Oral health and high cholesterol are intricately linked. Despite a general downward trend in high cholesterol between 1998 and 2019,[i] it has been estimated that more than half of UK adults still have higher levels than they should.[ii] This is largely due to unhealthy lifestyle factors, although age can also naturally increase cholesterol too.[iii] Given the potential relationship between high cholesterol and oral health, it is important to help patients optimise both aspects for their general wellbeing.
Contributing factors
To understand the association between cholesterol and conditions like periodontal disease, it is necessary to appreciate what is meant by ‘good’ and ‘bad’ cholesterol. The former is commonly used to describe the high-density lipoprotein (HDL) that carries cholesterol in the blood to and from cells. A healthy level of HDL can help to protect against heart attack and stroke. ‘Bad’ cholesterol refers to low-density lipoprotein (LDL), because it facilitates fatty build-ups in the arteries, narrowing the pathway for blood and increasing the risk of heart attack, stroke and peripheral artery disease.[iv]
Risk factors for increasing the concentration of LDL and, therefore, cardiovascular problems, include:
- Consuming excess saturated fat
- Physical inactivity
- Smoking
All of the above can be controlled with a balanced diet, moderate exercise and smoking cessation. However, unmodifiable risk factors also contribute to elevated LDL, such as the aforementioned age, being male, menopause and a family history of high cholesterol.[v] The genetic element is still the subject of research, but there is evidence to show that individuals with a family history of hypercholesterolemia are predisposed to also experience elevated LDL, without exhibiting other major risk factors.[vi]
Increased LDL levels have been directly linked to an increased risk of cardiovascular mortality.[vii] [viii] Reducing this ‘bad’ cholesterol is essential for lowering the risk of adverse cardiovascular events.
A link to the mouth
As is often the case with general health conditions, a link has been found between high cholesterol and oral health. Frequently referred to as ‘the gateway to the body’, problems in the mouth can have a direct influence on issues elsewhere. When it comes to ‘bad’ cholesterol, the literature suggests that the presence of periodontitis increases the risk of dyslipidaemia by up to 15%[ix] – a condition defined by the detection of abnormal levels of lipids in the blood, which is a significant risk factor for cardiovascular diseases.[x] The research also showed that periodontal patients have more than a 30% chance of lower levels of HDL compared to those without the disease.
The development of inflammatory markers appears to be the mechanism linking periodontitis with cardiac concerns. In fact, the release of inflammatory cytokines by inflamed oral tissues has been associated with various systemic diseases from dyslipidaemia to atherosclerosis and type 2 diabetes.[xi]
Consequently, this is another reason why oral health should be optimised and periodontal disease should be prevented or brought under control as quickly as possible.
Reducing risk
A significant part of arresting periodontitis progression is helping patients build motivation and identify opportunities to make changes to their oral health behaviours. Some clinicians may consider psychological interventions to support this process and help more individuals effectively make tangible changes to their habits.[xii]
The dental team also has an important role to play in the prevention of periodontitis. On a daily basis, this involves educating the population and helping patients to understand the importance of regular oral hygiene. Many will need support in designing and implementing an effective routine, so advice on what to do, when to do it and what products to use is crucial. For example, the TANDEX WOODI interdental brushes provide an efficient and easy-to-use method of removing plaque and bacteria from the interdental spaces for patients of all ages. Affording added benefits, the products are also more sustainable than traditional solutions, containing less than 0.1g of plastic and being made from FSC-certified birch wood.
Dental professionals can help patients reduce their risk of problems with their cholesterol in more ways than improving their oral health, but this is a crucial first step. Other areas of advice and guidance may include diet and exercise, but it is important that the basics are understood and adhered to first. With improved oral hygiene, patients have an excellent opportunity to lower their chance of cardiac issues in the future too.
For more information on Tandex’s range of products, visit https://tandex.dk/
Our products are also available from DHB Oral Healthcare https://dhb.co.uk/
Author – Dr Jacob Watwood
[i] Adults’ health: Cholesterol. Raised total cholesterol. Health survey for England, 2021, part 2. NHS Digital. https://digital.nhs.uk/data-and-information/publications/statistical/health-survey-for-england/2021-part-2/adult-health-cholesterol [Accessed September 2025]
[ii] The big cholesterol-busting experiment. BBC News. https://www.bbc.co.uk/programmes/articles/1gwkvHnPHRTlTQgzNrTrndx/the-big-cholesterol-busting-experiment [Accessed September 2025]
[iii] Camanas L. 2025 Cholesterol Statistics: insights from over 24,000 UK blood tests. June 2025. https://www.forthwithlife.co.uk/blog/uk-cholesterol-statistics/ [Accessed September 2025]
[iv] HDL (Good), LDL (Bad) Cholesterol and Triglycerides. American Heart Association. https://www.heart.org/en/health-topics/cholesterol/hdl-good-ldl-bad-cholesterol-and-triglycerides [Accessed September 2025]
[v] High cholesterol – symptoms, causes and levels. British Heart Foundation. December 2023. https://www.bhf.org.uk/informationsupport/risk-factors/high-cholesterol [Accessed September 2025]
[vi] Song C, Rosenson RS. Competing Genetic Traits and Their Influence on LDL Cholesterol Concentration in Familial Hypercholesterolemia. JACC Case Rep. 2023 Dec 15;29(2):102171. doi: 10.1016/j.jaccas.2023.102171. PMID: 38264304; PMCID: PMC10801839.
[vii] Jung E, Kong SY, Ro YS, Ryu HH, Shin SD. Serum Cholesterol Levels and Risk of Cardiovascular Death: A Systematic Review and a Dose-Response Meta-Analysis of Prospective Cohort Studies. Int J Environ Res Public Health. 2022 Jul 6;19(14):8272. doi: 10.3390/ijerph19148272. PMID: 35886124; PMCID: PMC9316578.
[viii] Brian A. Ference, Henry N. Ginsberg, Ian Graham, Kausik K. Ray, Chris J. Packard, Eric Bruckert, Robert A. Hegele, Ronald M. Krauss, Frederick J. Raal, Heribert Schunkert, Gerald F. Watts, Jan Borén, Sergio Fazio, Jay D. Horton, Luis Masana, Stephen J. Nicholls, Børge G. Nordestgaard, Bart van de Sluis, Marja-Riitta Taskinen, Lale Tokgözoğlu, Ulf Landmesser, Ulrich Laufs, Olov Wiklund, Jane K. Stock, M. John Chapman, Alberico L. Catapano, Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel, European Heart Journal, Volume 38, Issue 32, 21 August 2017, Pages 2459–2472, https://doi.org/10.1093/eurheartj/ehx144
[ix] Mirzaei A, Shahrestanaki E, Malmir H, Ejtahed HS, Tajbakhsh D, Seif E, Djalalinia S, Mahdavi-Gorabi A, Qorbani M. Association of periodontitis with lipid profile: an updated systematic review and meta-analysis. J Diabetes Metab Disord. 2022 Jun 29;21(2):1377-1393. doi: 10.1007/s40200-022-01071-7. PMID: 36404817; PMCID: PMC9672167.
[x] Pappan N, Awosika AO, Rehman A. Dyslipidemia. [Updated 2024 Mar 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560891/
[xi] Tran, TT., Lee, G., Huh, Y.H. et al. Disruption of cholesterol homeostasis triggers periodontal inflammation and alveolar bone loss. Exp Mol Med 55, 2553–2563 (2023). https://doi.org/10.1038/s12276-023-01122-w
[xii] Vilar Doceda M, Petit C, Huck O. Behavioral Interventions on Periodontitis Patients to Improve Oral Hygiene: A Systematic Review. J Clin Med. 2023 Mar 15;12(6):2276. doi: 10.3390/jcm12062276. PMID: 36983277; PMCID: PMC10058764.
