The role of dentists in the diagnosis of arterial hypertension associated with periodontal disease: integrative literature review
DOI:
https://doi.org/10.22491/1983-7550-52-2-R2Keywords:
Periodontal Disease, Arterial Hypertension, Cardiovascular Diseases, Randomized Controlled TrialAbstract
This study aimed to conduct an integrative literature review on the relationship between periodontal disease and arterial hypertension. A search was performed on PubMed using the Boolean operator AND with the following MeSH descriptors: “periodontal disease” and “arterial hypertension”. The following filters were applied: randomized controlled trials (RCTs) published in the last ten years. The inclusion criterion involved RCTs that simultaneously evaluated periodontal disease and arterial hypertension. The exclusion criteria referred to studies that evaluated other diseases and articles written in languages other than English. After reading, selecting, and organizing the studies, the final sample for result extraction comprised three articles out of the nine retrieved titles. These RCTs included a total of 308 patients. Although few RCTs have investigated the relationship between periodontal disease and cardiovascular disease, all analyzed studies indicated a beneficial effect of periodontal treatment on the reduction or improvement of arterial hypertension control. Further research is needed to clarify this relationship.
References
1. Saccucci M, Di Carlo G, Bossù M, Giovarruscio F, Salucci A, Polimeni A. Autoimmune diseases and their manifestations on oral cavity: diagnosis and clinical management. J Immunol Res. 2018 May 27:6061825. doi: 10.1155/2018/6061825.
2. Muñoz Aguilera E, Suvan J, Buti J, Czesnikiewicz-Guzik M, Ribeiro AB, Orlandi M, et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res. 2020;116(1):28-39. doi: 10.1093/cvr/ cvz201.
3. Barutta F, Bellini S, Durazzo M, Gruden G. Novel Insight into the mechanisms of the bidirectional relationship between diabetes and periodontitis. Biomedicines. 2022 Jan 16;10(1):178. doi: 10.3390/ biomedicines10010178.
4. Piepoli MF, Hoes AW, Agewall S, Albus C, Brotons C, Catapano AL, et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J. 2016;37(29):2315-81. doi: 10.1093/eurheartj/ehw106.
5. Pietropaoli D, Del Pinto R, Ferri C, Marzo G, Giannoni M, Ortu E, et al. Association between periodontal inflammation and hypertension using periodontal inflamed surface area and bleeding on probing. J Clin Periodontol. 2020 Feb;47(2):160-72. doi: 10.1111/jcpe.13216.
6. D’Aiuto F, Parkar M, Nibali L, Suvan J, Lessem J, Tonetti MS. Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J. 2006 May;151(5):977-84. doi: 10.1016/j.ahj.2005.06.018.
7. Vidal F, Figueredo CM, Cordovil I, Fischer RG. Periodontal therapy reduces plasma levels of interleukin-6, C-reactive protein, and fibrinogen in patients with severe periodontitis and refractory arterial hypertension. J Periodontol. 2009 May;80(5):786-91. doi: 10.1902/jop.2009.080471.
8. Tsakos G, Sabbah W, Hingorani AD, Netuveli G, Donos N, Watt RG, et al. Is periodontal inflammation associated with raised blood pressure? Evidence from a National US Survey. J Hypertens. 2010;28(12):2386-93. doi: 10.1097/ HJH.0b013e32833e0fe1.
9. Vidal F, Cordovil I, Figueredo CMS, Fischer RG. Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol. 2013 Jul;40(7):681-7. Doi: 10.1111/ jcpe.12110. Epub 2013 May 3.
10. Pietropaoli D, Del pinto R, Ferri C, Wright Jr JT, Giannoni M, Ortu E, et al. Poor oral health and blood pressure control among US hypertensive adults. Hypertension. 2018;72(6):1365-73.
doi: 10.1161/ hypertensionaha.118.11528.
11. Del Pinto R, Pietropaoli D, Munoz-Aguilera E, D’Aiuto F, Czesnikiewicz-Guzik M, Monaco A, et al. Periodontitis and hypertension: is the association causal? High Blood Press Cardiovasc Prev. 2020 Aug;27(4):281-9. Doi: 10.1007/ s40292-020-00392-z.
12. Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nat Rev Dis Primers. 2017 Jun;3(1):17038. doi: 10.1038/nrdp.2017.38.
13. Sanz M, Del Castillo AM, Jepsen S, Gonzalez-Juanatey JR, D’Aiuto F, Bouchard P, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020 Mar;47(3):268-88, 2020. doi: 10.1111/jcpe.13189.
14. Joshipura KJ, Wan HC, Merchant AT, Rimm EB. Periodontal disease and biomarkers related to cardiovascular disease. J Dent Res. 2004 Feb;83(2):151-5. doi: 10.1177/154405910408300213.
15. Amar S, Gokce N, Morgan S, Loukideli M, Van Dyke TE, Vita JA. Periodontal disease is associated with brachial artery endothelial dysfunction and systemic inflammation. Arterioscler Thromb Vasc Biol. 2003 Jul;23(7):1245-9. doi: 10.1161/01.ATV.0000078603.90302.4A.
16. Desvarieux M, Schwahn C, Völzke H, Demmer RT, Lüdemann J, Kessler C, et al. Gender differences in the relationship between periodontal disease, tooth loss, and atherosclerosis. Stroke. 2004 Sep;35(9):2029-35. doi: 10.1161/01.STR.0000136767.71518.36.
17. Merchant AT, Shrestha D, Chaisson C, Choi YH, Hazlett LJ, Zhang J. Association between serum antibodies to oral microorganisms and hyperglycemia in adults. J Dent Res. 2014 Aug;93(8):752-9. doi: 10.1177/0022034514538451..
18. Aoyama N, Suzuki J-I, Kobayashi N, Hanatani T, Ashigaki N, Yoshida A, et al. Associations among tooth loss, systemic inflammation and antibody titers to periodontal pathogens in Japanese patients with cardiovascular disease. J Periodontal Res. 2018 Feb;53(1):117-22. doi: 10.1111/jre.12494. Epub 2017 Nov 15.
19. Villoria GEM, Fischer RG, Tinoco EMB, Meyle J, Loos BG. Periodontal disease: a systemic condition. Periodontol 2000. 2024 Oct;96(1):1-13. doi: 10.1111/prd.12616.
20. Kapellas K, Maple-Brown LJ, Jamieson LM, Do LG, O’Dea K, Brown A, et al. Effect of periodontal therapy on arterial structure and function among aboriginal australians: a randomized, controlled trial. Hypertension. 2014 Oct;64(4):702-8. doi: 10.1161/HYPERTENSION AHA.114.03359.
21. Whittemore R. & Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005 Dec;52(5), 546-53. doi: 10.1111/j.1365-2648.2005.03621.x.
22. Hopia H, Latvala E; Liimatainen L. Reviewing the methodology of an integrative review. Scand J Caring Sci. 2016 Dec;30(4); 662-9. doi: 10.1111/scs.12327
23. Carvalho APV, Silva V, Grande AJ. Avaliação do risco de viés de ensaios clínicos randomizados pela ferramenta da colaboração Cochrane. Diagn Tratamento. 2013;18(1):38-44.
24. Sundh J, Tanash H, Arian R, Neves-Guimaraes A, Broberg K, Lindved G, et al. Advanced dental cleaning is associated with reduced risk of COPD exacerbations – a randomized controlled trial. Int J Chron Obstruct Pulmon Dis. 2021 Nov 25; 16:3203-15. doi: 10.2147/COPD. S327036.
25. Katanasaka Y, Yoshida N, Naitou H, Naruta R, Miyazaki Y, Sunagawa Y, et al. Effect of theaflavin on oral bacteria in japanese subjects: a randomized, placebo-controlled, double-blind study. J Med Food. 2021 Nov;24(11):1186-90. doi: 10.1089/jmf.2021.K.0050.
26. Jiang H, Xiong X, Su Y, Peng J, Zhu X, Wang J, et al. Use of antiseptic mouthrinse during pregnancy and pregnancy outcomes: a randomised controlled clinical trial in rural China. BJOG. 2016 Sep;123 Suppl 3:39-47. doi: 10.1111/1471-0528.14010.
27. Chou SH, Tung YC, Lin YS, Wu LS, Lin CP, Liou EJ, et al. Major adverse cardiovascular events in treated periodontitis: a population-based follow-up study from Taiwan. PLoS One. 2015 Jun 26;10(6):e0130807. doi: 10.1371/journal.pone.0130807. eCollection 2015.
28. Cullinan MP, Palmer JE, Faddy MJ, Westerman B, Carle AD, West MJ, et al. The Influence of Triclosan on Biomarkers of Cardiovascular Risk in Patients in the cardiovascular and Periodontal Study (CAPS): A Randomized Controlled 6 Trial. J Periodontol. 2015 Jul;86(7):847-55. Doi: 10.1902/ jop.2015.140716.
29. Zhou Q-B, Xia W-H, Ren J, Yu B-B, Tong X-Z, Chen Y-B, et al. Effect of Intensive periodontal therapy on blood pressure and endothelial microparticles in patients with prehypertension and periodontitis: a randomized controlled trial. J Periodontol. 2017 Aug;88(8):711-22. doi: 10.1902/jop.2017.160447.
30. Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M, Nosalski R, Pelka P, Nowakowski D, et al. Causal association between periodontitis and hypertension: evidence from Mendelian randomization and a randomized controlled trial of non-surgical periodontal therapy. Eur Heart J. 2019 Nov 1;40(42):3459-70. doi: 10.1093/eurheartj/ehz646.
31. Pejcic A, Kostic M, Marko I, Obradovic R, Minic I, Bradic-Vasic M, et al. Tooth loss and periodontal status in patients with cardiovascular disease in the Serbian population: a randomized prospective study. Int J Dent Hyg. 2023 May;21(2):317-27. doi: 10.1111/idh.12663.
32. Fischer RG, Gomes Filho IS, Cruz SS, Oliveira VB, Lira Jr R, Scannapieco FA, et al. What is the future of Periodontal Medicine? Braz Oral Res. 2021 Sep 24;35(Supp 2):e102. doi: 10.1590/1807-3107bor-2021.vol35.0102.
33. Offenbacher S. Periodontal diseases: pathogenesis. Ann Periodontol 1996 Nov;1(1): 821-78. doi: 10.1902/annals.1996.1.1.821.
34. Chen T-L, Lu H-J, Wang Y-E, Yue A-X, Wang S-F, Zhou Y-J, et al. Comment on: “Interaction between hypertension and periodontitis” by Ozmeric et al. Oral Dis. 2025 Jan;31(1):318-20. doi: 10.1111/odi.14990. 12.
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