Is undiagnosed gum disease contributing to your high blood pressure? Or increasing your risk of a heart attack or stroke? New research confirms a link between having gum disease (gingivitis or the more severe periodontitis) and hypertension.
A large analysis, presented at the dental congress, EuroPerio9, found that not only did having gum disease increase the likelihood of having hypertension, but periodontal therapy to treat the gum disease resulted in a significant reduction in blood pressure levels.
This confirms the results from previous studies which found that people with arterial hypertension were up to 64% more likely to have periodontal gum disease than those with normal blood pressure, and adds to previous research showing that gum disease is associated with heart disease and stroke.
Contents Of This Article
What is gum disease?
As many as 700 different species of bacteria live in the human mouth, making human bites one of the dirtiest and most prone to serious infections such as cellulitis and sepsis. While these bacteria usually live in the mouth without causing harm, they will turn on you at the slightest opportunity.
No matter how well you brush and floss, it’s easy to miss some areas on which bacterial plaque (a sticky film) and tartar (a crusty deposit) quickly develop. These build-ups cause irritation, leading to inflamed gums (gingivitis), which often goes unnoticed although you may notice some redness, soreness, or see blood staining when brushing your teeth.
If gingivitis is not diagnosed and treated, the gum disease can progress to periodontitis. Widening infection causes inflammation and swelling around the roots of the teeth (periodontitis) and can spread into your jawbone. Periodontal gum disease is a common causes of bad breath (halitosis), receding gums, loosening of the teeth and tooth loss. Now it seems, it also contributes to high blood pressure as well as heart disease and stroke.
As gingivitis is totally preventable with good mouth care, regular dental check-ups and dental hygienist appointments to remove the plaque and scale, don’t let this contribute to your hypertension. If periodontitis is already present, then intensive treatment can significantly lower your blood pressure and even prevent the need for medication.
Why does gum disease cause high blood pressure?
There are two main ways in which inflamed gums can increase blood pressure. The first is that any inflammation, anywhere in the body, increases circulating levels of inflammatory substances that can damage blood vessels and reduce their elasticity. This inflammation is partly triggered by endotoxins released by the bacteria, and partly by your own immune responses. These inflammatory substances (eg interleukin-6, TNF-alpha, c-reactive protein) can cause constriction of blood vessels and increased stickiness of blood, and are one way in which having periodontitis increases the risk of hypertension.
The second way in which gum disease can cause hypertension is that bacterial plaque destroys the normal barrier function of the periodontal pockets surrounding your teeth, allowing bacterial toxins and even bacteria themselves to invade blood vessel walls and enter the circulation.
Once in the circulation, mouth bacteria from infected gums irritate artery walls, causing oxidative stress and hastening hardening and furring up of the arteries (atherosclerosis). And, just as mouth bacteria trigger the formation of plaque in the mouth, they may also trigger the formation of plaque on artery walls. Live mouth bacteria and bacterial DNA have already been identified within atherosclerotic plaques as described below.
The combined result is reduced production of protective substances (such as nitric oxide which dilates arteries) and increasing arterial stiffness and constriction.
Blood pressure benefits of treating gum disease
Treating gum disease through better oral hygiene reduces systemic inflammation, decreases arterial stiffness and reduces blood stickiness.
Studies which reported the effects of gum therapy in people with hypertension found that, after periodontal treatment, the reported average reductions in blood pressure range from 7/0 mmHg to 12/10 mmHg. The researchers estimated that treating any existing gum disease in people with raised blood pressure could have a similar effect as that expected for prescribing an antihypertensive drug.
In another recent study involving 95 with both periodontitis and prehypertension, half underwent standard dental treatment for periodontitis, which included basic oral hygiene instructions and teeth cleaning with plaque removal above the gum line. The other half were assigned to intensive periodontal treatment over 4 consecutive weeks, which included the standard treatment plus cleaning down to the roots (under local anaesthetic), antibiotic treatment and dental extractions, if necessary. None of those taking part received any antihypertensive medication and they were followed with regular blood pressure readings for 6 months.
At the end of this time, both groups had significantly improved mouth hygiene, but those who had undergone the intensive periodontal treatment had markedly better blood pressure readings:
- One month after treatment, blood pressure was 3/0 mmHg in those receiving intensive treatment compared with standard treatment
- Three months after treatment, blood pressure was 8/4 mmHg lower in those receiving intensive treatment.
- Six months after treatment, blood pressure was 12.57/9.65 mmHg lower in patients receiving intensive treatment.
This reduction in blood pressure reflected the improvement in the depth of the gum pockets around the teeth (probing depth) which gradually became more shallow as inflammation improved.
This study shows for the first time that intensive periodontal treatment, on its own, can reduce blood pressure levels with additional tests showing that it also reduced levels of inflammation to improve the elasticity of blood vessel walls (endothelial function).
Gum disease and heart disease
A review with the imaginative title, Gum Bug, Leave My Heart Alone! states that live bacteria (Aggregatibacter actinomycetemcomitans and Porphyromonas gingivalis) have been cultured from human atheromatous plaques in a patient with periodontal disease. DNA sequencing has also identified Streptococcus mutans in 74% of investigated atheromatous plaque samples. Another study identified 98 different bacterial species in the peripheral blood from 151 people with bacteraemia (bacteria in the blood) from gum disease.
Researchers have found that the risk of an acute heart attack is increased by between two-fold and 4.5 fold in people with periodontal disease.
Gum disease and stroke
People with periodontal disease have increased thickening of their carotid arteries, which reduces blood flow to the brain. This increases the risk of ischaemic stroke, especially if blood is also more sticky and likely to form unwanted blood clots. And, of course, if you also have untreated high blood pressure. The good news is that carotid blood flow was significantly improved following periodontal treatment.
Some studies have found that the risk of stroke is increased by as much as four-fold to eight fold in people with periodontal disease.
Gum disease cure
Inflamed gums contribute to arterial disease, high blood pressure, heart disease and stroke.
- Brush your teeth at least twice a day.
- Use a soft toothbrush and a low-abrasive toothpaste.
- Rinsing your mouth with a glass of water is better than brushing immediately after eating as abrasion from a toothbrush after consuming an acidic drink/food may increase loss of enamel.
- Floss or use interdental brushes or water picks to remove bacteria from between your teeth – it’s estimated that daily flossing can add over 6 years to your life.
- Ask your dentist about using fluoride products.
- Have regular dental check-ups.
- Have regular visits to a dental hygienist to remove built up scale (tartar).
- Ask for intensive rather than standard periodontal treatment if you are diagnosed with periodontitis.
- Don’t smoke – smoking worsens gum inflammation and is independently associated with high blood pressure, heart attack and stroke (as well as just about every other medical condition except, possibly, ingrown toenail).
- Avoid sugary foods which fuel the growth of mouth bacteria, and acidic foods which attack and dissolve tooth enamel.
- Include plenty of enamel-building nutrients in your diet, which will also help your blood pressure, such as calcium, and vitamin D.
- Eat foods with plenty of texture – celery fibres are abrasive and help to clean your teeth, as do seeds, which literally brush your teeth, removing bacteria and debris as they go.
- Drink sufficient water to avoid dehydration and dry mouth.
- Consider taking coenzyme Q10 supplements – diseased areas of gum tissue have significantly lower levels of co-enzyme Q10 than healthy areas in the same mouth. Taking coenzyme Q10 supplements can improve the outcome of dental hygiene treatments, and are also used to improve a raised blood pressure.