CDEP: Regular Flossing Lowers Serum C-Reactive Protein

ORLANDO, March 6 -- Elevated levels of the cardiovascular-risk biomarker C-reactive protein should prompt adults to consider following the advice of their dentists to floss regularly.

In a cohort study of 300 patients in a lifestyle modification program aimed at reduction cardiovascular risk factors, patients who flossed their teeth least every other day reduced serum CRP to normal levels within six months, said Steven R. Gundry, M.D., of the International Heart and Lung Institute in Palm Springs, Calif.

"And when they stopped flossing, their CRP levels went back up," Dr. Gundry said at the American Heart Association's Conference on Cardiovascular Disease Epidemiology and Prevention here.

But it is unclear whether this "intriguing" observation will guarantee a healthy heart as well as healthier gums, he added.

He said he decided to study flossing following an experience in his own life. "I always hated flossing so I rarely did it and during this same time my CRP was fairly high," he said.

Eventually, his dentist convinced him to floss. and "I discovered after I had been regularly flossing for several months that my CRP was significantly lower."

The 300 patients in this study all had CRP measured at baseline and patients with levels higher than 1.5 mg/L, were asked to floss at least every other day.

According to the AHA, a CRP of 1.0 to 3.0 mg/L is considered average risk, while more than 3.0 mg/L is considered high risk.

After six months patients who did not floss had serum CRP levels that were less than 1.5 mg/L which was comparable to the levels of those who flossed at least once a day, Dr. Gundry said.

On the basis of these results, Dr. Gundry concluded that patients who are considered high risk by traditional risk factors including dyslipidemia, hypertension, smoking, and body mass index should also have CRP measured.

"If CRP is elevated, patients should be encourage to floss at least every other day as part of a program of lifestyle modification to reduce cardiovascular risk," he said.

This was not the first study to link inflammation with dental problems, but attempts to connect the dots from inflammation caused by gum infections to an inflammatory cascade that triggered an ischemic event have not yet been successful, said Richard A. Stein, M.D., an AHA spokesperson and director of preventive cardiology at Beth Israel Medical Center in New York.

Moreover, a number of recent studies have questioned the utility of biomarkers such as CRP and homocysteine for estimating risk of cardiovascular events.

Dr. Stein said that Dr. Gundry's report was "intriguing, but this is really just hypothesis generating, not yet proven."

Nonetheless, because flossing is a recommended part of good dental hygiene, Dr. Stein said there was no harm in encouraging patients to floss as long as they understood that it is not recommended as a way to prevent heart attacks or strokes.