“The keyword of the day is maintaining homeostasis. You want to maintain the balance that we have in the oral cavity that is compatible with health in the individual.”
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Your mouth does far more than help you chew; it may be quietly shaping your risk for heart disease, diabetes, and chronic inflammation. In this episode, we explore the powerful (and often overlooked) connection between gum health and whole-body health.
You’ll learn how everyday habits like brushing, flossing, smoking, and diet choices can influence inflammation throughout the body. We break down what science really says about gum disease, cardiovascular risk, blood sugar control, and the oral microbiome, plus which small changes can make an outsized impact over time.
If you care about heart health, diabetes prevention, or lowering inflammation naturally, this episode will change how you think about oral care.
Shireen Abdullah 0:00
Your mouth isn’t just about teeth. It’s a checkpoint for your heart. This episode breaks down how gum disease can drive cardiovascular risk, what nutrition and daily habits actually help, what the science says about mouthwash, and why oral health matters even more when it comes to diabetes. Stay tuned to the end for one small change with outsized impact.
Shireen Abdullah 0:25
Podcasting from Dallas, Texas. I am Shireen, and this is the Yumlish Podcast. Yumlish is working to empower you to take charge of your health through diet and exercise, and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.
Shireen Abdullah 0:58
Dr. Thomas Van Dyke is Senior Vice President of Clinical and Translational Research and Senior Member of Staff at the ADA Forsyth Institute in Somerville, Massachusetts. He received his D.D.S from Case Western Reserve University, his Master’s, Periodontic Certificate, and PhD from the State University of New York at Buffalo. He’s a diplomate of the American Board of Periodontology. He’s internationally recognized for his work on inflammation in periodontal disease and other systemic conditions, and on top of that, he has over 500+ original publications. Welcome, Dr. Van Dyke. How are you doing?
Dr. Thomas E. Van Dyke 1:34
I’m doing very well. Thank you for the invitation to be here.
Shireen Abdullah 1:36
Of course, such a pleasure having you on. So, first things first, let’s start out with, you know, what led you to this? What sparked this initial interest in oral health and this connection to heart disease? Where did that come from?
Dr. Thomas E. Van Dyke 1:48
Well, it actually came from the literature. In the mid-90s, in the middle of there was a lot of large national surveys going on. They’re called NHANES, which are the National Health Surveys that were done in the United States, and people started noting connections between oral health and systemic health. In other words, people who had heart disease were at higher risk for having periodontal disease. And vice versa, people who had periodontal disease were at higher risk for having heart disease and other systemic conditions, and the link seemed to be inflammatory, on the surface, but the periodontal disease in the mid-90s was considered an infectious disease, and so the immediate assumption was that this was a bacterial-driven association.
Dr. Thomas E. Van Dyke 2:49
And over the years, I became interested in it, mostly because I study inflammation, and I saw the link as inflammation. And so we began studies over time, and I think that what’s come out of it now is that all of these diseases of aging that we’re talking about: cardiovascular disease, type 2 diabetes, obesity, and etc, are all really inflammatory conditions, and the role of the oral microbiome in this is it’s the trigger.
Dr. Thomas E. Van Dyke 3:24
Okay, if you have periodontal disease, you are more likely to have these bacteria in your bloodstream, and they’re going to trigger systemic inflammation. And then you have a two-way street. You know what comes first. What comes second is what you have is the circle that feeds upon itself. And if you don’t interrupt that circle, then you know all these risk factors combine to to put the – put it all together, where you have more severe systemic disease or more severe periodontal disease as a result of having both at the same time.
Shireen Abdullah 4:06
And that’s fascinating. You defined it as a two-way street. Why is that the case?
Dr. Thomas E. Van Dyke 4:11
Well, first of all, from association studies like these, large national surveys. It’s why I started out by saying one is a risk for the other and vice versa. There’s no directionality. I mean, these are cross-sectional studies, meaning that you’re looking at people at one point in time. So there’s really no way to make inferences about what came first, which one causes the other one. So you know, over time, using animal models and various other experimental designs. Basically, what we’re showing is, is that it seems to be a two-way street, that you know, once you have inflammation, that allows bacteria into your bloodstream. Which further exacerbates inflammation. Okay, so you know, you get this. It’s a two-way street, or a circular sort of feedback loop, where you know it gets worse because you’re not taking care of either side of the circle, if that makes sense.
Shireen Abdullah 5:19
And you mentioned that this is about the bacteria in the bloodstream as well as inflammation. I guess. What is the root cause here?
Dr. Thomas E. Van Dyke 5:30
Well, the diseases, the systemic diseases we’re talking about, are inflammatory diseases. Okay, they all have a large inflammatory component. Periodontal disease is an inflammatory disease, according to the American Academy of Periodontology; it’s an inflammatory disease that’s initiated by bacteria in the oral cavity. Okay, of all the inflammatory diseases that we study and know about it, you know, periodontitis is one of the few where it’s so clear, okay, we know if you, if you control the bacteria in your mouth by brushing and flossing, that most people will never get periodontal disease.
Dr. Thomas E. Van Dyke 6:13
I mean, it starts out as gingivitis. You can control gingivitis by good oral hygiene for the most part. Okay, there are people who have excellent oral hygiene and still get periodontitis. Okay? So you know the inflammatory component is apparently under genetic control. Some people are higher responders than others, and if you’re unfortunate enough to be susceptible to inflammatory diseases. It would seem that you’re susceptible to all of them, okay, and this is what we see clinically, is, you know, people with, you know, metabolic syndrome, people who are obese, become type 2 diabetic or higher risk for cardiovascular disease sees this as all part of this inflammatory axis.
Dr. Thomas E. Van Dyke 7:05
And you know, one of the things we have to keep in mind because the gut is involved as well. Okay, that’s the other major area in the body where you have this huge load of bacteria, and when you get an inflamed gut that becomes leaky, so the bacteria from the gut get into the bloodstream as well. And it’s that, that bacteria in the bloodstream, we think is a trigger to perpetuate the inflammation, perhaps make it worse, and keep the cycle going. So in the case of periodontal disease, the etiology is bacteria, but the pathogenesis, the reason that your disease progresses, is inflammatory.
Shireen Abdullah 7:55
Fascinating. To our listeners here. What are some steps that folks can take today to improve their oral health? You know, you mentioned just a little bit ago that you can have great oral hygiene, but yet be at risk. So what are the types of things that one can do to improve their overall oral health, excuse me, and in turn, lower their risk of cardiovascular disease?
Dr. Thomas E. Van Dyke 8:17
Yeah. Well, the biggest one is, is taking care of your oral cavity, okay? You know, making sure that you get regular checkups. And you know we see this on TV all the time, and your dentist tells us this all the time, but people tend to ignore it, okay? And you know, flossing has been shown to have an impact, okay, so most people don’t like to floss, but in fact, it does improve your oral hygiene, and it does improve or reduce your risk for getting periodontal disease. Um, brushing your teeth a couple of times a day, doing it efficiently, doing it long enough that you’re removing all the plaque. All these things are very important, but there are also lifestyle behaviors that are pro-inflammatory, systemically pro-inflammatory.
Dr. Thomas E. Van Dyke 9:04
Smoking is, in fact, the largest risk factor for developing periodontal disease, okay? Because, you know, you create a lot of systemic inflammation by smoking, excess alcohol consumption, you know, a diet that is rich in pro-inflammatory foods. You know, red meats are implicated in that, you know, that kind of thing, you know. So it’s, it’s lifestyle things that make a difference as well. You know, the one of the, you know, there are sort of anti-inflammatory, or controlling of inflammation, lifestyle changes that people can make. We read a lot about omega-3 fatty acids in the diet. Omega-3 fatty acids in the diet do have a clinical Impact. There are a lot of studies to show that, epidemiologic studies, as well as various smaller studies, but the general, you know, the general message there is, you know, omega-3 fatty acid supplements, particularly if you’re prone to inflammation – do have an impact, and so you can, you can modify your lifestyle to modify your systemic inflammation.
Shireen Abdullah 10:29
You know, when you’re talking about nutrition, it’s a big one for us, for our listeners, just because of the work that we do at Yumlish and the types of things that we focus on. You know, you mentioned Omega-3. You mentioned something about red meats as well. Given that nutrition is such a such a big focus for our listeners, how does, how does what we eat affect the health of our overall gums and mouth?
Dr. Thomas E. Van Dyke 10:53
Well, the first caveat is it’s usually variable between people. Okay? So nothing, nothing is generalizable, okay, but you know, the trends that you see is that, you know, Mediterranean diet, which is low in red meat, high in vegetables, high in fish, and you know, things that contain omega-3s, vegetable omega-3s. You’ve got to define omega-3 fatty acids. Okay, so when you eat fish, you get the benefit of EPA and DHA, which you see advertised everywhere on the side of supplements and things like that. EPA and DHA are long chain fatty acids that fish make that have the ability to control inflammation in the diet, in the human diet. Humans don’t make these things very well, okay, fish make them very well. And they make them from Omega three precursors, alpha linolenic acid is the major precursor, and it’s found in seaweed and other leafy green vegetables.
Dr. Thomas E. Van Dyke 12:13
Flaxseed oil is loaded with alpha linolenic acid, and these are the precursors for the omega-3 fatty acids, EPA and DHA, which are the precursors for the molecules that actually control inflammation. Okay, so there’s this, this chain from the diet. Now, the, as I mentioned, EPA and DHA, we get mostly from the diet, because our body doesn’t make them very efficiently. Humans don’t make them very efficiently. But if you eat a lot of the Omega-3 precursor, the alpha-linolenic acid, that long-chain fatty acid, also gets into the pro-inflammatory pathways.
Dr. Thomas E. Van Dyke 13:03
And what you end up with is pro-inflammatory molecules that are not as potent. So you actually get a reduction in inflammation, because your prostaglandins have a slightly different structure, which is not as pro-inflammatory, your leukotrienes, which are another pro-inflammatory molecule from lipids or fatty molecules, long chain fatty acids are less potent, and that sort of thing. So, you know, you can, and it’s been shown in clinical trials in humans that this is measurable. You can actually measure the reduction in inflammation and these molecules in the bloodstream that correlate with these changes in diet. Now, you know the leap of faith is, is that, you know, okay, people who have come from regions where they have a very high Mediterranean diet, you know, live longer, you know, according to statistics and stuff, so that’s the leap of faith that these two are directly related.
Shireen Abdullah 14:06
How fascinating, beyond nutrients, how do ultra-processed foods, sugary beverages, affect the overall microbiome, and then, of course, the inflammation risk?
Dr. Thomas E. Van Dyke 14:18
Well, ultra-processed foods tend to be pro-inflammatory. High sugary drinks, first of all, feed the bacteria in your mouth or cause tooth decay and things like that, but they also make you fat. Being fat, you know, raises your inflammation. Okay, so obesity is related to insulin resistance, meaning it takes more your pancreas has to produce more insulin to keep your blood sugar levels at the same place. And you know, the more you know that this relationship between obesity and insulin resistance is what leads to type 2 diabetes. Eventually, you have to produce more and more insulin to control your blood sugar, and eventually your pancreas can’t keep up, and next thing you know, you’re a type 2 diabetic.
Dr. Thomas E. Van Dyke 15:14
So does that answer the questions?
Shireen Abdullah 15:18
For daily care, what two habits, if you could pick, move the needle most? And how should people choose between floss and, you know, the sort of brushing, the water flossers that we see a lot of commercials for?
Dr. Thomas E. Van Dyke 15:34
Well, the water flosses. You know, the most, the best way to get plaque off your teeth is to remove, remove it physically, okay, which was the argument for floss. The water flosses leave the, you know, supposedly, leave the matrix, you know, washes away the bacteria, but leaves the matrix behind on the surface of the tooth, which then can get recolonized more rapidly. Supposedly, you know, I’m not too sure how strong all of this data is, but you know, anything that you can do to, you know, keep your mouth clean is going to help. You know, losing weight is going to help.
Dr. Thomas E. Van Dyke 16:18
You know, keeping processed foods out of your diet, you know, pro-inflammatory foods out of your diet is going to help. So, you know, all of these things, I think lifestyle changes that are important. You know, within reason, you know, it’s sort of a day-to-day thing that doesn’t mean you can’t go to parties anymore. You just have to. It’s like when you’re dealing with your children, you can give them all the candy you want, as long as they clean their mouths after they eat the candy, right? Not, not two days later, right? The other thing that’s important is, in terms of lifestyle, is there’s a lot of work now showing that your oralmicrobiome actually is a biologically active and beneficial thing when it’s in homeostasis with the host with you. So one of those things is there’s a lot of bacteria in your mouth that are nitrate-producing, and nitrate reduction by that oral microbiome is important in controlling blood pressure for instance, okay.
Dr. Thomas E. Van Dyke 17:27
It’s been shown that the pathway of nitrate, or nitrate to nitrite to nitroxide production controls blood pressure, and you have to make sure that you’re not disturbing that. You want to remove this plaque from your teeth, you want to control your oral microbiome, but you don’t want to kill your microbiome, because if you kill all the nitrate-producing bacteria, it’s been shown that this relationship to raising blood pressure in people. So you know the key, the word of the day, is maintaining homeostasis. You want to maintain the balance that we have in the oral cavity that is compatible with health in the individual.
Shireen Abdullah 18:12
This next question is, is one very top of mind for me in my own household, because I was just having this conversation with my husband about it, but are antiseptic mouthwashes – you know, we hear a lot about this, but are helpful at all? Or can they disrupt the oral microbiome and even impact blood pressure via the nitrate pathway?
Dr. Thomas E. Van Dyke 18:35
Well, that, that’s, that’s an open question that people are studying right now. Okay, I don’t know that there’s a definitive literature about that. We do know, we know that these products kill bacteria, nitrate-producing bacteria, and we know that the nitrate participates, you know, the nitrate-producing bacteria participate in maintaining homeostasis, whether they’re directly harmful has not been definitively shown to my knowledge.
Shireen Abdullah 19:10
Okay, fair point. So the argument in my household continues.
Dr. Thomas E. Van Dyke 19:16
So, yeah, should fund a study to find out.
Shireen Abdullah 19:20
Okay, well, I’ll keep that in mind.
Shireen Abdullah 19:24
My next question for you is, does treating gum disease like scaling and root planing actually improve cardiovascular risk markers or outcomes? And what does the evidence say today about that?
Dr. Thomas E. Van Dyke 19:36
Yeah, there is, there is data to suggest that that’s true. You know, most of it’s in animals. It’s hard to do these experiments in people, but going back to the nitric oxide type of thing, you know, there was some papers that came out of England, [unintelligible] did some studies showing a relationship between periodontal disease and treatment of periodontal disease and reducing or improving the nitric oxide balance and nitric oxide, nitric oxide response of blood vessels to, you know, to stimulation. So the – and then, you know, there, there are other studies published showing reductions in systemic inflammation when you treat periodontal disease, there are studies that show that people with active periodontal disease have a lot more inflammation systemically and seem to be at higher risk for cardiovascular events, because the systemic inflammation seems to be what destabilizes cardiovascular plaques that leads to cardiovascular events.
Dr. Thomas E. Van Dyke 21:11
Now these are all small studies. None of them are definitive, but there’s, there’s a growing literature to show that this relationship is real, and it’s being – it’s under further study currently. You know, we talked earlier about omega-3 fatty acids. There’s one very definitive meta-analysis of all the studies of omega-3 fatty acids and its relationship to cardiovascular risk. That was by Yang and Frank Hu from Harvard, Harvard School of Public Health, and they show a basically a, linear relationship that increasing doses of omega-3s in the diet are protective in heart disease. And there was another study called the Reduce It trial, where they actually used pure EPA as the treatment at higher dose, and that was even more effective.
Dr. Thomas E. Van Dyke 22:15
Okay, so these relationships seem to be real. Controlling the inflammation systemically seems to be very important in terms of risk, you know, and risk is an important term, okay? Because risk is not – doesn’t mean that if you do this, you’re going to get it okay. Increases your risk, okay. So, you know, it just, it’s a statistical term that increases your odds of having some sort of outcome. But that’s what we use in public health criteria and patients, because they’re they’re population based statistics, as opposed to following an individual.
Shireen Abdullah 23:00
So, you know, for for our listeners here today, Dr. Van Dyke, you know, for people with diabetes with prediabetes, how does metabolic health interact with periodontal disease and and then do you tailor oral care recommendations that you could, that you can provide for them here?
Dr. Thomas E. Van Dyke 23:20
Well, in prediabetes, and we’re talking about type 2 diabetes. Type 1 diabetes is a different disease. But no, there’s a there seems to be a direct relationship. It’s that relationship is between periodontal disease and type two diabetes and pre-diabetes, is the best study, okay? And there are longitudinal studies that show that one impacts the other. Okay, people with type 2 diabetes who have periodontal disease have more trouble controlling their blood sugar. There are also people with types with periodontal disease are at higher risk for developing type 2 diabetes. And again, that’s a risk statement.
Dr. Thomas E. Van Dyke 24:15
Okay, so just because you have periodontal disease doesn’t mean everybody with periodontal disease is going to get type 2 diabetes. It’s a lot of other risk factors that contribute to that, but the relationship of the oral inflammation to the systemic inflammation has a direct impact. And it’s the, it’s the it’s the systemic inflammation that drives the development of type 2 diabetes, okay, you know, because that’s where the insulin resistance initially comes from. Is, you know, insulin resistance as a result of systemic inflammation, and then, you know, it gets the ball rolling. And again, no guarantee you’re going to develop type 2 diabetes, but it increases your risk.
Shireen Abdullah 25:00
I’m going to try to squeeze in one last question, real quickly in here, Dr. Van Dyke, which is for listeners again, what is one small change that someone could start today that could really make a huge impact and huge difference for both their gums and their heart?
Dr. Thomas E. Van Dyke 25:15
Stop smoking.
Shireen Abdullah 25:16
Okay.
Dr. Thomas E. Van Dyke 25:16
That’s the biggest one, the stop smoking. If you smoke, do not smoke. And that’s really easy for me to say, okay, it’s really, really hard to do. But you know, there are, smoking cessation programs. People should take it seriously and do everything they can to break that habit, and it’s going to have the biggest impact on oral and systemic health of anything you could possibly do.
Shireen Abdullah 25:49
Very helpful on that. On that note. Dr. Van Dyke, we are toward the end of the episode. If you could please tell us how we can connect with you. Stay in touch with your work. Where can we find more information?
Dr. Thomas E. Van Dyke 26:02
Well, you know, there are various. Well, first of all, you can go to the ADA Forsyth website, which, you know, has a page that follows what I do. You can also there are various ways to search the literature for our work, probably the simplest being Google, okay, but you know, there’s PubMed and a variety of other ways to access that information. And you know, you know a lot, you know. And of course, if you’re a professional, read the journals, you know. But, but I think, for people who are just interested, is following this information online, and, you know, going to reliable websites and reading the literature for yourself rather than having somebody interpret it for you. Okay, so you can, you can make rational decisions.
Shireen Abdullah 27:10
Very helpful. Dr. Van Dyke, thank you so much for your presence here and for being a guest on our podcast here. To our listeners. Thank you for tuning in to another episode of the Yumlish Podcast. You know what time it is, you head over to our social media and answer this quick question, which is: have you ever considered how your oral health could affect your heart? After today’s episode, what’s that one step that you can take today to change and/or add in your oral hygiene routine going forward? So again, head over to our Facebook, our Instagram @Yumlish, find this podcast post, and comment below again to tell us: have you ever considered how your oral health could affect your heart, and after today’s episode, what’s that one thing that you will change or modify for yourself in your oral hygiene routine With that, Dr. Van Dyke, thank you so much again.
Dr. Thomas E. Van Dyke 28:01
Thank you.
Shireen Abdullah 28:04
Thank you for listening to the Yumlish podcast. Make sure to follow us on social media, @Yumlish_ on Instagram and Twitter, and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions, and to chat and connect with us about your journey and perspective. You can also visit our website, Yumlish.com, for more recipe advice and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.