Hypertension, affecting over a billion people worldwide, is often viewed through a cardiovascular or renal lens. Yet mounting evidence suggests oral health—particularly periodontal disease—may influence blood pressure. Functional medicine practitioners, who take a whole-systems view of health, are well positioned to recognize this mouth–heart connection.

How Oral Health and Blood Pressure Are Linked

Epidemiologic studies and meta-analyses consistently show a higher prevalence of hypertension in people with periodontitis. A meta-analysis of more than 250,000 participants found periodontal disease was linked with a 22% greater risk of hypertension, and severe cases may increase risk by 50%. Conversely, hypertensive patients often present with more advanced periodontal destruction than normotensive peers. These correlations persist even after adjusting for age, smoking, and diabetes, pointing to direct biological links.

Why Gum Disease Could Drive Hypertension

The central mechanism is chronic inflammation. Periodontitis allows oral bacteria such as Porphyromonas gingivalis to enter circulation, prompting release of cytokines like IL-6 and TNF-α. These mediators damage vascular endothelium, promote arterial stiffness, and reduce nitric oxide availability—all hallmarks of hypertension.

Patients with periodontitis also show elevated CRP and leukocyte counts, mirroring inflammatory profiles seen in hypertension. Animal studies further suggest periodontal disease may activate the renin–angiotensin system, amplifying blood pressure elevation. Importantly, while lifestyle factors such as smoking and poor diet contribute to both conditions, the association remains significant beyond these shared risks.

Does Hypertension Affect Oral Health?

The relationship is bidirectional. Hypertension alters microvasculature, reducing gingival blood flow and impairing healing. Hypertensive patients often demonstrate accelerated periodontal breakdown. Medications add complexity: calcium channel blockers are associated with gingival overgrowth, and other antihypertensives may contribute to dry mouth or taste changes, which indirectly may increase risk of oral disease.

Interventions With Evidence

The encouraging news is that improving oral health appears to benefit cardiovascular outcomes. Intensive nonsurgical periodontal therapy has been shown to reduce systolic blood pressure by 7–8 mmHg. Other studies report systolic reductions of 2–3 mmHg among hypertensive individuals with healthy gums compared to those with untreated periodontitis. These modest improvements are clinically meaningful, translating to lower risk of stroke and myocardial infarction. Periodontal treatment also reduces systemic markers such as CRP and improves endothelial function.

Daily oral hygiene remains foundational. Brushing, flossing, and regular dental visits are not just for cavity prevention but may support cardiovascular health. An American Heart Association report emphasized toothbrushing as a low-cost tool to help prevent hypertension.

On the flip side, overuse of antiseptic mouthwash may be counterproductive. By eliminating nitrate-reducing oral bacteria, frequent antibacterial rinses (twice daily or more) have been associated with higher risk of developing hypertension. This highlights the need for balance: maintain oral hygiene without eradicating beneficial microbes.

Lifestyle measures overlap as well. Diets rich in whole foods, adequate vitamin C and D, stress reduction, restorative sleep, and smoking cessation all support both gum and cardiovascular health.

Integrated Care for Better Outcomes

Optimal care requires collaboration. Dentists can screen for hypertension in patients with severe periodontitis, while clinicians managing high blood pressure should inquire about oral health and consider dental referrals. This integrative model ensures earlier detection and treatment of both conditions.

Conclusion

Periodontal disease and hypertension are linked in a complex, bidirectional relationship mediated largely by inflammation and vascular dysfunction. For functional medicine practitioners, this underscores the value of broadening cardiovascular risk assessment to include oral health. Periodontal therapy, diligent oral hygiene, and shared lifestyle strategies provide a comprehensive path forward. Ultimately, a healthy mouth may indeed support a healthier heart.

-Carey Kunz, ND, IFMCP

Director of Education at FMP Essentials

References:

1. Muñoz Aguilera E, Suvan J, Orlandi M, et al. Periodontitis is associated with hypertension: a systematic review and meta-analysis. Cardiovasc Res. 2020;116(1):28-39. doi:10.1093/cvr/cvz201

2. Muñoz Aguilera E, Leira Y, Miró Catalina Q, et al. Association between periodontitis and blood pressure highlighted in hypertensive patients. Hypertension. 2021;77(5):1765-1774. doi:10.1161/HYPERTENSIONAHA.120.16558

3. Pietropaoli D, Monaco A, Del Pinto R, et al. Active periodontal treatment and systolic blood pressure: a randomized clinical trial. J Clin Periodontol. 2020;47(12):1437-1447. doi:10.1111/jcpe.13368

4. Sharma S, Sridhar S, Koirala P, et al. Periodontal therapy and its effects on endothelial function and systemic inflammation: a systematic review and meta-analysis. J Evid Based Dent Pract. 2021;21(4):101619. doi:10.1016/j.jebdp.2021.101619

5. D’Aiuto F, Orlandi M, Gunsolley JC. Evidence that periodontal treatment improves biomarkers and CVD outcomes. J Clin Periodontol. 2013;40(9):878-884. doi:10.1111/jcpe.12129

6. Zhou X, Han J, Liu Z, Song Y, Ni J. Periodontitis and hypertension: a bidirectional Mendelian randomization analysis. J Hypertens. 2020;38(9):1796-1805. doi:10.1097/HJH.0000000000002482

7. Graziani F, Cei S, Orlandi M, et al. Effects of non-surgical periodontal therapy on periodontal clinical parameters and systemic inflammation: results from a randomized clinical trial. J Clin Periodontol. 2018;45(6):678-687. doi:10.1111/jcpe.12897

8. Joshipura KJ, Munoz-Torres FJ, Fernandez-Santiago J, et al. Use of mouthwash and risk of hypertension: results from the San Juan Overweight Adults Longitudinal Study. Blood Press. 2020;29(2):103-112. doi:10.1080/08037051.2019.1662375

9. Sanz M, Marco Del Castillo A, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020;47(2):148-156. doi:10.1111/jcpe.13189

10. Zhao D, Khawaja AT, Jin L, et al. Poor oral health and blood pressure control among US adults. J Am Heart Assoc. 2019;8(23):e012272. doi:10.1161/JAHA.119.012272