A report from The Netherlands adds to the evidence tying chronic gum disease to heart disease and stroke.

In a study of more than 60,000 dental patients, those with gum disease were twice as likely to have had a heart attack, stroke or severe chest pain.

At the Academic Centre for Dentistry Amsterdam, the largest dental school in the Netherlands, investigators reviewed the medical records of 60,174 patients age 35 and older, looking for an association between periodontal gum disease and atherosclerotic cardiovascular diseases such as angina, heart attack and stroke.

About 4 percent of patients with periodontitis had atherosclerotic cardiovascular disease, compared to 2 percent without periodontitis, the researchers found.

Even after taking other risk factors for cardiovascular disease into account, such as high blood pressure, high cholesterol, diabetes and smoking, those with periodontal disease were still 59 percent more likely to have a history of heart problems, according to a report in the Journal of Epidemiology and Community Health.

In periodontal disease, the advanced stage of the gum disease gingivitis, the gums pull away from the teeth and create pockets that can become infected. Periodontitis has also been tied to other conditions such as skin disease and
dementia.

“It’s clear that periodontitis is associated with chronic inflammation, so it makes sense biologically that if you have a heavy infection in your mouth, you also have a level of inflammation that will contribute to heart conditions,” said Panos Papapanou of Columbia University in New York, who has studied the association between gum disease and heart disease, but wasn’t involved in the current study.

The research team suggests that gum disease develops first and may promote heart disease through chronic infection and bacteria in the circulatory system.

Dr. Bruno Loos, the senior author of the new report, said by email that “plausible mechanisms to explain the relationship” may include a common genetic background for the way the body handles inflammation, oral bacteria and immune responses.