28 June 2023

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Oral health, hypertension and cardiovascular diseases

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In an editorial published in Hypertension and Vascular Risk, clinicians said more than one billion people in the world suffer from the most advanced forms of periodontitis.

Arterial hypertension (HTN) and periodontitis are among the most prevalent diseases worldwide, according to the editorial. These conditions increase in prevalence as people age. This high presence of both disorders in the population not only makes it possible that, in many cases, they coexist in the same person, but there is also growing scientific evidence that points to the increased risk of developing hypertension in people with periodontitis.

The editorial was written by periodontists Dr. Miguel Carasol and Dr. Eva Muñoz Aguilera and Dr. Luis Miguel Ruilope, who collaborate through the Alliance for Periodontal and General Health in Spain.

Carasol said the publication of the editorial is a first for dentists. This "shows the growing importance that doctors give to the relationship of oral diseases such as periodontitis with systemic diseases such as high blood pressure," he said.

Consistent evidence

The editorial cites data from a recent systematic review which shows that people with moderate to severe periodontitis have a higher risk up to almost 50% of developing hypertension. This establishes a positive linear association driven by the severity of periodontitis.

In addition, the mere presence of periodontitis is associated with higher mean systolic blood pressure, as well as an increase in diastolic BP compared with individuals with healthy periodontium. These findings join those of other studies, which also reveal how the diagnosis of periodontitis in individuals without a diagnosis of systemic disease was associated with a 2.3 times greater probability of presenting a SBP value of 140 mm Hg (regardless of the usual cardiovascular risk factors).

"Every day the role of oral health, and specifically periodontitis, in hypertension is more demonstrated and admitted, which is especially important given the high prevalence and morbidity and mortality of these diseases in humans," said Carasol, who called for action from dentists, doctors, health authorities and the public.

Specifically, the Alliance for Periodontal and General Health proposes different actions and recommendations:

• Dentists must address the dental patient and their oral conditions as a whole. As Carasol points out, "our profession occupies a privileged place in everything related to systemic prevention, and in the case of hypertension this approach is absolutely fundamental."
  
  
• Physicians must understand the importance of the oral cavity in systemic processes, as well as the preventive role they can play if they refer their patients to the dentist when they suspect anything unusual in their patients' mouths.
  
  
• Health authorities should assume the importance of oral health in all people and focus efforts to improve the quality of prevention and care of the population.
  
  
• People with hypertension or high cardiovascular risk should evaluate and monitor their oral health. Clinicians should encourage patients to participate in preventive campaigns. If a person already suffers from periodontitis, they should be aware that this is a chronic condition that must be monitored to avoid very serious complications.

Portions of this article originally appeared in Odontologia33. 

M. Carasol, E. Muñoz Aguilera, L.M. Ruilope, "Oral health, hypertension and cardiovascular diseases," Hipertensión y Riesgo Vascular, 2023, ISSN 1889-1837, https://doi.org/10.1016/j.hipert.2023.04.001.