Relationship between Periodontal Diseases and Hypertension in Tunisia
Received: 31-Jan-2022 / Manuscript No. johh-22-52937 / Editor assigned: 03-Feb-2022 / PreQC No. johh-22-52937(PQ) / Reviewed: 17-Feb-2022 / QC No. johh-22-52937 / Revised: 21-Feb-2022 / Manuscript No. johh-22-52937 (R) / Accepted Date: 21-Feb-2022 / Published Date: 28-Feb-2022 DOI: 10.4172/2332-0702.1000300
Abstract
High blood pressure is the most common cardiovascular disease. It affects more than one billion people, or 25 to 30% of the adult. It increases the risk of stroke coronary heart disease, heart disease, kidney disease and cognitive impairment, and was responsible for 7-8 million deaths worldwide in 2011. According to the National Institute of Health (Tunisia) in 2016, 38% of adults suffered from high blood pressure. Periodontal diseases affect 20 to 50% of the world population. Numerous epidemiological studies have shown an association between periodontitis and hypertension indifferent countries. Thus, the objective of this study is to investigate the relationship between periodontal status and hypertension in the Tunisian population
Keywords: Periodontisis; Periodontal Health; Gingivitis; Hypertension
Keywords
Periodontisis; Periodontal Health; Gingivitis; Hypertension
Introduction
Hypertension represents a global public health problem and is a major risk factor for cardiovascular complications (stroke, myocardial infarction, renal failure, lower extremity arterial disease) in both men and women [1-4]. In 2011, hypertension was the cause of 7 to 8 million deaths worldwide [5, 6]. Overall, 28.7% of Tunisians aged 15 years and older were hypertensive.
Periodontal disease is an infectious disease resulting from the disruption of the homeostasis that exists between the bacteria of the dental biofilm and the immuno-inflammatory response induced by these micro-organisms. Inflammation is a natural phenomenon of defense against lesions or infections caused by the bacteria [7]. In periodontal disease, the response is inadequate and leads to a tissue loss that can go as far as the loss of teeth [8]. The prevalence of periodontal disease is constantly increasing affecting almost 50% of the world’s population [9]. Many studies have shown a close relationship between periodontitis and hypertension [10, 11].
Methods
This case-control study was conducted in the Mefteh Sadallah military oral health center in Bardo, Tunis, between March and August 2021. Control cases were normotensive subjects with blood pressure between 120 and 139 mmHg systolic (SBP) and between 80 and 89 mmHg diastolic (DBP). Hypertensive subjects had a systolic (SAP) exceeding 140 mmHg and a diastolic (DBP) exceeding 90 mmHg [12]. The assessment of the level of oral hygiene and the level of gingival inflammation were based on the O’Leary index [13] and the Papilla Bleeding Index [14], respectively. The final diagnosis was based on the assessment of attachment loss, pocket depth, bleeding on probing and radiological alveolysis (Table 1). The diagnosis of periodontitis was only made when there was detectable clinical loss of attachment on at least 2 non-adjacent teeth.
ss="table-responsive">| No history of periodontitis | With treated periodontitis | |||||
|---|---|---|---|---|---|---|
| Intact periodontium | Reduced periodontium | Reduced periodontium | ||||
| Periodontal health | Gingivitis | Periodontal health | Gingivitis | Periodontal health | Gingivitis | |
| Attachment loss |
No | No | Yes | Yes | Yes | Yes |
| Pocket depth | ≤ 3mm |
≤ 3mm |
≤ 3mm |
≤ 3mm |
≤ 4mm |
≤ 4mm |
| Bleeding on probing | < 10% | >10% | < 10% | >10% | < 10% | >10% |
| Radiological alveolysis | No | No | Possible | Possible | Yes | Yes |
Table 1: Differential diagnosis between periodontal health and gingivitis in the new classification of periodontal and peri-implant diseases and conditions.
Results were examined with IBM SPSS Statistics 25.0 for Mac using Student’s t test to compare means. The difference was considered significant for a value of p<0.05 for a 95% degreé of confidence.
Results
| Periodontal condition |
Blood pressure status | Total | |
|---|---|---|---|
| Normotensive | Hypertensive | ||
| Periodontal health on intact periodontium | 2 (3,5 %) | 0 | 2 (2%) |
| Periodontal health on reduced periodontium without history of periodontitis | 0 | 0 | 0 |
| Periodontal health on reduced periodontium with a history of periodontitis | 0 | 0 | 0 |
| Gingivitis | 18 (31 %) | 12 (28,6 %) | 30 (30 %) |
| Gingival inflammation on reduced periodontium | 0 | 0 | 0 |
| Periodontitis | 38 (65.5 %) | 30 (71,4 %) | 68 (68 %) |
| Total | 58 | 42 | 100 |
Table 2: Distribution of subjects according to periodontal disease and blood pressure status.
The mean number of sites with a loss of attachment of 1 to 2 mm and 3 to 4 mm was higher in hypertensive than in normotensives: 12.5± 15.3 and 2.02± 3.9 versus 5.9 ±9.9 and 0.9±3.2 with a value of p<0.05 . The same is true for the mean value of periodontal pocket depth: 2.47 ±0.63 for hypertensive versus 2.04 ±0.4 for normotensives with a value of p<0.01. La valeur moyenne de l’indice d’O’Leary des hypertendus est supérieure a` celle des normotendus: 83, 26 ± 16,08versus 69, 87 ±15, 25 (p< 0, 05). There was no significant relationship between mean attachment loss, bleeding on probing, mean number of sites with attachment loss >4 mm, and hypertension (Table 3).
| Periodontal condition |
Blood pressure status | |
|---|---|---|
| Normotensive | Hypertensives | |
| O'Leary Index | 69,87 ± 15,25 | 83, 26 ± 16,08* |
| Bleeding on probing index | 1.1 ± 0,93 | 1,3 ± 0.99 |
| Attachment loss | 4,96 ± 1,69 | 5,3 ± 1.8 |
| Pocket depth | 2,04 ± 0,4 | 2,47 ± 0,63** |
| Number of sites with 1 to 2 mm attachment loss | 5,9 ± 9,9 | 12,5 ± 15,3* |
| Number of sites with 3 to 4 mm loss of attachment | 0,9 ± 2,3 | 2,02 ± 3,9* |
| Of Attachment > 4mm *P ≤ 0.05. **P ≤ 0.01 |
||
Table 3: Average values of different periodontal parameters according to blood pressure status.
Discussion
In the present study, the hypertensive subjects were more affected by periodontal disease than the control cases. Thus, a linear association is established between these two diseases. Indeed, periodontitis is an inflammatory disease of bacterial origin. Periodontopathogenic bacteria by bacteremia and the release of pro-inflammatory mediators could influence the elevation of blood pressure by inducing a systemic vascular inflammation leading to endothelial dysfunction at the origin of cardiovascular pathology, in particular the elevation of blood pressure [11].
The microbiological study conducted by Desvarieux in 2010 shows a positive association between the growth of periodontopathogenic bacteria (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis) and the prevalence of hypertension [12]. Aggregatibacter actinomycetemcomitans is known to play a role in the pathogenesis of atherosclerosis, including endothelial permeability, serum lipoprotein concentration and lipoprotein binding in the arterial intima [15].
Conclusion
The absence of regular control of periodontal health in Tunisia with the existing association between periodontal disease and hypertension could explain in part the increase in the prevalence of hypertension in Tunisian. Randomized Controlled Trials should be conducted to determine the impact of periodontal treatment on blood pressure and further investigation is needed to reveal the detailed causal relationship between specific periodontopathic bacterial infection and hypertension. To combat this heart failure pandemic, improvement in the global control of heart failure risk factors and regular control of periodontal health will be required.
References
- MacMahon S, Peto R, Collins R, Godwin J, Cutler J, et al. (1990) Blood pressure, stroke, and coronary heart disease: part 1, prolonged differences in blood pressure: prospective observational studies corrected for the regression dilution bias. Lancet 335: 765-774.
- Kannel WB (1996) Blood pressure as a cardiovascular risk factor: prevention and treatment. Jama 275: 1571-1576.
- Assmann G, Schulte H (1988) The Prospective Cardiovascular Münster (PROCAM) study: prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J 116: 1713-1724.
- Walker WG, Neaton JD, Cutler JA, Neuwirth R, Cohen JD (1992) Renal function change in hypertensive members of the Multiple Risk Factor Intervention Trial: racial and treatment effects. Jama 268: 3085-3091.
- Robitaille C, Dai S, Waters C, Loukine L, Bancej C, et al. (2012) Diagnosed hypertension in Canada: incidence, prevalence and associated mortality. Cmaj 184: E49-E56.
- Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, et al. (2003) Seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension 42: 1206-1252.
- Pihlstrom BL, Michalowicz BS, Johnson NW (2005) Periodontal diseases. Lancet 366: 1809–1820.
- Petersen PE (2003) The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol 31: 3-24.
- Haj Amor S, Beaney T, Saidi O, Clarke J, Poulter NR, et al. (2021) May Measurement Month 2019: an analysis of blood pressure screening results from Tunisia. Eur Heart J 23: B144-B146.
- Nazir MA (2017) Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci 11:72-80.
- Tsioufis C, Kasiakogias A, Thomopoulos C, Stefanadis C (2011) Periodontitis and blood pressure: the concept of dental hypertension. Atherosclerosis 219: 1-9.
- Desvarieux M, Demmer RT, Jacobs DR, Rundek T, Boden-Albala B, et al. (2010) Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens 28:1413-1421.
- O'leary TJ, Drake RB, Naylor JE (1972) The plaque control record. J Periodontol 43:38.
- Saxer UP, Mühlemann HR (1975) Motivation und Aufklärung. Schweiz Monatsschr Zahnmed 85: 905-919.
- Bale BF, Doneen AL, Vigerust DJ (2017) High-risk periodontal pathogens contribute to the pathogenesis of atherosclerosis. Postgrad Med J 93: 215-220.
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Indexed at, Google Scholar, Crossref
Citation: Afif B, Kheireddine H, Toumadher M (2022) Relationship between Periodontal Diseases and Hypertension in Tunisia. J Oral Hyg Health 10: 300. DOI: 10.4172/2332-0702.1000300
Copyright: © 2022 Afif B, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
