Cardiovascular Health

Doctor checking patient’s heart

The Link Between Periodontal Disease, Systemic Inflammation, and Cardiovascular Disease

Periodontal disease, a chronic inflammatory condition affecting the gums and supporting structures of the teeth, has been linked to systemic inflammation—a key contributor to cardiovascular disease. The World Health Organization (WHO) notes that periodontal disease shares modifiable risk factors with cardiovascular conditions, such as tobacco use, poor diet, and alcohol consumption11. Inflammation originating in the gums may elevate systemic inflammatory markers, potentially contributing to the development or worsening of atherosclerosis6. Bacteria such as actinomycetemcomitans and Porphyromonas gingivalis (P. gingivalis) have been found in human vascular endothelium and other periodontal bacteria have been found in aortic plaques and the thrombi of patients with cardiovascular issues6.

A healthcare professional uses a stethoscope to listen to the chest of a person wearing a striped shirt during a medical examination

From Mouth to Heart: The Vascular Impact of Oral Bacteria

Research suggests that bacteria, such as P. gingivalis from inflamed gums can enter the bloodstream, triggering an immune response that may drive scar tissue buildup, known as fibrosis, which distorts the heart’s architecture and interferes with electrical signals4,11. This mechanism is one of the proposed biological links between poor oral health and cardiovascular disease. The Centers for Disease Control and Prevention (CDC) emphasizes that oral conditions should not be viewed in isolation, as they are often interconnected with chronic systemic diseases1.

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Healthcare professional using a stethoscope to examine a seated patient in a medical exam room

Help Protect More Than Your Patients’ Smile

The American Dental Association (ADA) highlights the importance of monitoring blood pressure in dental settings, especially for patients with hypertension or other heart conditions2. It is important to monitor the blood pressure of patients with hypertension, (classified as BP of 140/90 mmHg or above) as elevated blood pressure can increase the patient’s risk of bleeding more than anticipated during certain dental procedures like scaling and root planing or crown preparations3. For adult men and women between the ages of 21 to 65 years old, normal systolic blood pressure will range anywhere between 120-129 mm Hg plus/minus 9 points between ages, but anything above 130 is considered hypertension3. The ADA encourages integrated care approaches that consider both oral and cardiovascular health in clinical decision-making. Consider discussing the patients' blood pressure and medications with their cardiologist3.

How to Measure Blood Pressure

  • How to measure blood pressure during a patient visit with a digital sphygmomanometer

    Follow these steps for reliable readings with digital sphygmomanometer:

    1. Prepare the Patient: Ensure the patient is seated comfortably with feet flat on the floor, back supported, and arm at heart level8.
    2. Use Proper Equipment: A calibrated automatic sphygmomanometer is recommended8.
    3. Avoid Common Errors: Don’t measure over clothing and allow the patient to rest for 5 minutes before taking the reading8.
    4. Take Multiple Readings: If the first reading is elevated, wait a few minutes and repeat. Record the average8.
    5. Document and Discuss: Note the reading in the patient’s chart and explain its relevance to oral and systemic health8.

  • How to measure blood pressure during a patient visit with a manual sphygmomanometer

    1. Rest the patient: Ensure they’ve rested for 5–10 minutes9.
    2. Positioning: Make sure they are sitting upright with their back supported and feet flat, legs uncrossed. Patient’s arm should be supported at heart level, palm facing up9.
    3. Make sure you have the correct cuff size: The cuff should cover 80% of the arm’s circumference and be snug but not pinching10. Children would require a smaller cuff.
    4. Apply the cuff: Wrap it around the upper arm, about 1 inch above the elbow9. a. Ensure the tubing runs over the center of the arm.
    5. Place the stethoscope on the diaphragm over the brachial artery, just below the cuff. Place earpieces in your ears, angled forward9.
    6. Inflate the cuff and close the valve on the bulb9.
    7. Inflate until the gauge reads ~30 mmHg above expected systolic pressure (or 160–180 mmHg if unknown)9.
    8. You should no longer hear the pulse9.
    9. Deflate slowly: Open the valve slightly to release air at 2–3 mmHg per second 9. a. Listen for the first Korotkoff sound—this is the systolic pressure. b. Continue deflating until the sound disappears—this is the diastolic pressure.
    10. Record the reading: a. Example: 120/80 mmHg (systolic/diastolic).
    11. Repeat if needed. Wait a few minutes before retaking for confirmation9.
    12. Remove the cuff: Fully deflate and gently remove9.
Gender Age(Years) SBP(mm Hg) DBP(mm Hg)
Male 21 to 25 120.5 78.5
26 to 30 119.5 76.5
31 to 35 114.5 75.5
36 to 40 120.5 75.5
41 to 45 115.5 78.5
46 to 50 119.5 80.5
51 to 55 125.5 80.5
56 to 60 129.5 79.5
61 to 65 143.5 76.5
Female 21 to 25 115.5 70.5
26 to 30 113.5 71.5
31 to 35 110.5 72.5
36 to 40 112.5 74.5
41 to 45 116.5 73.5
46 to 50 124 78.5
51 to 55 122.55 74.5
56 to 60 132.5 78.5
61 to 65 130.5 77.5

Normal blood pressure for adults by age and gender7

Normal blood pressure varies by age and gender, please refer to the above table for adult men and women.

For childeren Aged <1-13 y  For children Aged > 13 y
Normal BP: <90th percentile Normal BP: <120/<80 mm Hg
Elevated BP: ≥ 90th percentile to < 95th percentile or 120/80 mm Hg to < 95th percentile(whichever is lower) Elevated BP: 120/<80 to 129/<80 mm Hg
Stage 1 HTN: ≥ 95th percentile to < 95th percentile + 12 mm Hg or 130/80 to 139/89 mm Hg(whichever is lower) Stage 1 HTN: 130/80 to 139/89 mm Hg
Stage 2 HTN: ≥ 95th percentile + 12 mm Hg or ≥ 140/90 mm Hg(whichever is lower) Stage 2 HTN: ≥ 140/90 mm Hg

Normal blood pressure for children5

What is considered nornal blood pressure for children varies by age and other factors such as gender and height. Please refer to this table for the recommended normative blood pressure based on normal-weight children.

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Oral Health and Other Systemic Conditions

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Oral Health and Diabetes

Explore the bi-directional relationship between oral health and diabetes.

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Patient Communication and Gum Health

Learn how to improve communication with your patients about gum health.

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