|DENTAL SCIENCE - ORIGINAL ARTICLE
|Year : 2015 | Volume
| Issue : 6 | Page : 543-547
Association between chronic periodontitis and hypertension in South Indian population: A cross-sectional study
Preethe Paddmanabhan, Bagvad Gita, SC Chandrasekaran
Department of Periodontics, Sree Balaji Dental College and Hospital, Pallikaranai, Tamil Nadu, India
|Date of Submission||28-Apr-2015|
|Date of Decision||28-Apr-2015|
|Date of Acceptance||22-May-2015|
|Date of Web Publication||1-Sep-2015|
Dr. Preethe Paddmanabhan
Department of Periodontics, Sree Balaji Dental College and Hospital, Pallikaranai, Tamil Nadu
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Aim: The aim of this work was investigating if there is any association between chronic periodontitis and hypertension, to assess any individual relationship with Basal metabolic index (BMI) and any association with white blood cell count (WBC count) in South Indian population. Settings and Design: This study is a cross-sectional study. The study sample consisted of 77 patients between the age group of 30-50 years, who were included after excluding risk factors for hypertension. Subjects and Methods: This cross-sectional study was conducted in Sree Balaji Dental College in the Outpatient Department of Periodontology. Blood pressure (BP) was recorded in the sitting, standing, and lying positions. The three positions were examined to assess the mean value of BP. Other data collected include sociodemographic details, diet, education status, height, weight, BMI, and WBC. The periodontal status of the subjects was assessed by the bleeding index (Ainamo and Bay) and community periodontal index by community periodontal index and treatment needs. Statistical Data: The statistical data were assessed by SPSS software version 17. Results: There were 77 subjects participated in this study. However, there was an association between BMI sitting systolic BP is negative the P = 0.044, which is significant. Mean of generalized chronic periodontitis in sitting systolic BP is 118.0833 (95% confidence intervals 112.17 123.99). Conclusions: We did not find any statistical significance between these two variables. However, this study is a cross-sectional study further; longitudinal studies need to be done to establish the true phenomena.
Keywords: Basal metabolic index, chronic periodontitis, hypertension, white blood cells
|How to cite this article:|
Paddmanabhan P, Gita B, Chandrasekaran S C. Association between chronic periodontitis and hypertension in South Indian population: A cross-sectional study. J Pharm Bioall Sci 2015;7, Suppl S2:543-7
|How to cite this URL:|
Paddmanabhan P, Gita B, Chandrasekaran S C. Association between chronic periodontitis and hypertension in South Indian population: A cross-sectional study. J Pharm Bioall Sci [serial online] 2015 [cited 2022 Aug 20];7, Suppl S2:543-7. Available from: https://www.jpbsonline.org/text.asp?2015/7/6/543/163535
Chronic periodontitis has been defined as an infectious disease resulting in inflammation within the supporting tissues of the teeth, progressive attachment loss and bone loss.  Evidence has also thrown light on the relationship between systemic disease and oral health that is, potential effects of periodontal disease on a wide range of organ system. Hypertension has been already a highly prevalent cardiovascular risk factor worldwide because of increasing longevity and the prevalence of contributing factors, e.g., obesity, smoking.
Focal infection theory
The notion of the oral sepsis then termed as the "focus of infection" was extensively debated among the dentist and the physician, that numerous diseases of unknown etiology and the etiopathogenesis were thought to be causally linked to the common oral infection such as dental caries and the pyorrhea. In the 19 th century, W.D Miller also mentioned oral infection as the cause of many diseases.  However, the focal infection theory fell into disrepute when it was found that extraction failed to eliminate or reduce the systemic disease to which the infected teeth were supposed to be linked. 
Chronic bacterial infection including periodontitis has been associated with the increase risk of atherosclerosis and coronary heart disease.  The etiological bacterial burden of chronic periodontitis has also been positively associated with blood pressure (BP) and prevalent hypertension.  A recent large study was performed on a data derived from the 3 rd National Health and Nutritional examination survey on 6617 men and 7377 women who received a periodontal examination and over in the USA.
After adjusting for age, sex, and ethnicity, 10% increase in the extent of gingival bleeding the average rise in the systolic BP was higher by 0.5 (0.3, 0.6) mm Hg in the fully adjusted model.  The objective of this study was to assess the there is any association between chronic periodontitis and hypertension, and any correlation of chronic periodontitis with Basal metabolic index (BMI) and white blood cell (WBC).
| Subjects and Methods|| |
A cross-sectional study was conducted in Outpatients who came to Sree Balaji Dental College Narayanapuram, Pallikaranai in the Department of Periodontics. The patients were free from cardiovascular diseases. The ethical committee approval was obtained.
Using student t test and the formula we estimated the sample size.
- Patients with ≥20 Permanent teeth. Aged 30-50 years
- Patients with no systemic illness such as diabetes, hypertension, no cardiac problems, and not under any medication
- No antihypertensive medications prior and for systemic illness, nonpregnant patients, patient not taken antibiotics for the past 6 months
- Informed consent was got from all patients
- Patients willing for clinical and dental examination that is, periodontal probing depth and gingival examinations
- Patients who were willing to do blood investigations were included in this study.
- Patients who were diagnosed with cardiovascular diseases, who are under medications for the same
- Patients who are under antibiotics for the past 6 months. Smokers and alcoholics were excluded from the study
- Patients who are not willing to take BP and blood investigations
- Patients who have already undergone periodontal treatment during last 6 months were not considered
- Patients who lost more than 70% of the teeth were excluded from the study.
Data were obtained from patients attending the Outpatient Department of Periodontics of Sree Balaji Dental College and Hospital from September 2012 to January 2014. Informed consent was obtained from all the patients. The sociodemographic characters were assessed by personal interviews. The sociodemographic characters in this study include age, sex, occupation, food habits, height, weight, BMI, address. Height and weight were measured for the calculation of the BMI (BMI = Weight [Kg/height 2 [m 2 ]). Data on hypertension were recorded in sitting position, standing position, and lying position. The blood investigation includes total WBC count. The dental status was determined by clinical examination. The gingival bleeding index was recorded using Ainomo and Bay index reveals the presence or absence of gingival bleeding. The periodontal status was assessed by measuring periodontal pocket depth by using the community periodontal index and treatment needs (CPITN). The data were analyzed by SPSS software version 17 (IBM).
| Results|| |
It also seems that periodontitis can influence some type of hypertension.  Several studies have taken into consideration the relationship between hypertension and periodontitis, and an association between periodontal disease measure and incident hypertension in cohort studies has not yet been documented. The novelty of this type of study is we have examined a variety of permutations of position changes such as sitting position, standing position, and lying position and BP were recorded in all the three positions. The three positions were examined to assess the mean value of BP. We are not able to compare the study because nobody has done based on all the positions. There were 77 study subjects participated in this study.
- On correlation between BMI and sitting systolic BP is negative, the P value 0.005* which is statistically significant [Table 1].
- On correlation between BMI and sitting diastolic BP is negative and P value 0.157 showing no statistical significance [Table 2].
- On correlation between BMI and lying systolic BP is negative and P value 0.085 showing no statistical significance [Table 3].
- BMI with lying Distolic BP, Standing systolic BP and standing diastolic BP found to be negative and P value showing no statistical significance[Table 4], [Table 5] and [Table 6].
- WBC and sitting systolic, BP found to be negative showing no statisticalsignificance [Table 7].
- On correlation on WBC and blood pressure, WBC and sitting Diastolic blood pressure is poor positive correlation, the P value 0.724 which shows no statistical significance [Table 8] WBC and lying systolic and Diastolic blood pressure is negative which shows no statistical significance [Table 9] and [Table 10].
Mean sitting systolic BP is higher in healthy individuals than in generalized chronic periodontitis and gingivitis and F-ANOVA is 0.448 and the P = 0.640, which is not significant. Mean sitting diastolic BP is higher in healthy individuals than in patients with generalized chronic periodontitis and gingivitis and ANOVA is 0.446 and the P = 0.642, which is not significant .
Mean lying systolic BP is higher in gingivitis than in healthy individuals and in generalized chronic periodontitis F-ANOVA is 0.721 and the P = 0.490, which is not significant. Lying diastolic BP higher in cases of gingivitis than in generalized chronic periodontitis and in healthy individuals and F-ANOVA is 0.105 and the P = 0.901, which is not statistically significant. The standing diastolic BP is higher in cases of healthy individuals than in gingivitis and generalized chronic periodontitis F-ANOVA is 1.940 and the P = 0.151, which is not statistically significant. Standing diastolic BP is higher in generalized chronic periodontitis than in healthy individuals and gingivitis and F-ANOVA is 0.112, the P = 0.894 which is not significant.
| Discussion|| |
Hypertension is a major global health disorder. Hypertension is defined as when patient has an elevated systolic BP >140 mmHg and/or diastolic BP >90mmHg. 
The American Heart Association recommends BP measurements to be made in the upper arm with 5 min of rest time prior to the first BP measurement.  Furthermore, the subjects should refrain from talking and the legs should be uncrossed and back and arm supported. Crossing the legs elevates systolic BP while an unsupported back raises diastolic BP. 
The highlight and important aspect of this study is that BP is recorded in all the three positions such as sitting, standing, and lying positions. The three positions were examined to assess the mean value of BP. No other studies are compared in all these positions.
The present study was conducted with 77 individuals in the age range of 30 to 50 years. We determined BMI and sitting systolic BP in patients, which was statistically significant [Table 1]. WBC and standing systolic BP was statistically significant [Table 11].
WBC and sitting systolic, sitting diastolic BP and in lying position both systolic and diastolic BP found to be negative showing nostatisticalsignificance [Table 7], [Table 8], [Table 9] and [Table 10] WBC and standingdiastolic BP showing poor positive correlation [Table 12].
Overall correlation of blood pressure with periodontitis, gingivitis and healthy individuals is tabulated in [Table 13].
|Table 13: Overall correlation of BP with periodontitis, gingivitis, and healthy individuals|
Click here to view
A study done by Holmlund et al. in Sweden a large population showed an association between pocket depth, clinical attachment loss, and hypertension.  Tooth loss might be a reflection of the previously continuous pain and mental stress that may contribute to an increased risk of hypertension. ,
Taguchi et al. found tooth loss to be associated with hypertension among n = 98 postmenopausal women.  Data from large, population-based study of health in Pomerania (SHIP) also demonstrated an association between tooth loss and both systolic BP and prevalence of hypertension. 
In contrast with Taguchi et al., the associations in SHIP were confined to Men while no association was observed among women. Study done by Inoue et al. in 2005 concluded that there was an association of periodontitis with increase white blood cell count and BP.  In this study, we found that there was a correlation between WBC and standing systolic BP is negative, the P = 0.044 which is statistically significant. Angeli et al. used CPITN, to investigate the relationship between CPITN and left ventricular mass in patients with essential hypertension. He found a progressive increase in both systolic and diastolic BP from CPITN score 0-4 (P = 0.0001 and the P = 0.05). 
| Conclusion|| |
The present study is carried out to throw a light on the periodontal status and hypertension. However, we did not find any statistical significance between these two variables. The Limitations of this study is that, this is a cross-sectional study and further longitudinal randomized studies to be done in a larger population that are necessary to establish the true relationship between both the phenomena.
| References|| |
Flemmig TF. Periodontitis. Ann Periodontol 1999;4:32-8.
Dussault G, Sheiham A. Medical theories and professional development. The theory of focal sepsis and dentistry in early twentieth century Britain. Soc Sci Med 1982;16:1405-12.
FOCAL infection. J Am Med Assoc 1952;150:490-1.
Mattila KJ, Valtonen VV, Nieminen MS, Asikainen S. Role of infection as a risk factor for atherosclerosis, myocardial infarction, and stroke. Clin Infect Dis 1998;26:719-34.
Desvarieux M, Demmer RT, Jacobs DR Jr, Rundek T, Boden-Albala B, Sacco RL, et al.
Periodontal bacteria and hypertension: The oral infections and vascular disease epidemiology study (INVEST). J Hypertens 2010;28:1413-21.
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;28:2386-93.
Angeli F, Verdecchia P, Pellegrino C, Pellegrino RG, Pellegrino G, Prosciutti L, et al.
Association between periodontal disease and left ventricle mass in essential hypertension. Hypertension 2003;41:488-92.
Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al.
The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: The JNC 7 report. JAMA 2003;289:2560-72.
Owens PE, O'Brien ET. Hypotension: A forgotten illness? Blood Press Monit 1997;2:3-14.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves JW, Hill MN, et al
. Recommendations for blood pressure measurements in humans: An AHA Scientific Statement from Council on high blood pressure research professional and public education subcommitee. J Clin Hypertens 2005;7:102-9.
Holmlund A, Holm G, Lind L. Severity of periodontal disease and number of remaining teeth are related to the prevalence of myocardial infarction and hypertension in a study based on 4,254 subjects. J Periodontol 2006;77:1173-8.
Davidson K, Jonas BS, Dixon KE, Markovitz JH. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults. Arch Intern Med 2000;160:1495-500.
Shinn EH, Poston WS, Kimball KT, St Jeor ST, Foreyt JP. Blood pressure and symptoms of depression and anxiety: A prospective study. Am J Hypertens 2001;14:660-4.
Taguchi A, Sanada M, Suei Y, Ohtsuka M, Lee K, Tanimoto K, et al.
Tooth loss is associated with an increased risk of hypertension in postmenopausal women. Hypertension 2004;43:1297-300.
Völzke H, Schwahn C, Dörr M, Schwarz S, Robinson D, Dören M, et al.
Gender differences in the relation between number of teeth and systolic blood pressure. J Hypertens 2006;24:1257-63.
Inoue K, Kobayashi Y, Hanamura H, Toyokawa S. Association of periodontitis with increased white blood cell count and blood pressure. Blood Press 2005;14:53-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13]