Is Your Sleep Partner At Risk For A Heart Attack?

September 11, 2013

Oral Signs Of A Heart Attack

SG, a patient of Dr. Liao’s, was a hard-working lawyer who biked to work. One morning, while his wife was expecting their first child, he had a heart attack. He was 41 years old.

Sudden death can be the first sign of a heart attack for 50% of Americans, and nearly half of those will die from the first attack (1). Dr. Liao has researched and discusses if you or any of your family members are at risk.

Mrs. JJ, another patient of Dr. Liao’s, said she was worried about her 33 year-old husband because he:

  • Grinds his teeth while sleeping
  • Snores, snorts, and gasps while sleeping
  • Wakes up feeling tired every day
  • Feels sleepy during the day


The last 3 are recognized signs of Obstructive Sleep Apnea (OSA), which accounts for 50% of high blood pressure cases, 30% of heart attacks, 60% of strokes, and 25 % of heart failures (3).

Teeth grinding follows brain arousal during sleep (4). The heart rate goes up 10 seconds after teeth grinding (4) because oxygen starvation is a life threatening crisis.

Heart disease is America’s leading killer (5) and the mouth is the key (6). Beyond the diet, the mouth contributes to heart disease in the following ways:

  • Painless periodontal (gum) inflammation (7, 8)
  • Teeth Grinding (6, 9)
  • Obstructive Sleep Apnea (10)
Oral Signs Of A Heart Attack CT Scan

Side view of face and jaws from CT Scan showing airway obstruction by the tongue. Minimal airway cross section should be 10-12 mm for women and 15 mm for men.


SG was among the lucky. Three years after his heart attack, he still works and enjoys being the dad of his lovely daughter. He is eating well, on heart medications, and doing PerioProtect at home.

Despite all that, SG is still at risk for a heart attack from airway obstruction by his tongue during sleep (2, 3).

During his last dental visit, SG reported a broken tooth. Why did it break, and what do teeth have to do with the heart attack?

Dr. Liao suspected that SG was grinding his teeth while sleeping, and recommended a 3D CT scan, which confirmed that SG’s tongue was blocking his airway.

In OSA, the tongue is forced into the throat like a 6-foot tiger in a 3 foot cage. The cage is framed by the jaws, and the tongue is an obstruction in the airway.

The mouth offers leading indicators for heart disease linked to OSA. The oral signs can include:

  • Teeth grinding (9)
  • Crowded teeth (5, 8)
  • Bony outgrowth inside the lower jaw (5)
  • Head-neck-jaw pain and jaw joint clicking (5, 8)
  • Tooth prints on the sides of the tongue (11)

Oral Signs of OSA: broken teeth, worn and chipped front teeth and bony outgrowth inside the lower jaw

Oral Signs of OSA: broken teeth, worn and chipped front teeth and bony outgrowth inside the lower jaw

A Holistic Mouth Score is a checklist for signs of teeth grinding and sleep apnea. Discuss your Holistic Mouth Score with your dentist and doctor. OSA is a medical diagnosis made only through a sleep test.

Now that you know the link from the Mouth to OSA to Heart Attacks, please don’t wait until your heart pays the price. Visiting a dentist familiar with sleep apnea’s medical symptoms and oral signs may help save your family from medical catastrophe.


1. Society for Heart Attack Education & Prevention (ShAPE)
2. Lattimore JDL, and others, J Am Coll Cardiol. 2003;41(9):1429-1437.
3. Dement WC, et al, It’s Time to Wake Up to the Importance of Sleep Disorders, JAMA 1993;269(12):1548-1550.
4. Bader, et al, Sleep (1997) 20(11)982-990.
5. America’s Leading Causes of Death
6. Singh GD, et al, Case report: Effect of mandibular tori removal on obstructive sleep apnea parameters. Dialogue, 1, 22-24, 2012.
7. Ohki, et al, Am Heart J. 2012 Feb;163(2):164-7.
8. Desvarieux M, et. al. Journal of Hypertension 2010, 28:1413–142.
9. Dental Distress Syndrome Quantified, Fonder A (1987) Basal Facts, 9(4), 141-167.
10. Miyao E, Intern Med. 2008;47(18):1573-8. Epub 2008 Sep 16.
11. Weiss et al, Archives of Otolaryngology, Head & Neck Surgery 2005:133(6)966-71.

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