Ask most health care professionals how to avoid heart disease and you will be told to exercise, eat a healthy diet and lower your LDL cholesterol (with a statin if needed).

At last count, about 50 million Americans were taking a medicine such as atorvastatin, rosuvastatin or simvastatin to treat or prevent heart disease.

We would be surprised if the usual advice on preventing heart disease included flossing your teeth regularly. That’s because it seems unrelated to the conventional idea that high cholesterol is the primary cause of heart disease.

Yet an analysis of data from the National Health and Nutrition Examination Survey shows that regular dental floss use may reduce the risk of atherosclerosis (Heart & Lung, May-June 2025). People who reported flossing three or four days a week lowered their chance of a stroke, heart attack, angina or coronary artery disease by almost half.

That probably comes as a surprise to many cardiologists and primary care physicians. How could flossing make such a difference?

Decades ago, researchers had detected a link between gum disease and heart attacks (European Heart Journal, December 1993, suppl.).

Periodontal disease (gum infection) can trigger body-wide chronic inflammation. Clogging of coronary arteries (atherosclerosis) is not only caused by cholesterol. Inflammation also contributes to the development of plaque in the lining of blood vessels (Current Pharmaceutical Design, 2012).

Bacteria in the mouth have been linked to an increased risk of heart attacks. One study reported that germs such as Bacteroides, Sphingomonas and Serratia were more common in the mouth or blood of heart attack patients (Journal of Translational Medicine, July 16, 2025).

Another bad actor in the mouth is Porphyromonas gingivalis. This pathogen is associated with atherosclerosis and elevated heart attack risk (BMC Oral Health, Feb. 2, 2023). The microbes spread throughout the body, burrow into the cells lining blood vessels and trigger an inflammatory reaction. Such a cascade of events leads to heart disease.

One way that statins may be reducing the risk of heart attacks is through an anti-inflammatory effect, including in the mouth (International Journal of Cardiology, Nov. 15, 2024). Maybe dentists should be prescribing statins to help treat gum disease and

cardiologists should be referring their heart patients to periodontal

experts.

All this brings us back to flossing. Many people find flossing boring at best and annoying at worst. The benefit is fairly impressive, though. Dental floss is cheap and is not associated with severe side effects, yet people who floss are 24% to 32% less likely to suffer heart attacks, strokes or other cardiovascular complications.

Maybe it is time for cardiologists to prescribe flossing along with statins for patients at risk of heart disease. And dentists may want to refer their patients with gum disease to a cardiologist for a thorough workup.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 300 W. 57th Street, 41st Floor, New York, NY 10019, or email them via their website: www.PeoplesPharmacy.com. Their newest book is “Top Screwups Doctors Make and How to Avoid Them.”

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