MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES 6
adults. It is more common in non-Hispanic Blacks (42.1%) than in non-Hispanic Whites (28.7%),
non-Hispanic Asians (27.2%), or Hispanic (29.4%) adults aged 20 years and over.
4
Compared
with other racial or ethnic groups, non-Hispanic Blacks tend to have higher average blood
pressure numbers and develop hypertension earlier in life.
5
Modifiable risk factors for hypertension include obesity, diabetes, high blood cholesterol levels,
lack of physical activity, stress, unhealthful diet, high sodium intake, high added sugar intake
(e.g. sugar-sweetened beverages), alcohol consumption, and tobacco use, including vaping.
6
Oral Health and Hypertension
Several studies report associations between oral health, mostly periodontitis and tooth loss,
and cardiovascular disease and ischemic stroke. Results from a nationally representative U.S.
study using the “gold standard” full-mouth periodontal probing protocol from 2009 to 2014
determined there is an association between periodontitis and systolic blood pressure levels,
even in a dose-response manner. That is, the more severe the periodontitis level, the greater
the mean systolic blood pressure. In people undergoing hypertension treatment, the mean
systolic blood pressure was 2.3 mm Hg to 3 mm Hg higher in those with periodontitis compared
to those without periodontitis. A systematic review and meta-analysis concluded that
periodontitis, especially severe disease, was associated with significantly higher risk of
hypertension.
7
Some people with hypertension may also exhibit signs of increased gingival
bleeding, periodontitis, hyposalivation, lichen planus lesions, or gingival enlargement.
8
All major groups of pharmaceuticals, such as diuretics, beta-blockers, angiotensin converting
enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), and calcium channel blockers,
can produce oral side effects including, but not limited to, xerostomia, taste changes, gingival
hyperplasia, gingival bleeding, lichenoid reactions, and increased risk of oral infections.
Therefore, people who take medications for hypertension may be at increased risk for poor oral
health consequences. Additionally, having periodontal disease may interfere with the
effectiveness of hypertension therapy.
Oral health providers can reference the Prescribers’ Digital Reference (PDR;
https://www.pdr.net/) for current information on any medication a patient may be taking for
hypertension. In general, patients should be instructed to continue taking their hypertensive
medication prior to any dental procedures. If there are any questions, patients and their oral
health providers should consult with the patient’s primary care provider for further guidance.
Why Michigan Oral Health Professionals Should Routinely Measure
Blood Pressure
A dental visit may be the only routine care visit that a patient receives. Dental visits provide the
perfect opportunity to screen for hypertension and refer patients to their primary care provider
for further evaluation. Many patients trust their oral health providers and welcome their
interest in their overall health, not only their oral health.
9
Measuring a patient’s blood pressure can assist with detecting, treating, and managing
hypertension in its early stages. Checking blood pressure readings also provides the oral health