# Cross Talk between Synthetic Food Colors (Azo Dyes), Oral Flora, and Cardiovascular Disorders
## 4 Discussion  
The application of food colors in bakery products, beverages, confections, dairy and ice cream, meat and savory foods, and seafood [59]. Among all of the synthetic food colors, tartrazine was the most commonly used azo dye (42.3%). According to the classification conducted by the International Union of Pure and Applied chemistry, azo dyes are derived from diazine HN=NH with the substitution of hydrogen by azobenzene, hydrocarbyl, or diphenyldiazene groups, and they also contain one or three azo bonds linked with phenyl and nephthyl rings, substituted by groups such as amino chloro, nitro, and hydroxyl. They are characterized by a strong coloration. When processed food is eaten by humans, the azo bonds (aromatic amines) present in these products are broken down by the enzymatic activity of the oral microbiome. Not only do they cause staining or plaque formation,  
Figure 4: Flow chart explaining the mode of travel of oral microbiomes from the oral cavity to the blood stream, causing the narrowing of arteries, which leads to cardiovascular disorders [3; 8; 32; 39; 58].  
but they also liberate many toxic chemicals into the blood stream line [60]. All these experimental data show that the oral microbiome travels through the bloodstream line and enters in different and major vessels and arteries, which lead to the heart. The external carotid artery is the artery that supplies blood to the face and neck [61]. It originates from the common carotid artery, and after that, it splits into the external and internal carotid artery [62]. The basic principle of this artery is to supply blood to the face and neck. In addition, most of the studies showed that sodium intake is associated with the carotid artery by producing tension in the artery walls [63]. The bacteria basically trigger the inflammation throughout the body, causing the narrowing of arteries. The carotid artery plays an important role in developing the link between the heart and face. The bacterial plaque starts developing in the external carotid artery, which produces the atherosclerotic plaque in the artery. This further promotes to the carotid artery and leads to the major arteries of heart [64; 65], causing the narrowing of arteries, which leads to heart attacks and heart strokes. A majority of studies claim that the plaque that is produced on our teeth is the same plaque that builds up in the different major arteries, which lead to the heart, causing heart attacks.  
The mild narrowing range of arteries lies between 15-49%. This blocking range also contributes to strokes, which lead to heart failure. Cardiovascular disorders are the most leading cause of death globally, with an estimated 17.9 million lives expired by CVDs globally in 2019, according to the WHO report released 11 June 2020. It included the top 10 diseases that lead to death in 2019, as shown in Figure 5[66]. The most common cause of CVDs is diet, through which high blood pressure, obesity, and uncontrolled diabetes develop. Almost 85% of deaths are caused by heart attacks and strokes. The basic cause that leads to CVDs is food. Healthy eating will reduce the risk of physical health problems, which are considered to be the leading disease caused by the food consumption style in our daily basic life. The food we eat is full of salt contents (sodium chloride, etc.) that lead to hypertension and also cause hypernatremia and many other CVD disorders [67]. Rather than salt content, they were higher in amines [68], which cause the narrowing of major arteries. Basically, these chemicals cause the shrinking of vessels and arteries. Ischemic heart disease (IHD) is considered to be the most leading disease, through which approximately 9 million people died globally [58].