1

Gum Infection and Heart Arrhythmia

Gum Infection May be a Risk Factor for Heart Arrhythmia

Emma Boudreaux, Tailynn Do

Lamar Institute of Technology

Dental Hygiene Program

 2
Gum Infection and Heart Arrhythmia

Abstract

Periodontitis can be a common problem seen in a dental patient. Researchers have now found

connections between the gums and a vital part of the body, the heart. There has been a

correlation found between periodontitis and arterial fibrosis in patients with cardiac disease.

Keywords: periodontitis, oral infection, arterial fibrosis, cardiovascular

 3
Gum Infection and Heart Arrhythmia

Gum Infection May be a Risk Factor for Heart Arrhythmia

Cardiac arrhythmia is an abnormal rhythm from the normal heartbeat. The normal rhythm has

been disrupted. Cardiac arrhythmias can involve a faster heartbeat, tachycardia, or a slower

rhythm, bradycardia. The normal heart rhythm is a sinus rhythm. (H. Fenton, et al., 2008)

Cardiac arrhythmias can be a product of disfunction of the sinoatrial node.

The history of cardiac arrhythmia begins in the late 19th century, when August D. Waller.

Recorded curves of electrical activity in the heart using electrodes filled with saline and the

capillary electrometer developed by Gabriel Lippman. In 1901, Willem Einthoven invented the

string galvanometer, which allowed the surface of electrocardiogram. Einthoven's galvanometer

measured heart activity by electric currents attached to strings in a magnetic field. Einthoven's

electrocardiogram is still considered today’s “gold standard”. (Antoni Bayes de Luna, 2019). In

1949, intracellular potentials were recorded with microelectrodes by Coraboeuf and Weidmann.

Weidmann recorded electronic potentials and exponential decay as a function of distance from

polarizing electrode. The two microelectrode techniques were used by two repetitive pulses and

superimposition of successive action potentials to demonstrate the time course of membrane

resistance changes throughout the cardiac cycle. (DiFrancesco et al., 2023).

There are many risk factors of atrial fibrosis, a very common one being hypertension.

Hypertension, also known as “the silent killer,” is the most common cardiovascular condition

seen in patients in the dental world. If left ventricular hypertrophy is present the risk for a cardiac

arrhythmia is quadrupled. (Hennersdorf et al., 2001). A new risk factor discovered with cardiac

arrhythmias is gingival inflammation, such as gingivitis and periodontitis. Plaque accumulation

causes inflammation in the gingiva, which leads to gingivitis. If gingivitis is not treated, the
 4
Gum Infection and Heart Arrhythmia

gingivitis will turn into periodontitis. (Rahimi et al., 2021). Other shared risk factors that

correlate to gingival inflammation and cardiac arrhythmias include smoking, diabetes, old age,

and addiction to substances.

The mechanism of action between gum disease and arterial fibrosis is the inflammation

of the gingiva, when the inflammation starts becoming chronic. Oral bacteremia can enter the

bloodstream in the inflamed gingiva and enter the heart. The toxins in oral pathogenic bacteria

cause these arrhythmic effects in the heart. Inflammation in the gingiva causes both a local and

systemic response with increases in WBC count, C-reactive protein, fibrinogen, cell adhesion

molecules, and proinflammatory cytokines. The immune response may increase cardiac risk.

Oral pathogens can turn into atherosclerotic plaque through the blood stream, and could promote

immune responses from the plaque, leading into the heart. (Stewart et al., 2016)

The oral cavity consists of many families of different types of bacteria and is a

transporting vessel to other parts of the body. Gingiva does comprise of a protective barrier to

prevent bacteria entering any other bodily systems, however, that does not mean there will never

be some that sneak through. The edematous gingival and periodontal tissues are prone to

bleeding, which facilitates the penetration of oral bacteria into the bloodstream (Aarabi et al.,

2018). Patients are prone to bleeding due to treatments like periodontal debridement and root

scaling. Therefore, researchers decided to look deeper into the correlation between the oral

cavity and other bodily systems. Research has revealed that there have been traces of oral

bacteria in “human atherosclerotic lesions, the pericardial fluid, heart valves, and thrombi

(Aarabi et al., 2018).” A recent study determined that 23 oral bacterial species were habitual in

atherosclerotic plaques: Campylobacter rectus, Porphyromonas gingivalis, Porphyromonas

endodotalis, Prevotella intermedia to name a few. A more common bacterium, Streptococcus

 5
Gum Infection and Heart Arrhythmia

mutans, was detected in biopsies from heart valves (40% positive) and atheromas (48% positive)

(Aarabi et al., 2018).

Infections in the oral cavity increase C-reactive proteins which are biomarkers associated

with systemic inflammation and are concurrent with other cardiovascular diseases. Researchers

discovered that oral inflammation influences cardiovascular markers and cytokines. To be more

specific, pro-inflammatory mediator IL-6 has been seen at elevated levels in patients with

periodontitis and heart failure. The highest levels have been observed in patients with acute and

chronic endodontic lesions (alveolar abscesses) (Aarabi et al, 2018). IL-6 contributes to

cardiomyocyte hypertrophy and apoptosis. These two conditions may further reach advanced

stages of fibrosis, thereby leading to atrial fibrosis. In conclusion, the published date suggest that

IL-6 may favor AF due to its direct effects on electrophysiological remodeling of the heart

(Aarabi et al., 2018). A decrease in inflammation has been reported following periodontal

treatment.

The research process for these two diseases is a work in progress. So far, the research

goes as far as learning about asymptomatic and chronic periapical pathology through

radiographs, rather than AF as an individual unit within the study of CVD effects. It is not new

knowledge that oral infections can influence other cardiovascular systems; however, recent

studies have not included AF until now. One recent retrospective study found that patients with a

history of AF had a statistically significant incidence of diagnosed apical infection (Hassan et al.,

2021). Researchers tested the hypothesis that periapical abscesses are associated with incident

AF, using the CHA2DS2VASc score (congestive heart failure, high blood pressure, diabetes,

stroke, heart disease, age, gender). Research has shown that “the CHA2DS2VASc score in
 6
Gum Infection and Heart Arrhythmia

patients with acute dental periapical abscess has significant predictive value for incident AF

(Hassan et al., 2021).”

In conclusion, CVD and gum infection have many correlations. More research still needs

to be conducted; however, the result looks promising. Scientists are hopeful this will become a

breakthrough for the medical world. Hopefully, this new profound discovery will only evolve

and become a pivotal moment for all to experience.