Everyone produces that sticky, bacteria-laden film on their teeth called plaque. If it is not brushed and flossed off within 24 hours, it hardens into a cement-like substance known as tartar. Tartar cannot be brushed or flossed off, but needs to be removed by a dental professional. Left unchecked, plaque can harden – a problem that sets periodontal (or gum) disease in motion.

Gum disease is an inflammation of the gums that affects the bone that surrounds and supports the teeth. “Gingivitis” is the earliest and mildest form of gum disease. Left untreated, it can progress to severe periodontitis, the most advanced stage of periodontal disease. The gums become loose and inflamed around the root of the tooth, creating a pocket that gradually deepens. Eventually, infection and inflammation can cause the tooth to loosen and possibly fall out.

Just as gum disease causes inflammation of the gums, heart disease is associated with inflammation of the heart’s arteries. Despite extensive research on the connection between periodontal disease and a person’s health, many health professionals still dispute there is a direct connection, claiming shared risk factors, such as smoking or an unhealthy diet, may explain the association.

Despite the ongoing debate, key studies have shown that periodontal disease, or periodontitis, increases the risk of cardiovascular disease and heart attacks.

In a European Journal of Preventive Cardiology study, researchers found that among nearly 16,000 people, those with tooth loss and bleeding gums were more likely to have cardiovascular risk factors, including higher levels of blood sugar, high blood pressure, artery-clogging LDL (“bad”) cholesterol, and obesity.

In a report published by the American Heart Association, researchers found that periodontitis significantly increased the risk of a heart attack, even after adjusting for different factors in patients such as smoking, diabetes, and other factors. Known as “PAROKRANK” (“Periodontitis and its relation to coronary artery disease”), the study comes from Karolinska University Hospital in Sweden. After researchers controlled for smoking, diabetes, education, and marital status, individuals with periodontitis had a 28% increased risk of their first heart attack.

Brushing your teeth and flossing can prevent and even reverse an early stage of gum disease. If your dentist or hygienist says you have gingivitis, ask for a brushing and flossing demonstration to make sure you’re doing them correctly. And ask your dentist how often you should come in for teeth cleanings. Sometimes, more than twice a year is necessary to improve your oral health.