Hypertension, or high blood pressure, is highly prevalent amongst world populations and is a major contributor to premature death and disability.48 According to the World Health Organization, 1.13 billion people are affected by elevated blood pressure worldwide.49 This number may be even higher when considering the updated American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults.50 The new ACC/AHA guidelines categorize Stage 1 hypertension at 130/80 mm Hg, rather than 140/90 mm Hg.

Several studies have indicated that periodontal disease and hypertension are related, but differences in population characteristics, diagnostic criteria and risk factors make it difficult to determine exactly how they are related.51 According to a retrospective study evaluating dental records of 90 patients that underwent periodontal therapy, a possible relationship between periodontal disease and hypertension was reported.52 A systematic review and meta-analysis found that periodontal diseases, especially severe periodontitis, were associated with a higher risk of hypertension.51 In a study by Lira-Junior and colleagues, it was noted that patients with hypertension demonstrated significantly higher counts of P. melaninogenica.34 Patients with hypertension and generalised bone loss had higher counts of S. mitis in their saliva.34 However, the medical conditions were disclosed through self-report, rather than a clinical examination and results should be considered accordingly.

In a study involving Japanese university students, periodontal disease was shown to be a risk factor for hypertension.48 Specific clinical factors, such as clinical attachment level and the number of missing teeth, were associated with increased systolic blood pressure in postmenopausal women who were not currently being treated for hypertension.53 The findings suggested that the cumulative effects of oral disease may be related to blood pressure control.53 However, it could also indicate that positive and negative habits accumulate over time. Thus, patients who floss most likely also exhibit other healthy behaviours, such as exercising and eating healthy food.

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