Do You Ask Your Patients with Hypertension About Dental Health?

Adam S. Harwood, DMD

For years, poor oral hygiene and inflammation of the gums have been linked to myriad health problems, including high blood pressure. Now, a recent study published in the American Heart Association’s journal Hypertension, suggested periodontal disease may also adversely impact patient response to medications used to control hypertension.

The study examined a pool of 3600 American dental patients suffering from periodontal disease and found those with the infliction were 20% less likely to reach systolic blood pressure goal numbers. “Periodontitis was associated with unsuccessful antihypertensive treatment after multiple adjustments, with higher odds by disease severity,” the study reported.

In light of this and other evidence, general practitioners would be prudent to add good oral hygiene to the tenets that make up a blood pressure control program. The suggestion would join measures like lowering salt intake, losing weight, and increasing exercise. While medications designed to lower blood pressure should still be administered, patients diagnosed with periodontal disease should be more closely monitored, as those medications may not work as effectively as they do on patients with good oral health.

The latest recommendations from the American Heart Association/American College of Cardiology suggest patients with hypertension seek an overall blood pressure range less than 130/80 mmHg. The presence of periodontal disease saw readings decrease to 3 mmHg higher than this target and up to 7 mmHg among patients with hypertension that had gone totally untreated. Treating those patients with blood-pressure medication narrowed the gap, down to 3 mmHg on average, but since treatment was unable to bring those patients into the goal range, periodontal disease is believed to be interfering with the effectiveness of an otherwise sound blood pressure treatment measures.

Raising awareness with patients who have been diagnosed with periodontal disease won’t be a challenge for physicians who are aware of the malady. But how many physicians ask their patients about their oral health, territory presumably covered by their dentists? With the effectiveness of their blood pressure program at stake, it’s time practitioners ask their patients about their dental health. Questions like: When was the last time they were seen by a dentist? Do your gums bleed after brushing and flossing? Have you been diagnosed with gum disease? What steps are you taking to improve your oral health and have those steps been effective? These are the questions primary care physicians should be asking their patients with high blood pressure so they can administer a program that will render desired results.

With hypertension affecting about 40% of those over the age of 25, worldwide, the cardiovascular risk posed by low-grade oral inflammation cannot be discounted, especially if it is interfering with medications being prescribed to treat the condition. It’s time for dentists to ask their patients about their blood pressure and physicians to ask them about their oral health.

Adam S. Harwood DMD is a New York City-based endodontist, a member of the American Dental Association and a specialist member of the American Association of Endodontists. He has taught endodontics at the Tufts University School of Dental Medicine, New York University School of Dentistry, and the Metropolitan Hospital Center. The piece reflects his views, not necessarily those of the publication.Healthcare professionals and researchers interested in responding to this piece or contributing to MD Magazine® can reach the editorial staff here.