Why Employers Should Be Paying Attention
When business leaders think about workforce health risk, they consider chronic stress, sedentary work habits, diet and lifestyle. Almost none think about their employees' oral health.
But researchers, cardiologists and public health bodies increasingly do. The evidence linking poor oral health to cardiovascular disease (CVD), including heart attack, stroke, coronary artery disease, heart failure and atrial fibrillation, is now extensive enough that the American Heart Association published an updated scientific statement on the subject in December 2025.
In Australia, the AIHW directly lists stroke and cardiovascular disease among the chronic conditions associated with poor oral health.
The cardiovascular link is one piece of a bigger picture. Poor oral health is connected to 50+ dental-related chronic conditions, which is why enterprise dental cover pays off across four dimensions at once: general health (the cardiovascular and chronic-disease risk this report covers), oral health, mental health (confidence, self-esteem, and reduced stress), and financial health (lower out-of-pocket dental costs for employees and their families). This report focuses on the cardiovascular evidence, but the return compounds across all four.
The Systemic Cost of Poor Oral Health
Poor oral health does not stay in the mouth. The same bacteria and chronic inflammation that begin at the gumline are linked to serious conditions across the entire body, from the heart to the brain. The figures below show how strongly poor oral health is associated with six of the most significant chronic health risks facing your workforce.
The Scale of the Problem in Australia
Cardiovascular disease is not a background health statistic. It is the defining driver of premature workforce absence, long-term incapacity and healthcare cost in this country.
CVD is Australia's most significant chronic disease burden. Yet most employers have never been told that their workforce's oral health status is directly connected to this risk.
The State of Oral Health in Your Workforce
Australia has a significant, well-documented oral health problem, and it sits largely within the working-age population. The driver is a combination of access barriers, unpredictable dental costs, and a system that places the full financial burden of dental care on employees.
Dental care sits entirely outside Medicare. Unlike a GP visit, dental appointments are paid entirely out of pocket for most working-age Australians. Without dental cover, employees face unpredictable and often expensive dental costs entirely on their own. Routine preventive visits get deferred. Reactive treatment gets avoided until it becomes unavoidable.
The predictable result is avoidance. Employees with early-stage poor oral health put off appointments. Those who notice bleeding gums dismiss it. Those who haven't seen a dentist in years keep finding reasons not to go.
What most employers have not considered is what that avoidance may be doing to their workforce's cardiovascular health, and what it ultimately costs the business.
Public dental waiting times range from 16.7 months in Victoria to 3.5 years in Tasmania (AIHW). For the majority of working-age Australians, enterprise dental cover is the most realistic path to regular preventive care.
How Oral Health Affects Cardiovascular Risk: The Science
The connection between poor oral health and cardiovascular disease is not metaphorical. It operates through three specific, well-documented biological pathways. Understanding them is an important context for any executive making decisions about workforce health investment.
The Cardiovascular Conditions Linked to Oral Health
CVD is an umbrella term covering several distinct diseases. Many share a common underlying cause: atherosclerosis, the gradual build-up and hardening of fatty deposits inside artery walls. The AHA's 2025/2026 scientific statement confirmed associations between poor oral health and multiple conditions under this umbrella.
Coronary Heart Disease
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Coronary heart disease (CHD) occurs when plaques narrow or block the coronary arteries — the blood vessels supplying the heart muscle with oxygen. When blood flow is severely reduced or cut off, the result is a heart attack (myocardial infarction). CHD is the single leading cause of death in Australian men.
Multiple meta-analyses and the AHA's updated statement confirm a strong association between poor oral health and coronary artery disease, heart attack, and cardiovascular death.
Increased risk of coronary heart disease. Meta-analyses show a 15–19% increased risk of CHD in individuals with poor oral health, rising to 44% in employees under 65.
Janket et al., Oral Surgery Oral Medicine; Khader et al., J Periodontol; BMC Oral Health umbrella review, 2024
An employee in their 40s or 50s with undiagnosed poor oral health is carrying a meaningfully elevated risk of the event most likely to cause sudden, extended workforce absence — a heart attack.
Stroke (Cerebrovascular Disease)
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A stroke occurs when blood flow to part of the brain is interrupted — by a clot (ischaemic stroke, ~85% of cases) or a burst blood vessel. Stroke is Australia's third leading cause of death. Employees who survive frequently require months of rehabilitation and many never return to their previous role.
Oral bacteria have been detected in carotid artery plaques — the arterial deposits that block blood flow to the brain — in 18–30% of cases examined.
Higher risk of ischaemic stroke. Employees with both poor oral health and dental cavities face an 86% higher risk of ischaemic stroke and a 36% higher risk of major cardiovascular events overall. Regular dental attendance was the single strongest protective factor identified.
Sen et al., Neurology Open Access, 2025
Stroke is the cardiovascular event most likely to result in permanent departure from the workforce or long-term disability. Regular dental attendance was identified as the single strongest protective factor — a compelling case for enterprise dental cover on its own.
Heart Failure
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Heart failure does not mean the heart has stopped. It means the heart muscle has become too weak or stiff to pump blood efficiently. The result is persistent fatigue, breathlessness and progressive inability to sustain normal activity. For employers, it typically means extended medical leave and, often, permanent departure from the workforce.
Chronic poor oral health elevates inflammatory markers that damage the heart muscle over time, contributing to the fibrosis and remodelling that characterise heart failure.
Increased risk of heart failure. Individuals with poor oral health have a 62% higher risk of developing heart failure (OR 1.62). For heart failure with reduced pumping capacity, the risk increase reached 99%.
Poor oral health and the Risk of Heart Failure: a Meta-analysis and Mendelian Randomisation Study, PubMed 2025
Heart failure is one of the most expensive cardiovascular conditions to manage. A 62% elevation in risk, driven by a condition manageable through routine dental care, represents a preventable cost most employers have never considered.
Hypertension (High Blood Pressure)
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Hypertension means blood pressure is consistently too high. Called the “silent killer” because it rarely causes symptoms — most affected employees have no idea. Over time it damages arteries, accelerates atherosclerosis, and is the single most important modifiable risk factor for heart attack, stroke, heart failure and kidney disease.
Poor oral health impairs endothelial function — blood vessel walls lose the ability to relax and regulate blood flow. Patients show higher systolic blood pressure (by 4.5 mmHg) and diastolic (2.0 mmHg). That may sound small, but clinically, a sustained 5 mmHg increase in systolic blood pressure is associated with a 25% increase in mortality from heart disease and stroke.
Increased risk of hypertension. Risk increases by 22% for moderate poor oral health, up to 49% for severe oral health issues. Treatment of poor oral health has been shown to reduce systolic blood pressure by up to 12 mmHg, comparable to some medications.
Aguilera et al., Cardiovascular Research, 2020; Current Hypertension Reports, 2021
Hypertension is the gateway condition. An employee whose poor oral health is elevating their blood pressure is experiencing a cascading risk — higher blood pressure accelerates atherosclerosis, which increases the risk of heart attack, stroke and heart failure. Enterprise dental cover addresses the root of this cascade.
Additional Cardiovascular Conditions Linked to Poor Oral Health
The AHA’s scientific statement and supporting research also identify associations between poor oral health and three further cardiovascular conditions:
Atrial Fibrillation
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The most common sustained heart rhythm disorder. AF causes the heart's upper chambers to beat irregularly, increasing stroke risk by up to fivefold. A meta-analysis of over 1 million patients found a 33% higher risk of AF in individuals with oral health issues (J Arrhythmia, 2023). Recovery from poor oral health was associated with reduced AF risk — confirming the risk is modifiable through treatment.
Peripheral Artery Disease
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Atherosclerotic narrowing of arteries supplying the legs, causing pain, reduced mobility, and in severe cases, amputation. A Korean cohort study (72,971 patients) found a 15% increase in PAD risk associated with poor oral health (Cho et al., 2020).
Aortic Aneurysm and Vascular Disease
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A dangerous bulge in the wall of the aorta — the body's largest artery. If it ruptures, it is a life-threatening emergency. The AHA classifies aortic atherosclerotic disease as part of the broader ASCVD category, sharing the same inflammatory pathways confirmed in the poor oral health–CVD relationship.
An employee with unmanaged poor oral health is not carrying a single elevated risk — they are carrying compounding risk across multiple cardiovascular conditions simultaneously. The same inflammatory burden drives coronary heart disease, higher blood pressure, stroke risk, heart muscle weakening, rhythm disruption, and arterial narrowing throughout the body. The employee who has been avoiding the dentist for three years is carrying measurably elevated risk of heart attack, stroke, heart failure, AF and hypertension — all from a single, modifiable, preventable source.
What the Risk Actually Looks Like in Numbers
Regular dental attendance was the single strongest protective factor identified in the 2025 Neurology Open Access study — more significant than any other variable. People who attend the dentist regularly are 81% less likely to carry the high-risk oral disease profile most strongly linked to serious cardiovascular events.
How Common Is Poor Oral Health in Your Workforce?
Poor oral health is not a rare condition affecting a small, identifiable at-risk group. It is extraordinarily common in the working-age population — and most of those who have it do not know.
Poor oral health begins as gingivitis — inflammation of gum tissue causing redness, swelling and bleeding during brushing. Most employees who notice bleeding assume it is normal. It is not. Healthy gums do not bleed.
Left untreated, gingivitis progresses to severe oral health problems — a deeper infection that destroys the bone and connective tissue holding teeth in place. Poor oral health is chronic, largely irreversible without clinical treatment, and almost always completely painless until advanced.
Which Employees Face the Highest Combined Risk?
Certain workforce groups face a compounded risk — where oral health and cardiovascular risk factors overlap and reinforce each other.
2 in 3 Australian adults avoid or delay dental care due to cost. Without enterprise dental cover, most employees have no structured support for routine preventive visits, no relief from unpredictable dental costs, and no incentive to attend before symptoms force them to. The avoidance cycle continues unchecked.
Chronic workplace stress is an independent cardiovascular risk factor — and stress is also associated with neglected preventive health behaviours, including dental avoidance.
Smoking is both a major cardiovascular risk factor and the strongest environmental driver of poor oral health. Smokers are up to six times more likely to develop severe oral health problems — and their symptoms are often masked, making the disease harder to detect.
Diabetes and poor oral health have a well-established bidirectional relationship. Poor oral health worsens blood sugar control. Uncontrolled blood sugar worsens poor oral health. Both elevate cardiovascular risk independently — and together the combined risk is substantially higher.
Poor oral health prevalence increases sharply across the working-age population. AIHW data shows that 33% of Australians aged 35–54 already have moderate to severe poor oral health — and by ages 55–74, the figure rises to 51%. Globally, this prevalence peaks at ages 50–59 — the same decade in which CVD burden accelerates.
Warning Signs Employees Should Not Ignore
Communicate the following to your workforce as part of any health awareness programme:
The Prevention Equation for Employers
The practical prevention point is routine dental care. When this is ignored, early signs of poor oral health are missed, minor issues escalate, and the risk compounds silently across the workforce. Moreover, 2 in 3 Australian adults avoid or delay dental care mainly because of cost, so treatments become expensive and complicated.
Enterprise dental cover changes that equation. 78% of Australian workers expect their employer to take care of their health and wellbeing, in and outside of work. When every employee and their family receives dental cover from Day 1, two things happen at once: preventive care becomes practically accessible before issues escalate, and the employer’s care becomes visible, in every check-up, every treatment, every dollar saved at home.
That visibility is what strengthens the employment offer, gives good people a reason to stay, and shows up in how employees feel about the organisation.
So the equation is simple. On one side, a preventable condition draining $1,562 to $7,500 per employee per year in salary loss alone, before the wider costs of chronic conditions and avoidable talent loss are counted. On the other, $99 per employee per year for cover that removes the barrier keeping people out of the dentist’s chair. That is the prevention equation, and it favours the employer at every scale.
Cumulative Annual Talent and Productivity Loss Due to Poor Oral Health
Both costs compound quietly across a workforce, and neither appears as a line item. Talent loss is the larger and less visible of the two, while the up-to $7,500 per employee per year productivity figure counts only the salary lost to absenteeism and presenteeism from dental pain. It leaves out every other cost, including the 50+ chronic conditions linked to poor oral health that drive longer absences and sustained workforce disruption.
See what avoidable talent loss linked to poor oral health is costing your organisation, based on your workforce size and salary profile.
See what lost productivity from poor oral health is costing your workforce, and the return enterprise dental cover delivers against it.
How Extras Cover or Wellness Perks Leaves the Gap
An extras cover is a legitimate benefit, but it is employee-paid, so dental access depends on each employee choosing it and being able to afford the high and rising annual cover cost. Those who hold it still face waiting periods, treatment exclusions, annual benefit limits and out-of-pocket costs, and pay more again to include family.
This is why 2 in 3 Australian adults still avoid or delay dental care, and why a dental benefit some employees happen to hold is not the same as a workforce with dental access — coverage stays uneven by design, and the employees carrying the most cardiovascular risk are often the ones outside it.
Wellness perks don’t reach it either. Allowances, discount apps and perks platforms are built to offer choice, not to cover a specific recurring health need, so they reach only the employees who enrol and claim, and rarely extend to family. They may add value elsewhere, but they leave dental costs exactly where they were.
Enterprise dental cover is structurally different on three fronts:
For employees who already hold extras cover, nothing is lost. They can present both cards at the dentist and be charged the lower of the two fees, keeping their extras cover rebate as usual. Or they can exit it, save the high annual cover cost and the added family cover cost, and still have dedicated dental cover, provided by their employer. Either way, your team wins.
Smile™ Enterprise Dental Cover: Win-Win By Design
Smile™ Enterprise Dental Cover creates value for both employees and the organisation. Employees gain easier access to dental care they might otherwise delay, while your organisation strengthens its employee value proposition — supporting talent attraction and retention, employee engagement, and a healthier, more present and productive workforce.
How It Works
The employer covers 100% of the cost of the dental cover — no employee contribution, no salary sacrifice.
No waiting periods, no annual benefit limits, no treatment exclusions — and pre-existing conditions covered, so the entire workforce can start benefiting immediately.
Employees, partners and dependant children access the benefit instantly.
Employees and their families gain improved financial health and peace of mind from unpredictable dental costs, making routine preventive, elective, and reactive visits a practical reality rather than a financial decision.
Employees and their families access care through a large national network of quality-assured dentists on the Smile™ app.
Under the ATO's $300 Minor Benefits Exemption (Section 58P), a benefit costing less than $300 per employee is exempt from FBT, provided it is offered on an infrequent and irregular basis. At $99 per employee per year, Smile™'s Enterprise Dental Cover is exempt from FBT.
Find out how Smile™ Enterprise Dental Cover will reduce cardiovascular risk across your workforce.
Sources & References (22)▼
- Heart, stroke and vascular disease: Australian facts (2025) — AIHW. aihw.gov.au
- Australian Burden of Disease Study 2024 — AIHW. aihw.gov.au
- Oral health and dental care in Australia (2025) — AIHW. aihw.gov.au
- Causes of Death, Australia, 2021 — ABS. abs.gov.au
- Tran AH et al. Periodontal Disease and Atherosclerotic CVD — AHA Scientific Statement. Circulation, 2026 (published Dec 2025). ahajournals.org
- Sen S et al. Combined influence of dental caries and periodontal disease on ischemic stroke risk. Neurology Open Access, Oct 2025. neurology.org
- Wang Z et al. The Impact of Periodontitis on Cardiovascular Disease. Int J Dent, 2025. pmc.ncbi.nlm.nih.gov
- Corredor Z et al. Presence of periodontal pathogenic bacteria in blood of patients with coronary artery disease. Sci Rep, 2022. nature.com
- CVD statistics and facts — Heart Research Institute. hri.org.au
- Janket SJ et al. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med, 2003. pubmed
- Khader YS et al. Periodontal diseases and the risk of coronary heart and cerebrovascular diseases: a meta-analysis. J Periodontol, 2004. pubmed
- Periodontal disease and cardiovascular disease: umbrella review. BMC Oral Health, 2024. springer.com
- Periodontitis and the Risk of Heart Failure: a Meta-analysis and Mendelian Randomisation Study, 2025. pubmed
- Periodontal disease and risk of atrial fibrillation or atrial flutter: A systematic review and meta-analysis. J Arrhythmia, 2023. pmc.ncbi.nlm.nih.gov
- Chen DY et al. Risk of Atrial Fibrillation or Flutter Associated with Periodontitis. PLoS One, 2016. doi.org
- Aguilera EM et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovascular Research, 2020. pubmed
- Periodontitis, Blood Pressure, and the Risk and Control of Arterial Hypertension. Current Hypertension Reports, 2021. pmc.ncbi.nlm.nih.gov
- Cho DH et al. Periodontal disease and risk of peripheral artery disease. NHIS-HEALS cohort (Korea), 2020. doi.org
- Periodontitis and peripheral artery disease: a mini-review. Frontiers in Oral Health, 2026. frontiersin.org
- Periodontitis and Cardiovascular Diseases: Consensus Report. Global Heart / J Clin Periodontol, 2019. globalheartjournal.com
- Association between periodontitis and arterial hypertension: A systematic review and meta-analysis. Am Heart J, 2016. pubmed
- Periodontal disease is associated with the risk of cardiovascular disease independent of sex: A meta-analysis. Frontiers in Cardiovascular Medicine, 2023. frontiersin.org