The potential for diagnosing high blood pressure at the dentist: an examination of periodontal disease and the oral microbiome in raised blood pressure.

Background: Hypertension is increasingly linked to periodontitis. However, the nature and specific mechanistic relationship of this remains unclear, however may involve reduced oral and systemic nitric oxide (NO) availability. There remains limited research on the oral microbiome during hypertension that could support such a causative mechanism involving NO.<br/>Aims: This project aimed to examine links between periodontal disease, the oral microbiome, and raised blood pressure, while establishing a cardiovascular risk case-finding clinic with a GP referral pathway.<br/>Methods: The project comprised three studies: Study I established and identified cardiovascular risk case-finding in a dental environment (n=200). Study II evaluated clinical markers and diagnoses of periodontitis obtained in dental clinics, against blood pressure readings (n=91). Study III collected oral saliva samples to measure the composition of bacterial populations, and bacterial activity (n=75). <br/>Results: Study I: 71.4% return rate for case-finding (n=200). Undiagnosed hypertension detected in 31.5% of participants. 4.5% of the population were confirmed with undiagnosed hypertension by their GP. Study II: Increased systolic blood pressure (SBP) demonstrated a positive association with the presence of periodontitis and deeper periodontal pocket depths (PPD ≥ 6mm) (Adjusted model: F[12,43]=3.085, P=0.003). Study III: Saliva in R-BP had a significantly higher oral nitrate reducing activity (ONRA) compared to N-BP (N-BP=322.7µM±233.8µM; R-BP=484.6µM±438.5µM; P=0.027). The abundance of oral nitrate reducing bacteria (ONRB) was also increased in R-BP (P&lt;0.0001), differences maintained when controlling for poor oral health. Increased abundance of Neisseria flavascens and Neisseria subflava were identified in R-BP. R-BP showed significantly lower ammonia levels (N-BP=63.4mg/L±41.0mg/L; R-BP=42.7mg/L±36.4mg/L; P=0.005). <br/>Conclusions: This project shows primary care dental clinics can effectively identify cardiovascular risk, whilst supporting literature linking periodontitis to R-BP, and suggests future studies on increased ONRA/ONRB as compensatory mechanisms in R-BP patients.

Author dc:creator

• Doble, Amazon

Contributors dc:contributor

• Zoe Brookes, Raul Bescos Garcia, Robert Witton

Language dc:language

eng

Repository record dc:identifier

https://pearl.plymouth.ac.uk/pds-theses/5

OAI identifier oai:identifier

oai:pearl.plymouth.ac.uk:pds-theses-1004