Article Archive
March/April 2022

Oral Health: Gum Disease and High Blood Pressure
By Lindsey Getz
Today’s Geriatric Medicine
Vol. 15 No. 2 P. 22

A recent study suggests a link between these two health concerns.

When it comes to health concerns of older adults, gum health might be low on the list—particularly if patients have a number of comorbidities that need to be managed. But this could be to the detriment of patients’ health on a larger scale. Gum disease can be a serious issue on its own, but now a study may have linked periodontitis (severe gum disease) with higher blood pressure in otherwise healthy individuals. This creates even more reason for patients and providers to pay attention to the gum health of older adults.

The research, published March 2021 in Hypertension, an American Heart Association journal, found that adults with periodontitis may be significantly more likely to have higher blood pressure than are individuals with healthy gums. According to the American Dental Association, periodontitis is characterized by an inflammation of the gums that, if severe, can lead to the loss of tissue that holds the teeth in place. This ultimately can lead to bone or tooth loss.

The potential effects of periodontitis are reason enough to be paying attention to the gum health of older adults, says cardiologist Nieca Goldberg, MD, a clinical associate professor of medicine at New York School of Medicine and medical director of Atria in New York City. But she adds that the link between gum health and general health should arouse even greater concern.

“Unfortunately, I do think many patients have been ignoring their dental health during the pandemic, and there has been an increase in problems as a result,” Goldberg says. “One problem in particular that needs to be on our radar as doctors is inflammation of the gums. This can sometimes go unnoticed or not talked about as it doesn’t always cause symptoms until it is severe.”

According to Goldberg, the study is helpful research for primary care physicians and geriatricians who may have patients with gum disease in their care.

The study looked at 500 adults with and without gum disease and found that those with severe gum disease could be twice as likely to have increased blood pressure.

“Patients with gum disease often present with elevated blood pressure, especially when there is active gingival inflammation, or bleeding of the gums,” according to lead study author Eva Muñoz Aguilera, DDS, MClinDent, senior researcher at UCL Eastman Dental Institute in London, United Kingdom, in a press release on the study. “Elevated blood pressure is usually asymptomatic, and many individuals may be unaware that they are at increased risk of cardiovascular complications. We aimed to investigate the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension.”

Blood Pressure and Inflammation
Study participants had comprehensive periodontal exams that included detailed measures of gum disease severity such as full-mouth dental plaque, bleeding of the gums, and the depth of the infected gum pockets. Participants’ blood pressure was measured three times to ensure accuracy, and fasting blood samples were collected and analyzed for high levels of white blood cells and high sensitivity C-reactive protein, or hsCRP, which are markers of increased inflammation in the body.

“Periodontal disease has been studied for a long time as a stimulus for bodily inflammation, and we believe that it can lead to an increase in vascular disease,” Goldberg says. “This study found that those with gum inflammation also had higher blood sugar, higher levels of bad cholesterol, and higher white blood cell levels, indicating inflammation in the body.”

These findings may link gum health to larger problems.

“This evidence indicates that periodontal bacteria cause damage to the gums and also trigger inflammatory responses that can impact the development of systemic diseases including hypertension,” corresponding author Francesco D’Aiuto, DMD, MClinDent, PhD, a professor of periodontology and head of the periodontology unit at the UCL Eastman Dental Institute indicated in the press release. “This would mean that the link between gum disease and elevated blood pressure occurs well before a patient develops high blood pressure. Our study also confirms that a worryingly high number of individuals are unaware of a possible diagnosis of hypertension.”

Goldberg says that one thing this study did not account for was whether the patients were already taking anti-inflammatory medications for pain. It also did not look at individual participants’ level of salt intake, which could have an impact on some of the results. The study press release also indicated that the research did not account for abdominal obesity, hormone treatments, stress, or other oral health conditions—all of which could also influence blood pressure.

“Even so, I think this is really valuable information that primary care doctors and geriatricians should take seriously,” Goldberg adds. “In general, dental health is often overlooked but can have serious implications for patients. As we head into this new year, this is a great time to be thinking about better dental health.”

Implementing Better Screening
The findings of this research underscore the importance of staying on top of patients’ gum health—and oral health as a whole. Professionals in the dental and medical fields must work together to devise a solution.

D’Aiuto, according to the study press release, suggests integration of hypertension screening by dental professionals with referrals to primary care professionals, and periodontal disease screening by medical professionals with referrals to periodontists, could improve detection and treatment of both conditions.

“Oral health strategies such as brushing teeth twice daily are proven to be very effective in managing and preventing the most common oral conditions, and our study’s results indicate they can also be a powerful and affordable tool to help prevent hypertension,” D’Aiuto added.

Goldberg agrees. “In clinical practice, we do not address oral health as often as we should, and this presents an opportunity to change that,” she says. “I think primary care physicians and geriatricians could make a point to encourage their patients to keep up with regular dental visits—and help them find a dentist if they do not already have one.”

Since older patients are more likely to see their primary care physicians or geriatricians more often than they see their dentists, Goldberg says, it also presents an opportunity for these clinicians to be up to date on some basic recommendations. “I think there is a great opportunity for doctors to echo some of the recommendations that dentists would be making such as brushing regularly and using dental floss,” she continues. “Though this is not our area of expertise, those reminders can only help.”

The pandemic’s ongoing impact on dental care must also be recognized, Goldberg says. Older adult patients who might be at a higher risk of serious side effects from COVID-19 could be particularly fearful about going to the dentist. This might be causing them to go extended periods of time without being seen by a dental professional.

“I do think that patients have had some concerns or some fear about visiting the dentist since the pandemic began,” Goldberg says. “Though there was some normalization for a period, the resurgence of a new variant might have raised new fears and made some patients reluctant about keeping up with dental care. But it’s important that we don’t let patients continue to overlook their dental health—or other potential health concerns.”

Goldberg explains that patients should ask their dental care providers what precautions are taken so that some of those fears can be allayed. Patients should also make sure they are fully vaccinated and continue to wear masks.

“We know that letting dental health fall to the wayside can come with poor consequences, so we must encourage our patients to remain diligent now, and in the future,” Goldberg says. “Gum health is absolutely an important factor in overall health and should not be ignored.”

— Lindsey Getz is an award-winning freelance writer in Royersford, Pennsylvania.