Association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension in middle‐aged and older adults in Korea: A 10‐year follow‐up study

Abstract

Background The relationship between periodontitis and hypertension remains controversial. This study aimed to investigate the association of periodontitis, missing teeth, and oral hygiene behaviors with the incidence of hypertension. Methods A total of 104,349 participants were selected from the National Health Insurance System‐Health Screening (NHIS‐HEALS) cohort. Incident hypertension and periodontitis were diagnosed based on the patients’ clinical records and health examinations. A multivariable Cox proportional hazards regression analysis was performed after adjusting for socioeconomic factors, coexisting disease, and health behaviors. Results The mean age of the participants was 51.1 years (range, 40–79 years) at baseline, and 55.1% were men. A total of 52,855 incident hypertension cases were identified during the median follow‐up period of 9.6 years. Among the participants, periodontitis (hazard ratio [HR]: 1.02; 95% confidence interval [95% CI]: 1.00–1.04), number of missing teeth (for ≥15 group, HR: 1.40; 95% CI: 1.29–1.52), dental scaling (HR: 0.93; 95% CI: 0.91–0.95), and toothbrushing frequency (for ≥3 group, HR: 0.85; 95% CI: 0.83–0.88) were significantly associated with incident hypertension after full adjustments for covariates. While periodontitis was significantly associated with incident hypertension (HR: 1.04; 95% CI: 1.02–1.06) in the middle‐aged group (40–64 years), the effect was insignificant in the older group (≥65 years). Conclusions Oral inflammation could contribute to the incidence of hypertension; thus, efforts to reduce oral inflammation should be encouraged. Future intervention studies are warranted to determine whether oral health care could be beneficial in the management 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 ).…”

“…However, home oral hygiene modalities were not explored. 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).…”

Practical Guidelines for Patients with Hypertension and Periodontitis

“…Notably, observational evidence indicates an increased risk of uncontrolled AH in adults receiving antihypertensive treatment who also suffer from periodontitis [10]. In parallel, home and professional oral care are associated with improved BP profile [11][12][13].…”

Periodontitis and hypertension are linked through systemic inflammation: A 5‐year longitudinal study

“…Cross‐sectional and case–control studies have indicated that periodontitis is associated with an increased likelihood of hypertension (Munoz Aguilera et al, 2020). However, evidence from longitudinal studies is limited and remains inconclusive (Hwang et al, 2022; Kawabata et al, 2016; Rivas‐Tumanyan et al, 2012). Moreover, the mechanisms underlying the association between these two conditions remain unknown.…”