Access to dental care and blood pressure profiles in adults with high socioeconomic status

Abstract

Background: Reduced access to dental care may increase cardiovascular risk; however, socioeconomic factors are believed to confound the associations. We hypothesized that the relation persists despite economic wellness and high education, with reduced access to dental care affecting cardiovascular risk at least in part through its effect on blood pressure (BP), possibly mediated by systemic inflammation. Methods:We first assessed the sociodemographic and clinical characteristics related to last dental visit timing (≤ or >6 months; self-reported) using national representative cross-sectional data. Then, the association of last dental visit timing with clinic BP was selectively investigated in highly educated, high income participants, further matched for residual demographic and clinical confounders using propensity score matching (PSM). The mediating effect of systemic inflammation was formally tested. Machine learning was implemented to investigate the added value of dental visits in predicting high BP over the variables included in the Framingham Hypertension Risk Score among individuals without an established diagnosis of hypertension.

Home oral hygiene is associated with blood pressure profiles: Results of a nationwide survey in Italian pharmacies

“…These findings provide the first evidence of the association between home oral hygiene habits and BP, and expand previous observational evidence on the association between periodontal health status and BP profile (Pietropaoli et al, 2018 ; Pietropaoli, Del Pinto, et al, 2020 ), while also adding to recent evidence linking oral health habits with cardiovascular health (Park et al, 2019 ; Del Pinto, Monaco, et al, 2021 ; Hwang et al, 2022 ). In fact, cross‐sectional evidence from the Korea National Health and Nutrition Examination Survey (KNHANES) 2008–2010 showed that the adjusted prevalence of hypertension decreased as the frequency of toothbrushing increased, but the impact of toothbrushing modality was only assessed in combination with the use of other oral products (Choi et al, 2015 ).…”

“…More recently, a study has assessed the association of tooth brushing frequency with incident hypertension in middle-aged and older Korean adults, reporting a 15% reduced risk of the outcome among individuals who brushed their teeth at least three times/day, but the modality of brushing (electric/manual) was not assessed (Hwang et al, 2022). In parallel, an analysis of 2350 propensity-matched, highly educated, high-income adults from the National Health and Nutrition Examination Survey (NHANES) found that regular access to dental care impacts on BP profiles independent of socio-economic confounders, with reduced risk of high/ T A B L E 3 Crude results of interaction analysis between daily toothbrushing (≥ or <3 times/day) and toothbrush type (manual/electric) uncontrolled BP in association with attendance ≤6 months compared with attendance >6 months (Del Pinto, Monaco, et al, 2021). From a biological standpoint, nearly 7% of the effect of accessing dental care on BP was mediated by low-grade systemic inflammation.…”

“…With an estimated 36 h/year devoted to home oral care, against the estimated 2 h/year spent in professional oral hygiene, the contribution of home oral hygiene habits to local and global health might be proportionally relevant (Del Pinto, Monaco, et al, 2021 ). The possible mechanisms behind the systemic benefit of home oral care practices include their modulating effects on the local microbiota and the immune system, two emerging factors in CVD pathogenesis (Del Pinto, Pietropaoli, et al, 2020 ; Pietropaoli, Del Pinto, et al, 2020 ; Del Pinto, Landi, et al, 2021b ).…”

“…According to meta-analytic evidence, non-surgical periodontal therapy might be beneficial for BP lowering and for improving hypertension control (Sharma et al, 2021). In agreement with this, novel evidence indicates that regularly attending the dental office has an independent association with improved BP, with a possible mediating effect of decreased systemic inflammatory burden (Del Pinto, Monaco, et al, 2021). Thus, it would be reasonable to argue that regular tooth brushing has an impact on cardiovascular health.…”

The Link between Stroke Risk and Orodental Status—A Comprehensive Review

“…Tooth loss has been debated as a potential marker of cerebral stroke. Some cross-sectional studies have addressed the fact that patients with a fewer number of teeth may be associated with increased risks of stroke or other systemic diseases [ 109 , 110 , 111 ]. On the other hand, if tooth loss is caused during the early years of life or is due to other factors such as caries or trauma, the patients might not have been affected by periodontal disease for the rest of their life [ 112 , 113 ].…”