Adults with periodontitis may be significantly more likely to have higher blood pressure than individuals with healthy gums, according to researchers at the University College London (UCL) Eastman Dental Institute and the Universitat Internacional de Catalunya Department of Dentistry.
Previous studies have found an association between hypertension and periodontitis, though research confirming the details of this association is scarce, the researchers said.
Periodontitis can lead to progressive inflammation as well as bone and tooth loss, but prevention and treatment is cost-effective and can lead to reduction of systemic markers of inflammation as well as improved function in the endothelium, which is the thin membrane lining the inside of the heart and blood vessels.
“Patients with gum disease often present with elevated blood pressure, especially when there is active gingival inflammation, or bleeding of the gums,” said lead author Eva Muñoz Aguilera, DDS, MClinDent, senior researcher at UCL Eastman Dental Institute.
“Elevated blood pressure is usually asymptomatic, and many individuals may be unaware that they are at increased risk of cardiovascular complications. We aimed to investigate the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension,” Muñoz Aguilera said.
The study included 250 adults with generalized, severe periodontitis (50% or more of teeth with gum infection) and a control group of 250 adults who did not have severe gum disease, all of whom were otherwise healthy and who had no other chronic health conditions. The median age was 35, and 52.6% were female.
All participants underwent comprehensive periodontal exams including detailed measures of gum disease severity such as full-mouth dental plaque, bleeding of the gums, and the depth of the infected gum pockets. Blood pressure assessments were measured three times for each participant to ensure accuracy,
Also, fasting blood samples were collected and analyzed for high levels of white blood cells and high-sensitivity C-reactive protein (hsCRP), as both are markers of increased inflammation in the body. Additional information analyzed as confounders included family history of cardiovascular disease, age, body mass index, gender, ethnicity, smoking, and physical activity.
The study found that a diagnosis of gum disease was associated with higher odds of hypertension, independent of common cardiovascular risk factors. Individuals with gum disease were twice as likely to have high systolic blood pressure values equal to or greater than 140 mm HG, compared to people with healthy gums (14% and 7%, respectively). Also:
- The presence of active gum inflammation identified by bleeding gums was associated with higher systolic blood pressure.
- Participants with periodontitis exhibited increased glucose, LDL (“bad” cholesterol), hsCRP and white blood cells, and lower HDL (“good” cholesterol) levels compared to those in the control group.
- Nearly 50% of participants with gum disease and 42% of the control group had blood pressure values for a diagnosis of hypertension, defined as equal to or greater than 130/80 mm Hg.
“This evidence indicates that periodontal bacteria cause damage to the gums and also triggers inflammatory responses that can impact the development of systemic diseases including hypertension,” said corresponding author Francesco D’Aiuto, DMD, MClinDent, PhD, professor of periodontology and head of the periodontology unit at the UCL Eastman Dental Institute.
“This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure. Our study also confirms that a worryingly high number of individuals are unaware of a possible diagnosis of hypertension,” said D’Aiuto.
“Integration of hypertension screening by dental professionals with referrals to primary care professionals and periodontal screening by medical professionals with referrals to periodontists could improve detection and treatment of both conditions to improve oral health and reduce the burden of hypertension and its complications,” D’Aiuto said.
“Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study’s results indicate they can also be a powerful and affordable tool to help prevent hypertension,” D’Aiuto said.
The study did not account for other factors that may also impact blood pressure, such as abdominal obesity, salt intake, use of anti-inflammatory medications, hormone treatments or stress, or any other oral health conditions.
The study, “Association Between Periodontitis and Blood Pressure Highlighted in Systemically Healthy Individuals,” was published by Hypertension.
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