Thirty years ago, when I started associating periodontal disease to cardiovascular risk, other dentists told me I was overstepping.
“Stay in your lane,” they said.
But I kept seeing the same pattern.
Patients with gum disease often had high blood pressure, AFib, valve issues—or worse.
Decades later, the research confirms what I’d been seeing in my chair.
A 2024 umbrella review by Arbildo-Vega et al. analyzed 41 systematic reviews and found that periodontal disease raises cardiovascular risk. (Source)
Even more important: A 2024 meta-analysis by Meng et al. found that treating gum disease lowers CRP and IL-6, two key markers of inflammation that drive heart risk. (Source)
This is reversible inflammation that your cardiologist is measuring in your blood without knowing where it’s coming from.
Heart disease kills one American every 33 seconds. It’s the leading cause of death in this country.
To close that gap, I created the Physician-Dentist CRP Letter.
I’ve made it free. Thousands of patients have used it to connect their care teams and catch inflammation that was being missed.
→ Download the CRP Letter here
→ Learn how to use the CRP letter here
But if you want to go further and actively lower inflammation, you need a plan that targets the root cause in the mouth.
Over the years I’ve refined what I call the Mouth–Heart Protocol—a simple, evidence-informed framework for supporting oral and cardiovascular health. It’s the same approach I used to use with patients in my private practice in the Silicon Valley to help them control inflammation and protect their hearts.
It’s not medical advice; please use this along with your healthcare team!
The Mouth–Heart Protocol
These steps help you control inflammation at its source—the mouth—and support your cardiovascular system. Educational only. Discuss with your healthcare team before making changes.
1. Get a High-Sensitivity CRP Test
Ask your physician to run this inflammation marker. A result above 1.0 mg/L often points to hidden inflammation, including gum disease.
2. Use the Physician–Dentist CRP Letter
Give one copy to your doctor and one to your dentist so they can coordinate care and interpret CRP results in context. Most physicians don’t realize gum inflammation can elevate CRP.
3. Switch to 3–4 Month Cleanings
Quarterly cleanings prevent recurring inflammation and lower systemic load.
4. Find a Dentist Who Treats Whole-Body Health
Choose a provider who understands how oral inflammation affects cardiovascular and metabolic function. Use the Functional Dentist Directory to find one.
5. Optimize Your Airway
If you snore, wake unrefreshed, or have blood pressure that’s hard to control, ask about a sleep airway evaluation from an AADSM dentist (find one here). Sleep apnea worsens cardiovascular inflammation.
6. Check Existing Root Canals
Failed or infected root canals can drive chronic inflammation. Have them reviewed with a 3D cone beam scan every few years.
7. Rebuild Your Oral Microbiome
Support beneficial bacteria that protect your gums and blood vessels:
- Drink green tea daily for catechins that reduce harmful bacteria, support nitric oxide production, and improve vascular function (link to the one I drink)
- Use a prebiotic toothpaste with nano-hydroxyapatite (link to the one I use)
- Chew xylitol gum after meals
- Scrape your tongue daily (link to the one I use)
- Avoid mouthwash—it destroys beneficial bacteria
8. Support Inflammation Control with Nutrition
Key nutrients that maintain gum and cardiovascular health:
Both your dentist and doctor should be monitoring your oral inflammation as aggressively as they monitor your cholesterol.
You deserve integrated care.
Mark
Further Reading & Listening
The Three I’s: Injury, Infection, and Inflammation
A breakdown of the biological mechanism connecting gum disease to systemic inflammation. I explain how each stage contributes to cardiovascular and metabolic risk. Read the article
Stop Using Mouthwash! (Ask the Dentist Podcast)
The shocking connection between mouthwash and high blood pressure. How everyday oral care products disrupt nitric oxide production and increase cardiovascular risk. Listen on Apple Podcasts or Spotify
Functional Dentistry with Dr. Mark Burhenne (Dr. Kara Fitzgerald’s New Frontiers in Functional Medicine)
I discuss the CRP letter, the oral-systemic connection, and why I started tracking patterns between gum disease and heart issues in my South Asian male patients. Listen here
Periodontal disease and cardiovascular disease: umbrella review
Arbildo-Vega et al., BMC Oral Health, October 2024
41 systematic reviews show periodontal disease raises cardiovascular risk. Read the study
Effect of non-surgical periodontal therapy on risk markers of cardiovascular disease
Meng et al., BMC Oral Health, June 2024
Meta-analysis showing that treating gum disease significantly lowers CRP, IL-6, TNF-α, and other inflammatory markers for at least six months. Read the study
Periodontal disease and subsequent risk of cardiovascular outcome and all-cause mortality
Guo et al., PLOS ONE, September 2023
Meta-analysis of 39 cohort studies with over 4 million participants confirming the link between periodontal disease and cardiovascular events. Read the study
Risk of incident cardiovascular disease in people with periodontal disease
Larvin et al., Clinical and Experimental Dental Research, 2021
Systematic review and meta-analysis of longitudinal cohort studies quantifying cardiovascular disease risk in periodontal disease populations. Read the study
Skip the rinse, save your heart (August 2025)
A landmark 2019 three-year trial showing people who used mouthwash twice daily had dramatically higher rates of hypertension. Here’s how to reverse the damage. Read here
What’s wrong with mouthwash? (October 2023)
From the Mondays with Mark newsletter archive: Mouthwash is a waste of money, a waste of time, and at worst—increases blood pressure by damaging your oral microbiome. Plus what to do instead. Read here
Nitric Oxide and Oral Health (Updated August 2025)
The deep dive into why nitric oxide is critical to cardiovascular health, how half of it comes from bacteria on the back of your tongue, and how mouthwash destroys this pathway. Read here
Interview: Why We Shouldn’t Ignore the Oral Microbiome
My conversation with an oral microbiome researcher about how oral bacteria affect cardiovascular health in real time. Read here