Here's a compelling reason to keep those dreaded appointments with your dentist: New research suggests that red, tender or bleeding gums could trigger high blood pressure.
In a review of 81 studies that included more than 250 000 people, UK scientists found that those who had moderate to severe gum disease (periodontitis) had a 22% increased risk for high blood pressure, and those with severe gum disease had a 49% higher risk.
"Oral health is closely linked to general health," explained researcher Dr Francesco D'Aiuto, head of the periodontology unit at University College London's Eastman Dental Institute.
"Looking after your teeth and gums is often neglected, but [it] should be as important as managing other general health risks," he added.
Among people with periodontitis, systolic pressure (top number) was 4.5 mm Hg higher and diastolic pressure (bottom number) was 2 mm Hg higher, on average, than people without gum disease, the researchers found.
In five of the studies analysed, researchers found that blood pressure dropped when periodontitis was treated. Blood pressure also dropped in patients treated for gum disease who didn't have hypertension, they added.
But whether treating periodontitis really is the cause of a drop in blood pressure isn't certain, D'Aiuto said, since the study did not prove a cause-and-effect link.
"Bad brushing and bacteria accumulation around teeth causes gum bleeding and disease, but also could raise body inflammation and cause blood vessel damage," D'Aiuto said.
Increased risk for heart disease
When the gums are infected, the disease can spread to other parts of the body causing systemic inflammation, which can harm blood, the researchers noted.
Some people may have a genetic susceptibility that might also play a part, along with other risk factors such as smoking and obesity, they added.
"Every dentist should inform their patients of the potential link and the risk of developing high blood pressure," D'Aiuto said.
In addition to giving advice on good dental hygiene and treatment, dentists should advise patients to keep tabs on their blood pressure with their primary care doctor, he said.
"Future research should look at the effects of treating gum disease on blood pressure," D'Aiuto said. "If the association is proven true, then patients could benefit from managing gum disease beyond the mouth."
A growing body of evidence shows an association between periodontitis and hypertension, along with hardening of the arteries, said Dr Gregg Fonarow, a professor of cardiology at the University of California, Los Angeles.
More studies needed
More than 50 studies have shown that periodontitis is associated with increased risk for heart disease and an association between tooth loss and stroke, cardiovascular death and death from any cause, he said.
"However, it remains unclear whether gum disease is a marker or mediator," Fonarow said.
"If causal, these associations would be of great importance because of the potential that preventing or treating periodontal disease could reduce blood pressure levels, as well as reduce the risk of major adverse cardiovascular events," he said.
More studies are needed to see if improving oral health can influence heart and vascular health, Fonarow added.
The report was published in the journal Cardiovascular Research.
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