CC BY 4.0 · Eur J Dent
DOI: 10.1055/s-0043-1772246
Original Article

Impact of Nonsurgical Periodontal Treatment on Blood Pressure: A Prospective Cohort Study

1   Department of Oral Medicine and Public Health, Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
Javier Mareque-Bueno
1   Department of Oral Medicine and Public Health, Faculty of Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
Michel Zabalza
2   Department of Oral Medicine and Public Health, Faculty of Dentistry and Faculty of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
› Author Affiliations
Funding None.


Objectives Arterial hypertension and periodontitis are two of the most common diseases worldwide and recent evidence supports a causal relationship between them. Despite all antihypertensive strategies, an important number of patients are undiagnosed and a large number of the diagnosed fail to achieve optimal blood pressure (BP) measurements. Some studies point out that periodontal treatment could have positive effects on BP levels. The aim of this study is to determine if nonsurgical periodontal treatment can help BP level control in prehypertensive patients with periodontitis.

Materials and Methods Thirty-five patients were included in the study and received nonsurgical periodontal treatment according to necessity. Clinical data, periodontal data, and BP measurements were taken at baseline, periodontal re-evaluation visit (4–6 weeks after treatment), and 6-month follow-up.

Results Periodontal treatment caused a statistically significant reduction (p < 0.05) of systolic blood pressure (SBP) and diastolic blood pressure (DBP) at re-evaluation visit of 4.7 (p = 0.016) and 3.4 mm Hg (p = 0.015), respectively. The effect was maintained at 6-month follow-up visit with a reduction in SBP and DBP of 5.2 (p = 0.007) and 3.7 (p = 0.003) mm Hg, respectively.

Conclusion Despite the limitations of this study, it suggests that nonsurgical periodontal treatment can be effective in lowering BP levels in patients with prehypertension and periodontitis. Moreover, it highlights the importance of dentists in prevention, detection, and control of this important cardiovascular risk factor.

Ethical Approval Statement

Ethics Committee of Hospital Universitario Dexeus – Grupo Quironsalud with code 2018/ODI-2018-01.

Supplementary Material

Publication History

Article published online:
20 September 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (

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  • References

  • 1 Stanaway JD, Afshin A, Gakidou E. et al; GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet 2018; 392 (10159): 1923-1994
  • 2 Williams B, Mancia G, Spiering W. et al; ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur Heart J 2018; 39 (33) 3021-3104
  • 3 Drummond GR, Vinh A, Guzik TJ, Sobey CG. Immune mechanisms of hypertension. Nat Rev Immunol 2019; 19 (08) 517-532
  • 4 Kotseva K, De Backer G, De Bacquer D. et al; EUROASPIRE Investigators*. Lifestyle and impact on cardiovascular risk factor control in coronary patients across 27 countries: results from the European Society of Cardiology ESC-EORP EUROASPIRE V registry. Eur J Prev Cardiol 2019; 26 (08) 824-835
  • 5 Egan BM, Stevens-Fabry S. Prehypertension–prevalence, health risks, and management strategies. Nat Rev Cardiol 2015; 12 (05) 289-300
  • 6 Khanam MA, Lindeboom W, Razzaque A, Niessen L, Milton AH. Prevalence and determinants of pre-hypertension and hypertension among the adults in rural Bangladesh: findings from a community-based study. BMC Public Health 2015; 15 (01) 203
  • 7 Rahman MA, Parvez M, Halder HR, Yadav UN, Mistry SK. Prevalence of and factors associated with prehypertension and hypertension among Bangladeshi young adults: an analysis of the Bangladesh Demographic and Health Survey 2017–18. Clin Epidemiol Glob Health 2021; 12 (November): 100912
  • 8 Tonetti MS, Jepsen S, Jin L, Otomo-Corgel J. Impact of the global burden of periodontal diseases on health, nutrition and wellbeing of mankind: a call for global action. J Clin Periodontol 2017; 44 (05) 456-462
  • 9 Czesnikiewicz-Guzik M, Osmenda G, Siedlinski M. 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; 40 (42) 3459-3470
  • 10 Muñoz Aguilera E, Suvan J, Orlandi M, Miró Catalina Q, Nart J, D'Aiuto F. Association between periodontitis and blood pressure highlighted in systemically healthy individuals: results from a nested case-control study. Hypertension 2021; 77 (05) 1765-1774
  • 11 Surma S, Romańczyk M, Witalińska-Łabuzek J, Czerniuk MR, Łabuzek K, Filipiak KJ. Periodontitis, blood pressure, and the risk and control of arterial hypertension: epidemiological, clinical, and pathophysiological aspects-review of the literature and clinical trials. Curr Hypertens Rep 2021; 23 (05) 27
  • 12 Munz M, Richter GM, Loos BG. et al. Meta-analysis of genome-wide association studies of aggressive and chronic periodontitis identifies two novel risk loci. Eur J Hum Genet 2019; 27 (01) 102-113
  • 13 Pietropaoli D, Monaco A, D'Aiuto F. et al. Active gingival inflammation is linked to hypertension. J Hypertens 2020; 38 (10) 2018-2027
  • 14 Kebschull M, Demmer RT, Papapanou PN. “Gum bug, leave my heart alone!”–epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res 2010; 89 (09) 879-902
  • 15 Desvarieux M, Demmer RT, Jacobs Jr DR. et al. Periodontal bacteria and hypertension: the oral infections and vascular disease epidemiology study (INVEST). J Hypertens 2010; 28 (07) 1413-1421
  • 16 Del Pinto R, Landi L, Grassi G. et al; Italian working group on Hypertension, Periodontitis (Hy-Per Group). Hypertension and Periodontitis: a Joint Report by the Italian Society of Hypertension (SIIA) and the Italian Society of Periodontology and Implantology (SIdP). High Blood Press Cardiovasc Prev 2021; 28 (05) 427-438
  • 17 Muñoz Aguilera E, Suvan J, Buti J. et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res 2020; 116 (01) 28-39
  • 18 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; 151 (05) 977-984
  • 19 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; 40 (07) 681-687
  • 20 Hada DS, Garg S, Ramteke GB, Ratre MS. Effect of non-surgical periodontal treatment on clinical and biochemical risk markers of cardiovascular disease: a randomized trial. J Periodontol 2015; 86 (11) 1201-1211
  • 21 Houcken W, Teeuw WJ, Bizzarro S. et al. Arterial stiffness in periodontitis patients and controls. A case–control and pilot intervention study. J Hum Hypertens 2016; 30 (01) 24-29
  • 22 Bizzarro S, van der Velden U, Teeuw WJ, Gerdes VEA, Loos BG. Effect of periodontal therapy with systemic antimicrobials on parameters of metabolic syndrome: a randomized clinical trial. J Clin Periodontol 2017; 44 (08) 833-841
  • 23 Zhou Q-B, Xia W-H, Ren J. 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; 88 (08) 711-722
  • 24 Papapanou PN, Sanz M, Buduneli N. et al. Periodontitis: consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions. J Periodontol 2018; 89 (Suppl 1): S173-S182
  • 25 Vandenbroucke JP, von Elm E, Altman DG. et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4 (10) e297
  • 26 Orlandi M, Graziani F, D'Aiuto F. Periodontal therapy and cardiovascular risk. Periodontol 2000 2020; 83 (01) 107-124
  • 27 Kawabata Y, Ekuni D, Miyai H. et al. Relationship between prehypertension/hypertension and periodontal disease: a prospective cohort study. Am J Hypertens 2016; 29 (03) 388-396
  • 28 Taylor B, Tofler G, Morel-Kopp M-C. et al. The effect of initial treatment of periodontitis on systemic markers of inflammation and cardiovascular risk: a randomized controlled trial. Eur J Oral Sci 2010; 118 (04) 350-356
  • 29 Jockel-Schneider Y, Bechtold M, Haubitz I. et al. Impact of anti-infective periodontal therapy on parameters of vascular health. J Clin Periodontol 2018; 45 (03) 354-363
  • 30 Pietropaoli D, Del Pinto R, Ferri C. et al. Poor oral health and blood pressure control among US hypertensive adults. Hypertension 2018; 72 (06) 1365-1373
  • 31 Wang R, Lu X, Hu Y, You T. Prevalence of prehypertension and associated risk factors among health check-up population in Guangzhou, China. Int J Clin Exp Med 2015; 8 (09) 16424-16433