Swollen red gums, warning sign of hypertension?

In many countries across the world, oral health is not checked regularly, and gum disease remains untreated for many years. In this report by SADE OGUNTOLA, experts say that gum infection may also be involved, at least in part, in the development of hypertension.

HAVING a yearly dental checkup is assumed to be a waste of time by many people. But these yearly checks to detect gum diseases and have treatment will ensure a bright smile, clean white teeth, and protect from many health conditions including heart disease, diabetes and hypertension.

Research shows that the promotion of good oral health could help reduce gum disease and the risk of high blood pressure and its complications. Severe gum disease, also called periodontitis, when left untreated causes tooth loss and can result in difficulties, chewing, speaking, and smiling. In addition, gum disease is associated with nearly 60 other health conditions, including heart disease and diabetes.

According to a research published in Hypertension, an American Heart Association journal, adults with periodontitis, a severe gum infection, may be significantly more likely to have higher blood pressure compared to individuals who have healthy gums.

The study looked at the association between severe periodontitis and high blood pressure in healthy adults without a confirmed diagnosis of hypertension. It included 250 adults with at least 50 per cent of their teeth having severe gum infection and another group of 250 adults who did not have severe gum disease, all of whom were otherwise healthy and had no other chronic health conditions, serving as control.

All the participants underwent comprehensive periodontal examinations including detailed measures of gum disease severity. Blood pressure assessments were measured three times for each participant to ensure accuracy.

The researchers found that a diagnosis of gum disease was associated with higher odds of hypertension, independent of common cardiovascular risk factors. Individuals with gum disease were twice as likely to have high systolic blood pressure (the upper number in a blood pressure reading), values greater than 140 mm Hg, compared to people with healthy gums.

Moderate-to-severe gum disease was associated with a 22 per cent raised risk for hypertension, while severe gum disease was linked with 49 per cent higher odds of hypertension.

Also, the presence of bleeding gums was associated with higher systolic blood pressure. The participants with gum disease had increased glucose, LDL (“bad” cholesterol), white blood cell levels, and lower HDL (“good” cholesterol) levels compared to those in the control group.

Hypertension is defined when a patient has an elevated systolic blood pressure greater than 140 mmHg and/or diastolic blood pressure (the lower number in a blood pressure reading) greater than 90 mmHg. Its complications occur when elevated pressure weakens vessels and blocks blood flow to vital organs, causing cardiovascular disease, including stroke and heart attack. But many factors may also affect blood pressure, such as abdominal obesity, salt intake and the use of medications like ibuprofen and stress.

Dr Olusola Ibiyemi of the Department of Periodontology/Community Dentistry, University of Ibadan, stated that individuals with severe gum disease stand a risk of hypertension because bacteria contained in the plaque in the mouth, can cause damage to the tissues of the heart, including blood vessels, and with time, causing high blood pressure.

According to him, “when the gum, the tissues around the teeth are destroyed, plaques get carried and deposited by the blood vessels into organs of the body, including the heart and the kidney, thus affecting their functions.”

Dr Ibiyemi said everyone has a dental plaque, a sticky film of bacteria on the teeth, to some degree, adding  :“The bacteria produce acids after eating or drinking. These acids can destroy tooth enamel and cause holes in the tooth and gingivitis (gum disease).”

Gum disease occurs in Nigerians at an early age, a pattern of deterioration which is closely linked to poverty and the poor economic growth in the country. The World Health Organisation (WHO) estimates that 15 per cent to 58 per cent of Nigerians have gum disease and that up to 30 per cent of Nigerians enduring the pain of dental caries (cavities).

But plaque can also develop under the gums on tooth roots and break down the bones that support teeth. Untreated plaque can harden into tough-to-remove tartar. Essentially, proper oral hygiene, including daily brushing and flossing, gets rid of plaque.

The dentists stated that since plaque is associated with hypertension, including heart disease, it is important that individuals maintain good oral hygiene.

He added, “Gum disease is silent. It doesn’t hurt, so people don’t know they have it. The catch, therefore, is that individuals brush their teeth properly and they should come in regularly for tooth scaling and polishing.

“Also, individuals that are hypertensive should clean their teeth very well. Already, the blood pressure is high, if now the plaques continues to be an issue, it becomes double jeopardy.”

Dr Yemi Raji, also a consultant nephrologist at the University College Hospital (UCH), said although severe gum disease is not established as a risk factor for hypertension, there is a link between the two conditions.

According to him, “the bacteria cause inflammation. This inflammation also affects the blood vessels, it makes them to thicken and less compliant, thus affecting the blood vessels. Hypertension is a problem of the blood vessels.”

What is more, Dr Sylvester Lawal, a physician and cardiologist, said it is established that conditions in the mouth such as streptococcus infection of the throat can damage the heart valve, causing rheumatic heart disease.

Also, rheumatic fever can develop if streptococcus throat and scarlet fever infections are not treated properly. Early diagnosis of these infections and treatment with antibiotics is key to preventing rheumatic fever.  Rheumatic heart disease is a condition in which the heart valves have been permanently damaged by rheumatic fever.

Meanwhile, researchers said preventing and treating gum disease may be a cost-effective way to reduce systemic inflammation and improve the function of the endothelium, the thin lining inside the heart and blood vessels.

The study’s lead study author and senior researcher at the University College London (UCL) Eastman Dental Institute in London, United Kingdom, Dr Eva Muñoz Aguilera, stated that patients with gum disease often present with elevated blood pressure, especially when there is bleeding of the gums.

In a release, the authors of the study said because high blood pressure often has no outward symptoms, many individuals may be unaware that they are at increased risk for heart-related problems.

They suggested that having dental professionals screen for high blood pressure and make referrals to primary care providers, while medical professionals also screen and refer for gum disease could benefit patients’ health and reduce the burden of high blood pressure and its complications.

Moreover, the researchers said that just like gum disease is a potential risk factor for hypertension, the reverse could also be true. They indicated that further research is needed to examine whether patients with high blood pressure have a raised likelihood of gum disease.

Similarly in 2013, researchers in the Journal of Periodontology said that advanced gum disease may contribute to poor blood pressure control among older adults. It was associated with high blood pressure, after adjusting for age, gender, smoking, and binge drinking. The study involved Puerto Rican elderly who were 70 years and older and residing in the San Juan metropolitan area.

So, every time when brushing your teeth, remember to devote at least two minutes to the task. This a step towards a healthy life, and possibly normal blood pressure.

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