Struggling to keep hypertension under control, even with the help of drugs?
Open your mouth and say "aha!" If you see caries or gums that are sore, bleeding or elusive. You may have found the culprit.
The researchers reported that in adults whose hypertension was being treated with drugs, systolic blood pressure – which measures pressure in the vessels when the heart beats – is increased with decreased health of the teeth and gums.
Compared to hypertensive patients who did not show signs of periodontal disease, those with inflamed gums were 20% less likely to have blood pressure within healthy limits.
In addition, patients whose dental health was poor had systolic blood pressure values that were on average 3 mmHg more than similar patients with healthy gums.
The results have been published in the journal Hypertension.
It is estimated that one in three adults in the United States has high blood pressure, placing them at greater risk of heart attacks and strokes.
Hypertension is a primary or contributory cause of over 1,000 deaths a day in the United States. However, only 54% of those with the condition brought the blood pressure readings under control with a combination of medication, diet and exercise.
The new study is in line with a mountain of research that links gum disease with higher rates of heart disease, blood vessels and kidneys – all the organs that are affected by arterial hypertension. And it opens up new horizons by describing in detail how poor dental health efforts tend to control hypertension.
In fact, the study found that people with untreated hypertension and healthy gums had blood pressure readings roughly equal to those taking drugs for their hypertension, but they also suffered from gum disease.
In other words, poor dental health has largely negated the effects of administering blood pressure medications.
The new research does not establish that gingival diseases cause hypertension and its adverse health effects. Many researchers suspect that, like rigid blood vessels, sore and bleeding gums are just another manifestation of inflammation throughout the body.
Nor does the study show that the treatment of periodontitis will reduce hypertension.
But it suggests that when dental health is poor, the challenge of keeping arterial pressure under control will be more expensive and more likely to fail.
Researchers from Italy scoured the records of 11,753 people who participated in the National Health and Nutrition Examination Survey in the United States between 2009 and 2014 and were screened for periodontal disease.
Some 4,095 of the participants had been diagnosed with hypertension, of which 88.5% were taking drugs for the condition and 11.5% were not.
The moderate and severe periodontal disease rates tended to be higher among the study participants who were men, the elderly, Latin American, smokers and those with less income and education.
Participants who were 65 or older and had long-standing periodontal disease were much more likely than those with less severe, older gingival disease to have uncontrolled high blood pressure.
Both hypertension and periodontitis are more common in African Americans and Latins in the United States. Those patient populations also have surprisingly higher rates of diseases related to both, including heart disease, renal failure and cerebrovascular diseases such as stroke and some forms of dementia.
There is no doubt that access to health care differs by race and ethnicity and that impediments to good medical and dental care play a key role in disparities in ethnic and racial health.
In particular, dental care is expensive and much less likely than medical care to be completely covered by insurance. As a result, economic factors play an important role in influencing the health of a patient's gums.
In addition, many primary care physicians and cardiologists can not ask their patients about their dental health, or refer them to dentists unless they are undergoing cardiac procedures and have clear signs of caries. And dentists do not necessarily check the blood pressure of their patients.
The study authors wrote that patients with high blood pressure should take into account their gum health when considering their treatment options.
"Our data suggest that all racial / ethnic subgroups, especially Hispanics, could benefit from this approach," they wrote.
"On the contrary, ignoring the additional burden of an insufficient periodontal status on blood pressure could result in a higher long-term cardiovascular risk."
Charlene Niemi, Health Director for Care Harbor, a California-based nonprofit charity offering medical, dental, and free vision services in huge "pop-up" clinics across the state, said it is "imperative that people be informed that the treatment and treatment of gum disease play a role in blood pressure".
While everyone needs regular dental check-ups, "those with hypertension should understand the importance of having a dental home, looking for a routine follow-up and practicing good oral hygiene," he said.
Patients with hypertension should make every effort to improve their oral health, and those with poor gum health should be vigilant for hypertension. – Los Angeles Times / Tribune News Service