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Healthy gums, healthy heart—that’s been the conclusion for several studies in the past, and now there’s even more major evidence that it’s true.

In a recent study out of South Korea, published in the European Journal of Preventive Cardiology, researchers looked at over 161,000 participants with no history of atrial fibrillation or heart failure in research done by the Korean National Health Insurance System. In addition to oral health and oral hygiene habits, participants provided information on previous illnesses, lifestyle habits like alcohol consumption cholesterol levels, and blood pressure

At a 10-year follow-up, participants who brushed their teeth three or more times per day had a 10 percent lower risk of atrial fibrillation and a 12 percent lower risk of heart failure compared to those who brushed their teeth less often. This was independent of other factors like hypertension, exercise and age.

One possible reason? According to the study, having dental plaque in the pockets of your gums allows oral bacteria to seep into your circulatory system and cause inflammation. “Systemic inflammations due to poor oral hygiene care and periodontal disease are associated with [atrial fibrillation],” the study states. Inflammation, the study goes on to say, could mess with your heart’s electrical system , which can lead to atrial fibrillation or heart failure.

This research falls in line with previous studies connecting heart health and lower inflammation with good oral hygiene, according to Mazen Natour, D.M.D., a New York City-based prosthodontist. He told Runner’s World there is ample evidence showing a connection between gum disease and increased risk of cardiovascular problems.

In part, the research is getting stronger because microbiology tests are more advanced than ever, he said, and that gives researchers more insight into how bacteria travels through the body and where it ends up.

“We can see bacteria that has formed in the gums traveling through the bloodstream,” he said. “When that happens, it can attach to artery walls and potentially cause small blood clots. In a worst-case scenario, those clots can get bigger and cause cardiovascular events like stroke or heart failure.”

But it’s not only the heart that can be affected, past research suggests. Because the bacteria can increase inflammation in the body, that can increase risk of other issues as well. For example, a study published in the International Journal of Cancernoted that dental plaque, which can be a reservoir for bacteria, may boost pancreatic cancer risk.

The American Academy of Periodontology points out that for men—who have higher incidence of poor oral health—gum disease can affect prostate health and even have increased risk of impotence.

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