Is There an Association between Periodontitis and Hypertension?

Abstract

Cardiovascular diseases are the leading cause of deaths. Also, cardiovascular risk factors start the atherosclerotic process, which leads to cardiovascular diseases. Nowadays, periodontal disease can also be considered another cardiovascular risk factor. It involves inflammatory, immunological and humoral activities, which induce the production of proinflammatory cytokines and the destruction of the epithelium. This allows the entry of endotoxins and exotoxins in the bloodstream, which may contribute to atherogenesis and thromboembolic events. There is also direct invasion of the vessel wall by oral pathogens, triggering an inflammatory response that produces endothelial dysfunction. In hypertension, changes in microcirculation can cause ischemia in the periodontium, which favors periodontal disease. Moreover, endothelial dysfunction promotes the formation of atherosclerotic plaque and the development of lesions in target organs. Periodontitis has also been associated with insulin resistance and a higher risk for the metabolic syndrome, which is characterized by oxidative stress. This seems to act as a common link to explain the relationship between each component of the metabolic syndrome (including hypertension) and periodontitis. This article will discuss clinical and experimental evidence, as well as possible pathophysiologic mechanisms and links involved in the relationship among periodontal disease, hypertension and cardiovascular disease.

Correlation between the state of periodontal tissues and selected risk factors for periodontitis and myocardial infarction

“…Differences between periodontal status (number of teeth, PI, BoP and CPI indices) in patients with arterial hypertension and diabetes a very important risk factor for cardiovascular disease, and recent studies increasingly indicate a relationship between the state of marginal periodontal tissues and blood pressure values. 38 This correlation appears to result from the outflow of bacteria associated with periodontitis, which may be responsible for the increase in both systolic and diastolic blood pressure through an immune reaction by activating T lymphocytes. The immune reaction may cause increased sensitivity of the body to the action of angiotensin II.…”

Risk factors for chronic periodontitis in Sri Lankan adults: a population based case–control study

“…Self-reported hypertension was associated with chronic periodontitis and in agreement with previous studies [ 30 ]. Changes in microcirculation associated with hypertension may cause ischaemia in the periodontium favouring the development of periodontal disease [ 31 ].…”

Pilot Study of Laser Doppler Measurement of Flow Variability in the Microcirculation of the Palatal Mucosa

“…Blood cells moving within the volume illuminated by the beam will cause the light frequency [ 2 ] and are useful for measuring the microcirculation in healthy tissue in humans and nonhuman animals [ 3 ]. This approach was first used in the 1980s [ 4 , 5 ] and has since been applied for many tissues, including the skin [ 6 ], tongue, and oral mucosa of healthy individuals [ 7 ], and the tooth [ 8 ], periodontal tissues [ 9 – 11 ], and the masseter muscle [ 12 ].…”