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As scientists link oral bacteria to heart disease and cognitive decline, a push is under way to treat the mouth as a source of bodywide inflammation

The eyes are a window to the soul, but the mouth may reveal just as much about a person’s health—and the diseases that shape how we age.

To better understand those connections, scientists are studying how issues that start in the mouth may contribute to chronic inflammation elsewhere in the body. In particular, they’re examining how bacteria from diseased gums, and the immune response they trigger, may contribute to conditions including heart disease, diabetes, cognitive decline, arthritis, respiratory disease and chronic liver disease.

The emerging science poses a challenge for healthcare, given the traditional divide between medicine and dentistry—fields that have long been divided by separate training, records and insurance systems. “Dentists haven’t traditionally been trained to think about whole-body health in relation to the mouth, and doctors haven’t been trained to see dental health as a first step to overall well-being,” says Dr. Jessica Lederhausen, a dentist and author of “Oral,” a book exploring the role of lifestyle on oral health.

But that is changing. Dental schools, which have taught how diseases like diabetes affect the mouth, are also placing greater emphasis on how oral disease can affect the rest of the body. Medical-education leaders have called on medical schools to better integrate oral health into physician training.

At the Harvard School of Dental Medicine, the Initiative to Integrate Oral Health and Medicine is researching how oral-health policy and health-system design can better support “whole-person care,” according to its director, Dr. Lisa Simon, who is both a dentist and a physician.

“We envision a future where a heart doctor asks patients if they are seeing their dentist regularly, and whether they are aware their periodontal disease could mean they have a much worse heart situation,” says Wenyuan Shi, an oral-microbiology researcher who heads the ADA Forsyth Institute, the research arm of the American Dental Association.

With better coordination, including shared medical and dental records, experts say, primary-care doctors might increasingly refer patients with diabetes or at high risk for heart disease to a dentist or periodontist for evaluation and treatment of gum disease. Meanwhile, more dentists may identify signs of uncontrolled diabetes and coordinate care with the patient’s physician.

The longevity link

The growing understanding of the mouth-body connection is also leading to new diagnostic tools, prevention strategies and treatments. And it is intensifying calls to provide more widespread coverage for preventive dental procedures, especially for older adults who are at highest risk.

According to the Centers for Disease Control and Prevention, nearly half of all adults aged 30 years and older have periodontitis, the more serious type of gum disease that involves bone loss around teeth. But federal data also shows prevalence increases with age, when close to 60% of those 65 or older have some level of disease—just as people become more vulnerable to conditions that can dramatically affect a healthy lifespan. In turn, conditions such as diabetes can make gum disease more severe or harder to treat.

A 2023 review in the journal Biogerontology concluded that oral health plays a significant role in reaching “exceptional longevity,” in part because of its connection to inflammation. And research on adults 65 and older has found that oral diseases—including periodontal disease, tooth decay and tooth loss—remain a substantial source of years lived with disability, suggesting that oral health can shape the quality, not just the length, of later life.

The plaque connection

At the heart of current research is the oral microbiome, the community of hundreds of bacteria, fungi and other microbes that live in the mouth. Most are part of a healthy ecosystem, but a smaller group can thrive below the gumline, inflame the gums and drive diseases such as gingivitis and periodontitis. Over time, severe gum disease can destroy the tissue and bone that hold teeth in place.

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A big challenge is dental plaque, a protective structure known as a biofilm that helps bacteria adhere to teeth and makes them more resistant to removal by saliva, mouth rinses and some antimicrobial agents. When plaque builds up, it can harden into tartar and trigger chronic gum inflammation.

Periodontists often manage patients with deep cleaning and scaling, and occasionally lasers. The procedures remove plaque below the gumline and disrupt bacterial biofilms that contribute to gum inflammation.

But plaque can shed bacteria or bacterial products into the bloodstream, says Dr. George Hajishengallis, a professor at the University of Pennsylvania’s dental school specializing in microbiology and immunology. Most of the time, the immune system clears them quickly. With periodontitis, inflamed gums can weaken the body’s usual barriers, and ordinary activities such as chewing, brushing or flossing can allow small amounts of bacteria or bacterial products to enter the bloodstream repeatedly, potentially adding to inflammation elsewhere in the body.

Research by Hajishengallis and another Penn professor, immunologist John Lambris, led to the development of an experimental drug applied into gum tissue, aimed at calming the immune response. In an early trial in people with gum disease, the drug was reported to reduce gum inflammation for several months. While the researchers say it won’t replace traditional dental cleaning, it could be used along with such cleanings to keep gum-disease inflammation at bay.

Amyndas Pharmaceuticals, a company founded by Lambris and spun off from Penn, is planning larger trials, says Lambris.

Another company, Denteric, is developing a therapeutic vaccine designed to help patients who already have gum disease. Earlier this year, the FDA cleared the vaccine for a Phase 2 clinical trial in the U.S.

“The goal is not to replace existing dental care, but to work alongside it by helping the body address one of the key biological drivers of disease progression,” says CEO Sean McLoughlin.

A dose of prevention

A growing number of startups are entering the oral-health field, developing new approaches to preventing and managing disease, such as reducing harmful bacteria in the mouth while preserving helpful ones, and controlling biofilms before they cause lasting damage.

Dr. Ana Becil Giglio, a New York periodontist and president of the American Academy of Periodontology, says some of the most promising future treatments for gum disease are aimed at controlling the body’s inflammatory response rather than simply removing plaque or killing bacteria.

One approach would block destructive enzymes that break down gum tissue; another would help the body naturally turn off inflammation once it has done its job; and a third would slow the loss of gum tissue and bone that keep teeth firmly in place.

A recent report in the Journal of Periodontology predicts that technology such as AI, diagnostic saliva tests and sensor-based monitoring will allow for more early detection and individualized treatment. Sensors, for example, could be placed in the oral cavity for real-time monitoring, continuously tracking changes in the oral environment and watch for things like markers of inflammation. The sensors could also pair with apps or wearable technology to offer users feedback.

Oral-health experts are also turning to AI to analyze the growing amount of data from patients’ mouths. A group of ADA Forsyth researchers is using AI in a five-year federally funded project to help develop smart dental-filling materials and to assist in reading dental X-rays and other digital images for signs of cavities, gingivitis and gum disease. Machine-learning models have already shown promise in analyzing radiographs, according to a 2025 review.

Better care, shared records

A big challenge is the lack of dental-care insurance for those 65 and older, according to Dr. Frank A. Scannapieco, a professor at the University at Buffalo School of Dental Medicine. A study he co-wrote, published in 2023, found that a preventive dental visit in the year before hospitalization was associated with a 10% lower risk of a type of pneumonia that strikes hospitalized patients, while periodontal therapy within six months was associated with a 30% lower risk.

And a review of research he co-wrote concluded that the addition of dental benefits to the Medicare program for diagnosis, prevention and control of oral diseases could improve health and potentially reduce medical costs.

Meanwhile, there are efforts to overcome a behind-the-scenes barrier between doctors and dentists: records systems. Very often, the two types of caregivers use different digital systems to store patients’ vital information, and those systems can’t talk to each other.

One effort comes from PDS Health, a Henderson, Nev.-based company that supplies business and administrative support services for more than 1,200 dental and primary-care practices nationwide, including the widely used Epic electronic health records system. That has helped dental and medical providers collaborate around a shared patient record, and allows patients to see their oral and medical information via a single patient portal, says Chief Executive Stephen V. Thorne IV.

Since 2020, more than 303 million patient records have been exchanged between medical and dental providers, and PDS is working with dental schools including the University of Michigan to expand the use of Epic records in dental education. The university’s health system and its medical school already use Epic, and a dental-school spokesperson says the ability to view a complete health record will enable its students and faculty to get a complete view of patients’ unique healthcare needs.

The push toward better oral health isn’t confined to dentists’ and doctors’ offices. A global oral-care industry worth roughly $40 billion a year is promoting new products such as smart toothbrushes connected to an app and more natural toothpaste ingredients.

And some companies are promoting brushing and flossing to younger consumers as part of a broader wellness routine, “like skin care,” says Stephan Habif, chief technology officer and head of research and development at oral-care giant Colgate-Palmolive. “We are trying to create an experience for the consumer, so they are doing the right thing, but also not seeing it as a chore.”

• Cancer: Scientists have found a correlation between gum disease and certain cancers, including of the kidneys, pancreas and blood, says the American Academy of Periodontology.
• Diabetes: Gum disease often goes hand-in-hand with diabetes and may make it more difficult to control blood sugar.
• Heart disease: Studies link gum disease to an increased risk of heart disease. Scientists suspect inflammation is the culprit.
• Respiratory disease: Research suggests bacteria from gum disease can get into the lungs, contributing to illnesses such as pneumonia.
• Alzheimer’s: Research suggests gum-disease bacteria may travel to the brain, contributing to the development of Alzheimer’s disease.
• Liver disease: Systemic inflammation and changes in the oral microbiome from periodontal disease may be linked to chronic liver disease and cirrhosis.
• Rheumatoid arthritis: There is a significant association between rheumatoid arthritis and periodontitis, and treatment of gum disease can reduce the severity of RA.