Non‐surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study

Abstract

Periodontal therapy significantly reduced levels of CRP, IL-6, fibrinogen, blood pressure, LVM and arterial stiffness, lowering cardiovascular risk in refractory hypertensive patients.

Effect of Intensive Periodontal Therapy on Blood Pressure and Endothelial Microparticles in Patients With Prehypertension and Periodontitis: A Randomized Controlled Trial

“…Chronically elevated levels of systemic inflammation could mediate association between periodontitis and hypertension because both conditions have been linked to inflammation 18 . Indeed, epidemiologic studies and some clinical studies suggest a potential linkage between periodontitis and hypertension 14 , 40 , 41 . However, many studies reporting the association between periodontitis and hypertension were cross‐sectional in design and either did not make any adjustments or only adjusted for a small number of potential confounders 14 , 40 , 42 .…”

“…Indeed, epidemiologic studies and some clinical studies suggest a potential linkage between periodontitis and hypertension 14 , 40 , 41 . However, many studies reporting the association between periodontitis and hypertension were cross‐sectional in design and either did not make any adjustments or only adjusted for a small number of potential confounders 14 , 40 , 42 . Also, some of these investigations were not designed with the primary aim of testing the link between periodontitis and hypertension 15 , 20 .…”

“…Unfortunately, previous evidence of an association between periodontitis and BP has been derived from small intervention studies 14 , 15 and cross‐sectional studies, 16 , 17 in which no causal link can be established. Therefore, one of the great difficulties with the linkage between periodontitis and hypertension is the so‐called “chicken and egg phenomenon.” 11 , 18 , 19 In patients diagnosed with refractory hypertension and generalized chronic periodontitis, it has been reported that together with antihypertensive management, periodontal treatment may further reduce BP levels 14 . However, some interventional studies could not find the beneficial effect of periodontal management on reduction of BP levels 15,20‐23 .…”

Association between Hypertension and Periodontitis: Possible Mechanisms

“…Higashi et al [65] reported that periodontal therapy reduced serum concentrations of CRP and IL-6 and enhanced acetylcholine-induced vasodilatation in patients with periodontitis. Severe periodontitis is associated with significant endothelial dysfunction that is reversible after successful periodontal therapy in hypertensive patients [113]. Elter et al [114] also demonstrated that periodontal treatment significantly improved endothelial function, serum CRP, and IL-6 levels.…”

Does Treatment of Periodontal Disease Influence Systemic Disease?

“…33 Periodontal treatment: effects on risk factors for cardiovascular events Instead of exploring the direct effect of periodontal treatment on the actual end points, such as heart attacks, the effect on factors that are known to be risk factors for such events has been investigated. There is evidence that periodontal therapy improves Levels of several pro-inflammatory cytokines 33,98 Concentrations of CRP in patients without and with coronary heart disease 33,98-100 Levels of fibrinogen and white blood cells 100 Levels of total cholesterol 33,101 Levels of low-density ("bad") cholesterol 32,101 Levels of high-density ("good") cholesterol 101 Triglyceride levels 33 Blood glucose levels (hyperglycemia is a risk factor for CVD) Endothelial function, 31 especially in persons with diabetes and CVD 33 Systolic and diastolic blood pressure 35 Left ventricular mass (improvement is a reduction) 35 Pulse-wave velocity (measure of arterial function). 35 Of particular interest is that the concentrations of the cytokines IL-18 and IFN-g are shown to be decreased by 90% at 12 months postperiodontal therapy.…”