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Flossing and Heart Disease

A global protocol followed among all dentists and oral care providers is the association between oral health and systemic diseases. Comprehensive screening with thorough assessment of oral hygiene can create a good prophylaxis and also determine the relationship between oral health and systemic diseases. Research has proven that the link between oral health and systemic inflammatory diseases can be evaluated to assess the deteriorating effects on the organ systems.


Inflammatory response

The inflammatory response patterns that manifest in the body are redness, swelling, pain and loss of function. The process of inflammation predominantly affects the periodontium. The biofilm formed may contain bacteria of different types mainly gram positive and gram negative in origin. The microorganisms colonize in the regions of interproximal spaces and gingiva releasing exotoxins, cytotoxins and also protein toxins respectively. In the process of infection the visible changes appear which include bleeding gums, redness etc. This phenomenon is called periodontitis. Prolonged cased of periodontitis can eventually cause coronary diseases such as atherosclerosis.

These conditions occur because of the proliferation of soluble compounds and the release of interleukins and tumor necrosis factors and prostaglandins. The local inflammation thus formed begins to sustain by chemical mediators leading to the development of atherosclerotic lesion. The lesion progresses and the action of extra cellular proteolytic enzymes may cause rupture. This may lead to the formation of thromboses facilitating the blood flow into the heart causing infarction. The identification of inflammatory markers may help in effective diagnosis.


Oral conditions causing heart disease


  • Poor oral health and improper assessment of oral hygiene associated disease can progress to cardiovascular disease.
  • Patients with a history of gum disease are at a risk of developing a heart disease.
  • Patients with fewer teeth due to tooth decay are susceptible to coronary conditions.
  • Alcohol, smoking, diabetes can also lead to deterioration of oral hygiene which may result in coronary conditions.

Development of coronary condition due to poor oral hygiene is mainly associated with the type of inflammatory response generated due to infection in the oral cavity. The research on periodontitis associated heart disease is still underway and the plausible theory of oral hygiene and systemic diseases is slowly being ruled out by extensive study carried out in the respective area.

Flossing

Since the development of heart disease is related to oral hygiene, one of the effective methods to avoid inflammatory conditions suggested by dental care experts is through flossing. Flossing regularly can prevent the onset of periodontitis which occurs due to plaque and tooth decay. The type of floss recommended may be multi filament nylon or monofilament PTFE in origin. The floss is generally coated with waxy layer to avoid the damage or tearing of gums. The method of flossing has to be carefully followed as it may sometimes erode or lead to bleeding of the gums which may also be associated with the travel of formed blood clots in to the heart. Preexisting heart conditions may also lead to the development of bacterial endocarditis due to poor oral hygiene. Other conditions associated are myocardial infarction, congenital heart valve defects and also hypertrophic cardiomyopathy.


  • Inform your doctor about medications that you are taking for any health problem or underlying history of heart disease.
  • In case of the use of blood thinning medications, the dentists and cardiologists have to be notified.
  • Good oral hygiene such as brushing and flossing is suggested to the patients.

Estradiol Test

Heart disease is gender-neutral and isn't anymore categorized as a man's disease. Continued research by the American Heart Association indicates that close to 43 million women in the U.S are affected by heart disease. 1 in 4 female deaths is due to heart disease. Diabetes, obesity, poor diet, physical inactivity and excessive consumption of alcohol are the key risk factors and 90% of women have one or more of these risk factors for developing heart disease.


Apart from these risk factors, in women who enter menopause, the tapering estrogen levels also increase the risk of developing cardiovascular disease. Estradiol is a form of estrogen, a female sex hormone produced by the ovaries. In women, the ovaries and reproductive tissues are involved in making estrogen. In men, testosterone is transformed into estrodiol. Though estrogen is considered a hormone of importance only to women, research and tests indicate that the imbalance poses health issues for men too. Be it excess or lack of estrogen levels, the imbalance increases the risk of degenerative diseases.


  • Excess estrogen contributes to development of atherosclerosis.
  • Elevated estrogen levels double the risk of stroke and is a strong indicator of coronary artery disease.
  • Men with benign prostate enlargement or prostate cancer show high blood estrogen levels.
  • Lack of sufficient estrogen increases risk of osteoporosis and bone fracture.
  • Low estradiol levels are rated as high risk factor for cardiac patients, especially men.
  • Elevated estrogen levels doubles the possibility of stroke in senior men.
  • In elderly men, high level of estradiol is associated with peripheral artery disease.
  • Elevated estradiol level predisposes men over 50 years to development of an abnormal blood clots (thrombus).
  • In aging men, higher estradiol level is regarded as a risk factor for prostate cancer.

    Thus it is proved that estrogen, primarily categorized as a sex hormone does cast its effect on heart health. The estradiol or E2 test procedure is the same for men, women and adolescents. In adolescents, the test is to assess early puberty or Precocious puberty. The test results are useful for healthcare providers to assess and analyze women's health issues such as menstrual problems, ovarian tumors, gynecomastia, menopausal problems and breast cancer. In men, high levels of estradiol are associated with abdominal fat, enlargement of the prostate and cardiovascular risk. Low levels of estrogen are associated with osteoporosis.

    Too much of estrogen is estrogen dominance. Women who have opted for estrogen replacement may experience symptoms of estrogen dominance. In aging men, estrogen dominance can be natural phenomenon. Side effects of estrogen dominance are the same for men and women.


    • Headaches
    • Swelling in the breast area for women
    • Bloating
    • Decreased sex drive
    • Mood swings
    • Weight gain
    • Hair loss
    • Thyroid disease
    • Slowed metabolism
    • Excess facial hair in women
    • Fatigue
    • Memory loss
    • Difficulty sleeping
    • Susceptibility to allergies

    Besides, estrogen dominance accelerates the aging process. Men and women keen on avoiding estrogen dominance need to know the factors that contribute to estrogen dominance. Avoid those that contribute to increasing the level and bring healthy changes to live a healthy life.


    • Certain foods and items in our environment contribute to estrogen dominance. Estrogen-producing compounds are found in haircare products, sunscreen, pesticides, and car exhaust, cosmetics, moisturizers and carpeting.
    • Excess body fat helps the body in making more estrogen.
    • Highly processed foods, MSG, caffeine and beer are associated with high estrogen levels.
    • Compared to grass fed and pasture raised animals, estrogen levels are high in animals that are fed high carbohydrate feeds.
    • Unfermented soy products have high estrogen levels compared to fermented soy products.
    • Herbicides and pesticides contain a type of xenon-estrogen.
    • Broccoli, cabbage, kale, Brussels sprouts and cauliflower reduce estrogen in the body.
    • Leafy vegetable like spinach, parsley, dandelions, Swiss chard and celery can have a lowering effect in the body.


    Hemoglobin A1c test

    Heart disease is a common complication for diabetes patients. For an early assessment of diabetes and also to detect risk of developing heart disease, the American Diabetes Association recommend Hemoglobin A1c test.


    High blood glucose (sugar) levels over time can lead to increased deposits of fatty materials on the insides of blood vessel walls. These deposits may affect blood flow, which increases the chance of clogging and hardening of blood vessels and leads to heart disease. Hemoglobin A1c test reflects blood sugar levels. If non-diabetic, the test result would be around 5%. Diabetic persons aim for a score of 7% or lower. However, the health care provider would discuss the most appropriate target that is individual specific.


    In general, if the test score is 8% or more, it indicates necessary changes in diet, exercise and medicines in order to manage the glucose levels. Higher A1C level, poorer blood sugar control and higher is the risk of diabetes complications. As the level rises above 6.5%, correspondingly the risks rise.


    The Hemoglobin A1c test is a measure of blood sugar control over the past 2 to 3 months. There is a valid reason for specifically measuring it for the last three months. The life of red blood cells (which is measured as part of the test) is three months. By measuring this part, a good indication of the average blood glucose over the previous 2-3 months can be obtained.

    The lab test can be done in two ways, a quick finger stick or a sample of blood from vein. Compared to other tests for measuring blood glucose levels, Hemoglobin A1c test is preferred to assist in predicting the risks of coronary heart disease among diabetes.


    • Diabetes is a well-known risk factor for cardiovascular disease. The risk increases with A1c levels.

    • Hemoglobin A1C is an important early clinical marker of disease risk.

    • Most doctors consider A1C level the best method to check how well a person is controlling his or her diabetes.

    • Used as a screening test for diabetes, American Diabetes Association has approved the test as a screening tool.

    • Urine tests or daily finger sticks are reliable only for limited period as blood sugar can vary depending on time of day, activity levels, hormone changes etc.

    • Hemoglobin A1C tests measure average blood glucose over the past two to three months. Hemoglobin cells are constantly dying and regenerating. They have a life span of approximately three months.

    • Fasting or any special preparation is not required for Hemoglobin A1c test. This test can be done any time during the day, even after a meal.

    • Measuring and keeping blood sugar close to normal is essential to prevent complications of diabetes.

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    Bibliography / Reference

    Collection of Pages - Last revised Date: September 15, 2019