The Scottish Health Survey ( which draws a nationally representative sample of the general population living in households in Scotland) had an objective  to see if self reported tooth brushing behaviour is associated with cardiovascular disease and markers of inflammation. 

The study concluded that poor oral hygiene is associated with higher levels of risk of cardiovascular disease and low grade inflammation, though the causal nature of the association is yet to be determined.

Over the past two decades, there has been an increasing interest in the possible link between dental disease, specifically periodontal disease, and cardiovascular disease.  Inflammation plays an important role in causes of atherosclerosis, and markers of low grade inflammation have been consistently associated with a higher risk of cardiovascular disease.  Consequently, contributing factors associated with inflammation and chronic infections, including oral infections such as periodontal disease, have been investigated to explain the relationship between dental disease and cardiovascular disease.  Poor oral hygiene is the major cause of periodontal disease, a chronic infection of the tissue surrounding the teeth. It is one of the most common chronic infections and is associated with a moderate systemic inflammatory response.  Systemic inflammation could represent the underlying mechanism that links oral health and cardiovascular disease.  Thus, oral infections might add to the inflammatory burden of the individual and result in increased levels of cardiovascular risk.  In this study, participants who brushed their teeth less often had a 70% increased risk of a cardiovascular disease event in fully adjusted models.

Infrequent tooth brushing is associated with cardiovascular disease, even after adjustment for age, sex, socioeconomic group, smoking, visits to dentist, BMI, family history of cardiovascular disease, hypertension, and diagnosis of diabetes.  These results largely confirm those of previous studies.  The role of oral health in the etiology of cardiovascular disease has received considerable attention. Periodontal disease is a complex chronic inflammatory disease, resulting in a loss of connective tissue and bone support of the teeth.  It is a major cause of tooth loss in adults aged over 40, and, according to the World Health Organization, affects people worldwide at prevalence rates of up to 10-20% for the most severe forms. Periodontal disease is highly prevalent, especially in late middle age when coronary artery disease is also most common, and it is caused mostly by poor oral hygiene.

Given the high prevalence of oral infections in the population, doctors should be alert to the possible oral source of an increased inflammatory burden. In addition, educating patients in improving personal oral hygiene is beneficial to their oral health regardless of the relation with systemic disease.

This study may be found in it’s entirety at http://www.bmj.com/content/340/bmj.c2451.full