Should dental treatment be considered for lowering inflammatory markers in hypertensive patients?

While dental treatment has been reported to lower inflammatory marker levels, such studies were small and did not involve subjects with cardiovascular diseases. The present prospective study examined the effect of interventional dental treatment on serum C-reactive protein (CRP) and fibrinogen levels in patients with essential hypertension.

The study enrolled 50 subjects (age: 53.1+/-7; 23 men and 27 women) diagnosed with moderate or severe essential hypertension. Patient clinical characteristics were as follows: 80% had hypercholesterolemia, 72% were obese/overweight, 6% had diabetes mellitus, 16% were current smokers, 40% had target organ damage, and the overall general dental health status was poor. CRP and fibrinogen levels were assessed prior to treatment and again after 6 months. Dental treatment was mainly for periodontal disease and dental caries and its complications, and consisted of extractions of hopeless teeth, supragingival scaling, subgingival curettage, anti-inflammatory rinses and metronidazole treatment. There was a mean 4 treatment sessions per patient over 11 weeks.

Dental treatment resulted in improved sulcus bleeding index (51+/-19 vs. 42+/-17, p<0.001) and approximal plaque index (50+/-23 vs. 42+/-13, p<0.001) scores, but had no effect on CRP (1.66 vs. 1.2 mg/l, p=0.44) or fibrinogen (3.27 vs. 3.22 g/l, p=0.08) levels.

We suggest that the lack of effect of dental treatment on CRP and fibrinogen levels could have resulted from smaller impact of dental disease on the total inflammatory burden in the presence of hypertension and other cardiovascular risk factors.