What are the symptoms of tooth infection spreading to the heart?

tooth infection spreading to the heart
It all starts with a small cavity. If left untreated, it will continue to progress in depth to reach the dental pulp, where the tooth vessels and nerves are located.

The problem is that the blood vessels of the tooth are not disconnected from the body. Under certain conditions, a tooth infection can spread in the body and reach our vital organs. The most common and threatening is the heart.

In this article, you will learn 3 cardiovascular complications of untreated tooth infection.

Tooth infection and atherosclerosis

What is atherosclerosis?

It is the deposit of a plaque ( called atheroma) made up mainly of lipids and more particularly of LDL (low-density lipoprotein which is the bad cholesterol) inside the arteries.
This can lead to poor or even obstruction of blood circulation, which can have dramatic consequences.

Different studies have confirmed the relationship between gum disease and atherosclerosis. But the impact of dental infections, especially apical periodontitis which affects the tip of the tooth root, has not been studied much.

What is apical periodontitis, and how does it occur?

When tooth decay reaches the pulp, as long as the tooth is alive, it will try to hold the infection within itself. Once the pulp is dead (pulp necrosis), the infection spreads beyond the pulp to the area near the root tip, called the periapex, leading to apical periodontitis.

periapical periodontitis

The problem with apical periodontitis is that it can be asymptomatic, meaning that you can have apical periodontitis without feeling anything. Hence the need to see your doctor regularly, an X-ray examination can easily reveal these lesions allowing us to treat them from their initial stage. Sometimes apical periodontitis can produce symptoms, among them:

  • Continuous and radiating pain towards the jaws, the temporomandibular joint, and the ear.
  • Sensitivity to hot food.
  • Long tooth feeling.
  • Bad breath and bad taste.
  • The appearance of an abscess near the tip of the root.
  • Swelling of the cheeks and under the lower jaw.
  • Fever.

Apical periodontitis and gum disease have many bacteria in common including Actinobacillus actinomycetemcomitans (Aa) and Porphyromonas gingivalis (Pg) which are strongly involved in atherosclerosis. But first, we need to understand how atherosclerosis occurs.

How does atherosclerosis occur?

how does atherosclerosis occur

The bad cholesterol from high-fat diets will accumulate in certain arterial sites, forming a lipid mass. Gradually, the cholesterol will oxidize and become inflammatory. The immune cells trying to eliminate this mass will absorb this cholesterol and become bulky.

These cells eventually die and accumulate to form what we call atheromatous plaque. In some cases, substances will be released that can damage these plaques. This will result in their rupture and the formation of a blood clot within the arteries which can block the blood flow and lead to fatal complications.

How can dental infection be involved in atherosclerosis?

The bacteria of the dental infection and their toxin will trigger a general immune response. This will increase the inflammatory substances in the general circulation.

Since atherosclerosis is recognized as a chronic inflammatory disease, dental infections may accelerate this process. The inflammatory mediators will then stimulate reactions on a pre-existing plaque, increasing its volume.

This may increase the risk of plaque rupture and the appearance of serious complications, including heart attack (if the coronary artery is affected) or stroke (if the carotid artery is concerned).

Moreover, apical periodontitis increases CRP (a marker of inflammation in the body). Elevated levels of CRP have been linked to an increased risk of developing atherosclerosis.

In summary, inflammation is supposed to have a protective effect. However, some conditions, such as tooth infection, can lead to long-lasting inflammation that can cause serious complications. These include:

  • Accelerate the process of atherosclerosis, leading to fatal consequences such as stroke (if the carotid artery is involved) or heart attack (if the coronary artery is involved).
  • Increased oxidative stress in the body.
  • Decrease the antioxidant properties of HDL (good cholesterol).
  • High blood pressure

Tooth infection and coronary artery disease

What is coronary artery disease?

Coronary artery disease (CAD) refers to a condition in which the coronary arteries, which supply blood to the heart, become narrowed or blocked by a buildup of plaque.

According to one study, people with chronic (long-lasting) apical periodontitis had a 2.79 times higher risk of developing coronary artery disease.

The mechanism involved is the same as that of atherosclerosis. The increase in inflammatory mediators in the blood will affect the coronary arteries, which will gradually narrow. This will reduce the blood supply to the heart.

This can lead to symptoms such as chest pain, shortness of breath, and fatigue. Coronary artery disease can also lead to more serious conditions, such as heart attack and heart failure.

Tooth infection and infectious endocarditis

What is infectious endocarditis?

It's an infection affecting the heart valves, a kind of gate that prevents the blood pumped by the heart from changing direction.
It results from bacteria that enter the body through a lesion, circulate in the bloodstream, and eventually attach to the heart.

According to the American Heart Association, oral infection is among the leading causes of infective endocarditis. It may result from poor dental hygiene, tooth brushing that causes minor injury to the lining of the mouth, or gums/dental procedures

In people with weakened immune systems, bacteria that have reached the bloodstream are more likely to affect the heart.
They can stick to a heart valve and form a bacterial plaque. This can lead to ulceration or even perforation of the affected valve, resulting in potentially fatal heart dysfunction.

How can bacteria from a tooth infection reach the heart?

Bacteria can reach the general bloodstream through any injury. It can occur after brushing, chewing, or during a surgical procedure such as tooth extraction.

In healthy people, this is a temporary phase that is quickly resolved by the immune system. However, in people with certain medical conditions, these bacteria may persist and attach to the heart.

Symptoms that indicate a risk of heart complications

Depending on the virulence of the bacteria involved and the resistance of the immune system, there are several symptoms that can signal a risk of heart complications. They can range from mild fever to general malaise. Among them:

  • Fever, fatigue, and dehydration: A fever that exceeds 38 degrees means a generalized immune response. This is a complication of untreated dental infection and should prompt you to see your dentist quickly as it may indicate the spread of the infection.
  • Increased heart and breathing rate: Dental infection can affect the arteries indirectly by increasing inflammatory mediators in the blood. As a result, the heart rate will increase to meet the body's need for oxygen. It is an urgent condition that should concern you as it may indicate the onset of sepsis.
  • Swelling: One of the signs of dental infection is a localized swelling on the gum called a dental abscess. Sometimes the swelling can spread to the surrounding tissue and cause cellulitis. In its diffuse form, it can be life-threatening, damaging the heart, lungs, and brain.

Risk factors for heart complications

Heart complications from dental infection are rare, but certain factors increase the risk drastically. Some of them include:

  • Weakened immune system due to diabetes, HIV infection, chemotherapy or radiotherapy, or blood disorders.
  • Wearing a heart valve prosthesis
  • History of endocarditis
  • Unoperated congenital heart disease
  • Stress
  • Smoking
  • High cholesterol levels.
  • High blood pressure
  • Overweight

How to prevent heart complications

The best way to prevent cavities and gum disease, therefore, potential heart complications, is to practice good oral hygiene.
Cleaning your mouth regularly and properly will help reduce plaque build-up and bacterial load, which can help prevent dental infections and possible heart damage. Oral hygiene measures include:

  • Brush your teeth twice a day and clean between your teeth with dental floss or interdental brushes daily. This will help you remove bacterial plaque, the leading cause of cavities and gum disease.

  • Eat a healthy diet that includes essential nutrients for your oral and heart health. These include vitamin C, vitamin D, essential fatty acids, iron, and other minerals.

  • Quit smoking and reduce your alcohol consumption to reduce your risk of both oral and cardiovascular diseases.

  • Schedule regular check-ups and professional dental cleanings with your dentist to remove tartar buildup and detect any dental infections early on.

  • If you have heart disease, make sure to inform your dentist and provide them with a list of your medications and contact information for your cardiologist. This will help them take the necessary steps to avoid any complications.

  1. Association between chronic apical periodontitis and coronary artery disease https://pubmed.ncbi.nlm.nih.gov/24461397/
  2. Apical periodontitis and atherosclerosis: Is there a link? Review of the literature and potential mechanism of linkage https://pubmed.ncbi.nlm.nih.gov/28462408/
  3. The connection between C-reactive protein and atherosclerosis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3364506/
  4. Periodontal Disease-Induced Atherosclerosis and Oxidative Stress https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4665422/
  5. Heart Valves and Infective Endocarditis https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/heart-valves-and-infective-endocarditis
  6. What Is Sepsis? Symptoms and Treatment https://share.upmc.com/2017/09/what-is-sepsis/