd January 2013].

[vi] European Heart Network and European Society of Cardiology (2012) European cardiovascular disease statistics. P10. Available through: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002098 [Accessed 19th December 2012].

[vii] British Heart Foundation website (2012) Coronary heart disease statistics: a compendium of health statistics. P10. Available through: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002097 [Accessed 19th December 2012].

[viii] British Heart Foundation website (2012) Coronary heart disease statistics: a compendium of health statistics. P14. Available through: http://www.bhf.org.uk/publications/view-publication.aspx?ps=1002097 [Accessed 19th December 2012].

[xi] Hujoel PP, Cunha-Cruz J, Banting DW, Loesche WJ (2006) Dental flossing and interproximal caries: a systematic review. J Dent Res. 85(4): 298-305.

[xii] Berchier et al (2008) The efficacy of dental floss in addition to a toothbrush on plaque and parameters of gingival inflammation: a systematic review. Int J Dent Hygiene. 6(4): 265-279.

[xiii] Barnes, CM, Russell CM, Reinhardt RA et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis and supragingival plaque. J Clin Dent. 16(3): 71 -77.

[xiv] Barnes, CM, Russell CM, Reinhardt RA et al (2005) Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis and supragingival plaque. J Clin Dent. 16(3): 71 -77.

[xv] Jolkovsky DL et al. Clinical and microbiological effects of subgingival and gingival marginal irrigation with chlorhexidine gluconate (1990). J Periodontol. 61: 663-669.

[xvi] Rosema NAM, Hennequin-Hoenderdos, NL, Berchier CE, Slot DE, Lyle DM, Van der Weijden GA (2011) The effect of different interdental cleaning devices on gingival bleeding. J Int Acad Periodontol. 13(1):2-10.

[xvii] Cutler CW, Stanford TW, Abraham C, et al. (2000) Clinical benefits of oral irrigation for periodontitis are related to reduction of pro-inflammatory cytokine levels and plaque. J Clin Periodontol 27(4):134-143.

[xviii] Sharma NC, Lyle DM, Qaqish JG, Galustians J, Schuller R (2008) Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Ortho Dentofacial Orthoped. 133(4):565-571.

[xix] Gorur A et al (2009) Biofilm removal with a dental water jet. Compend Contin Ed Dent 30 (Special Iss 1):1–6.

Biographical Information for Deborah M. Lyle, RDH, MS

Deborah received her Bachelor of Science degree in Dental Hygiene and Psychology from the University of Bridgeport and her Master of Science degree from the University of Missouri - Kansas City.  She has 18 years clinical experience in dental hygiene in the United States and Saudi Arabia with an emphasis in periodontal therapy.  Along with her clinical experience, Deborah has been a full time faculty member at the University of Medicine & Dentistry of New Jersey, Forsyth School for Dental Hygienists and Western Kentucky University.  She has contributed to Dr. Esther M. Wilkins’ 7th, 8th, 9th and 10th editions of Clinical Practice of the Dental Hygienist and the 2nd and 3rd edition of Dental Hygiene Theory and Practice by Darby & Walsh.  She has written numerous evidence-based articles on the incorporation of pharmacotherapeutics into practice, risk factors, diabetes, systemic disease and therapeutic devices.  Deborah has presented numerous continuing education programs to dental and dental hygiene practitioners and students and is an editorial board member for the Journal of Dental Hygiene, Modern Hygienist, RDH, and Journal of Practical Hygiene and conducted several studies that have been published in peer-reviewed journals.  Currently, Deborah is the Director of Professional and Clinical Affairs for Waterpik, Inc.

Related Posts