Sounds ridiculous, doesn’t it? How could your mouth hurt your heart? Especially since I don’t mean something you really regret saying to your spouse, your best friend, or your child. But the answer, regrettably, is YES.

Gum disease — an often hereditary infection of the gums that eventually infects the jawbone anchoring the teeth — can send oral bacterial through the bloodstream, which may be deposited in the heart valves and arteries. Once deposited, research strongly suggests that these oral toxins contribute to heart disease (heart valve infection and hardening of the arteries).

In fact, it’s such a recognition of the harmful interaction between mouth bacteria and the heart that has made it standard practice to administer antibiotics, prior to most dental procedures, to patients who have a heart murmur. (This is because damaged heart valves are at highest risk for an infection known as “infective endocarditis,” an inflammation of the interior lining of the heart and heart valves.)

Not coincidentally, researchers have concluded that people with gum disease, also called periodontal disease, are twice as likely to suffer from coronary artery disease. (Oral bacteria attach to the fatty plaque build-up in the coronary arteries and may contribute to arterial clot formation.) Periodontal disease is, in fact, now believed to be an important risk factor for heart problems — in concert with such other risk factors as age, smoking, diabetes, hypertension and elevated blood cholesterol.

And heart disease (like periodontal disease) is very common in this country. The American Heart Association estimates that 58 million people suffer from cardiovascular disease. That’s one person in every five. Small wonder it’s the number one cause of death among Americans.

But, like all the other risk factors for heart disease, (except age) gum disease can be treated and often reduced in its risk, if not eliminated, as a factor in the development of heart disease.

How? First, you have to know whether you have it. A number of commonly experienced symptoms exist. Most often, what you may notice is red, swollen, or sensitive gums, and/or bleeding when brushing or flossing your teeth. Later on, if ignored and left untreated, you may find that your gums are pulling away from your teeth, or that you have loose or separating teeth, or even pus appearing between your gums and teeth. Other signs include persistent bad breath, a change in the way your teeth fit together, or a change in the fit of partial dentures.

All of the above are signs of a progression of the bacterial infection causing periodontal disease. But perhaps the “clue” easiest to remember is that healthy gums do not bleed when teeth are brushed or flossed; so, if you notice blood, don’t ignore it. Take it seriously as a symptom of gum disease.

On the other hand, you may have no symptoms at all. Gum disease is always painless. And like high blood pressure, can be symptomless in its early stages. Smokers, in particular, experience no bleeding when they brush or floss because their blood vessels are constricted by the chemical agents in cigarettes. Yet smokers are five times more likely to suffer from periodontal disease than are non-smokers and, as a result, when smokers quit smoking, they sometimes find blood on the pillow as their gums “refind” the ability to bleed, once nicotine and other chemical agents are no longer being ingested.

Of course, the best way to find out whether you have gum disease is to visit a dentist and ask for a periodontal screening and evaluation. After the age of 18, it’s also wise to check with a periodontist — especially if you have, or have had, such compelling health factors as hereditary or non-hereditary heart problems, diabetes, or respiratory illness like pneumonia, bronchitis or emphysema.

But let’s say your gums begin to bleed when you floss. What then? Once your dentist or periodontist confirms the presence of a periodontal infection, you may learn that it’s actually a “fortunate” time to have gum disease; because state-of-the-art therapies now exist, and more are regularly being developed.

Depending on the severity of your periodontal disease, treatment may include nonsurgical therapy such as scaling and root planing (to remove the buildup of tartar that contributes to infection, and smooth the root surfaces to allow the gums to heal and reattach to the root.) It may involve bacterial cultures to isolate the specific oral bacteria causing your specific infection. A DNA probe analysis is also utilized to qualify what specific bacteria are present. And antibiotic susceptibility testing is used to “target” your specific infection with the correct antibiotic regimen. It is important to point out that antibiotics by themselves are not enough. Treatment is necessary to gain the long term benefits of “targeted” antibiotic therapy such as non surgical and/or surgical periodontal therapy (which may include regenerative therapy to rebuild the lost jawbone.)

Much can be done, in other words, to restore damaged gums, bone loss and lost teeth that can result from gum disease left untreated over time. But the most important thing — if you do, indeed, have gum disease — is to start treatment before what goes on in your mouth has an adverse effect on your heart.

Dr. Robert A. Levine is a Diplomate of the American board of Periodontology and is Chairman Emeritus of the Department of Periodontics at the Albert Einstein Medical Center. He maintains a private practice in dental implants and periodontics in Northeast Philadelphia. He is an outspoken advocate for periodontal screenings in many national forums, and has published close to 50 articles on periodontal therapy, cosmetic periodontal procedures, dental implants, and oral medicine. He is on the editorial board of numerous international journals and has also appeared frequently on national and local TV and radio discussing periodontal issues, therapies and dental implants. He is a Fellow of the International Team for Implantology (ITI) of Basel, Switzerland committed to implant teaching and research. Dr. Levine founded and has been President and Program Chairman of the Northeast Philadelphia Dental Implant/Periodontal Prosthesis Study Club since 1984. The Study Club is dedicated to providing advanced cutting edge dental education to the Philadelphia dental community at large.

Most expectant mothers would never knowingly do anything to harm their unborn baby — even when it means giving up habits like drinking alcohol and caffeine during their pregnancy. Yet many of these same mothers are walking around with a potential time bomb ticking away in their mouths — a time bomb that may account for a large share of the previously unexplainable premature births in the United States.

The culprit is gum disease, a condition that affects more than 75 percent of the adults in America. Gum disease, or gingivitis, is a bacterial infection of the gums, bone, and attachment fibers that support the teeth and hold them in the jaw. Because it is virtually painless, gum disease often goes unchecked for years.

How, you must be wondering, can such a seemingly minor, not to mention physically far-removed condition, harm fetus?

According to accumulating research, published in the Journal of Periodontology, generated by studies at the University of North Carolina and the Veterans Administration Outpatient Clinic in Boston, gum disease is not only implicated in some cases of premature birth, it is linked to heart disease and diabetes.

While the research is still preliminary, a strong circumstantial case pointing to these links has emerged. Gum disease is caused by smoldering pockets of infection that contain billions of bacteria. The North Carolina study makes the point that this bacteria and related toxins are released into the bloodstream, which in turn can reach the placenta and interfere with fetal development.

To show why, let’s look at the research that recently appeared in The Journal of Periodontology. A team of periodontists and obstetrician/gynecologists conducted a study of women in the high-risk obstetrics clinic at the University of North Carolina Hospital in Chapel Hill. They examined 124 of these women for gum disease, after they’d delivered their babies. The researchers performed these periodontal exams within three days of childbirth and didn’t know which of the women had given birth to a full-term infant, and which had delivered prematurely. Thus the examiners were not informed as to whether the women delivered pre-term or low-birth weight infants.

What they found — once all other risk factors were taken into account — was that women with gum disease were seven times more likely to deliver low-birth weight infants than women without periodontal problems. Dr. Steven Offenbacher and his co-workers at Chapel Hill concluded that an estimated 18% of the 250,000 premature infants (those born during or before week 36, weighing less than five and a half pounds) who are delivered annually may be directly linked to untreated gum disease during pregnancy.

What this means is that an astonishing estimate of 46,000 infants are born prematurely each year due to gum disease in the mother. Gingivitis may also be the “infection of unknown origin” that, OB/GYN researchers have concluded, accounts for a large number of unexplained pre-term births. (As a side note, there is a fairly common phenomenon known as pregnancy gingivitis, that is, gum disease that occurs with the advent of pregnancy.)

Periodontal disease, as innocuous as it may seem, actually releases bacteria and toxins into the bloodstream, which in turn can reach the placenta and cause premature labor.

The same low grade infection can also impair a diabetic’s ability to process and/or utilize insulin, and has also been linked to increased incidents of clogged arteries and heart disease.

Yet despite its serious and far-reaching effects, gum disease is surprisingly simple to both prevent and treat.

Pregnant women, as well as those contemplating pregnancy, should get a careful periodontal evaluation and have any clinical problems treated prior to delivery — before becoming pregnant is even better. Also, inform your physician and obstetrician/gynecologist about the Chapel Hill study. Make sure they understand the strong likelihood of gum disease resulting in a premature delivery, and a baby who is less healthy than he/she would otherwise have been. Be aware, too, of the cost of having a premature baby. According to the National Center for Health Statistics, neonatal hospital costs account for a $5 billion expenditure each year. But there are other costs, as well. Preterm deliveries can result in cerebral palsy, epilepsy, lung problems, and learning disabilities — all of which tax families emotionally, psychologically and financially, and have profound long-term consequences for society as a whole. The sad fact is that many of these tragic outcomes may be avoided if pregnant women and their physicians are informed.

For diabetics and people with a history of heart disease, the onset of periodontal disease can compromise the clinical treatment and maintenance plan created for them by their doctors. These individuals should have a thorough periodontal check-up, and treat any problems immediately. When caught in its early stages, gum disease can be arrested with nonsurgical therapy, which involves scaling and root planing, followed by quarterly checkups with dental cleanings.

Finally, the importance of brushing and regular flossing cannot be underestimated. As this important research indicates, a healthy mouth can have long-term and far-reaching affects — on both an individual’s long-term health, and in the case of a pregnant mother, the health of her baby.

ROBERT A. LEVINE, DDS, is a clinical associate professor of post-graduate Periodontics in the Department of Perio-Prosthesis and Implantology at the University of Pennsylvania School of Dental Medicine. A board-certified member (Diplomate) of the American Board of Periodontology, he has also held the position of Chairman Emeritus of the Division of Periodontics (1984 – 2003) at the Albert Einstein Medical Center. Dr. Levine is the founder and current director of The Pennsylvania Center for Dental Implants and Periodontics in Philadelphia, Pennsylvania.