Background: Recently, a positive association has been reported between hypertension and periodontitis.
The authors hypothesized that oral hygiene promotion activities could have an effect on hypertension prevention or the degree of hypertension control. Therefore, this study examines the relationship between oral
hygiene behaviors and hypertension using data from a nationally representative survey, the Korea National
Health and Nutrition Examination Survey (KNHANES).
Methods: Using data from the KNHANES (2008 to 2010), 19,560 adults with complete data sets were
included. The authors analyzed the relationship of the prevalence and control rate of hypertension and
numerous variables, including oral hygiene behavior.
Results: As the frequency of toothbrushing increased, the prevalence of hypertension decreased in
multivariate analysis after adjusting for various factors, including the presence of periodontitis. In a subgroup analysis, this relationship was also observed in individuals without periodontitis. In particular,
systolic blood pressure levels progressively decreased as the frequency of toothbrushing and the number of secondary oral products used increased. The adjusted odds ratio of hypertension prevalence was
1.195 (95% confidence interval 1.033 to 1.383) for individuals who brushed their teeth hardly ever or
once daily compared with those who brushed after every meal.
Conclusions: Individuals with poor oral hygiene behavior are more likely to have a higher prevalence
of hypertension, even before periodontitis is shown. Oral hygiene behavior may be considered an independent risk indicator for hypertension, and maintaining good oral hygiene may help to prevent and
control hypertension. J Periodontol 2015;86:866-873.
KEY WORDS
Blood pressure; epidemiology; hypertension; oral hygiene; periodontitis; prevalence.
* Department of Internal Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Republic of Korea.
Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Periodontics, College of Medicine, The Catholic University of Korea.
doi: 10.1902/jop.2015.150025
866
Demographic Variables
All participants were asked about their demographic
characteristics, socioeconomic characteristics, and
medical history. Trained interviewers conducted faceto-face interviews with a structured questionnaire.
Smoking status was categorized into three groups:
1) non-smokers, who had never smoked or had
smoked <100 cigarettes in their lifetime; 2) ex-smokers,
who had smoked in the past and had stopped smoking;
and 3) current smokers, who were smoking currently
and had smoked 100 cigarettes.15,16
The amount of pure alcohol consumed (grams per
day) was calculated, and the participants were divided into three groups depending on the amount of
alcohol consumption per day (non-drinker; light-tomoderate drinker [1 to 30 g/day]; and heavy drinker
[>30 g/day]).17,18
The nutrition surveys included questions about the
participants eating patterns, use of dietary supplements, knowledge of nutrition, and food intake using
the 24-hour recall method. Total energy intake and
percentage of energy from each nutrient (fat, carbohydrate, and protein) were then calculated.
Exercise was defined as strenuous physical activity performed for 20 minutes at a time at least
three times a week. Low income corresponds to the
lowest quartile of household income. Education level
was classified as high if the respondent finished education beyond high school. Data about place of
residence (urban or rural areas), presence of spouse,
and self-reported oral status were also obtained.
Measurements
Physical measurements of the participants were done
by trained staff members in the Division of Chronic
Disease Surveillance under the Korea Centers for
Disease Control and Prevention and the Korean Ministry
of Health and Welfare.
A standard mercury sphygmomanometer was
used for blood pressure (BP) measurement. Systolic
BP (SBP) and diastolic BP (DBP) were measured twice
at 5-minute intervals, and the average values were
used for the analysis. Hypertension was defined as an
average BP 140/90 mmHg or the use of antihypertensive medication.2,19 Hypertension was considered
to be controlled if participants with hypertension had
an average BP <150/90 for individuals aged 60 years
and BP <140/90 for everyone else, according to recently revised Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High
Blood Pressure recommendations.20
Total body fat was measured using dual-energy x-ray
absorptiometry examinations.i Total body fat percentage was determined as fat mass divided by total mass.
Baumanometer, W.A. Baum, Copiague, NY.
i Discovery-W fan beam densitometer, Hologic, Bedford, MA.
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Volume 86 Number 7
Table 1.
Yes
13,639
5,921
Age (years)
40.1 0.2
55.1 0.3
<0.0001
Male sex
47.2 (0.4)
56.8 (0.7)
<0.0001
27.1 0.1
28.5 0.2
<0.0001
23.1 0.0
25.1 0.1
<0.0001
79.1 0.1
86.0 0.2
<0.0001
Exercise (yes)
24.7 (0.5)
26.1 (0.8)
0.0727
Higher education
79.1 (0.6)
50.1 (1.1)
<0.0001
Low income
12.4 (0.5)
24.7 (0.9)
<0.0001
Characteristic
2,012.4 12.2
1,967.4 16.9
0.0225
18.8 0.1
15.9 0.2
<0.0001
Rural residence
17.3 (1.5)
22.3 (1.8)
<0.0001
Spouse (yes)
66.6 (0.7)
74 (0.8)
<0.0001
Periodontitis (yes)
23.9 (0.7)
42.4 (1)
Smoking
Non-smoker
Ex-smoker
Current smoker
57.9 (0.5)
14.4 (0.3)
27.7 (0.5)
50.6 (0.7)
24.2 (0.7)
25.2 (0.7)
Alcohol Consumption
Non-drinker
Light-to-moderate drinker
Heavy drinker
20.4 (0.4)
62.6 (0.5)
17 (0.5)
29.8 (0.7)
45.3 (0.9)
24.9 (0.7)
28.3 (0.6)
33.0 (0.6)
38.7 (0.7)
23.3 (0.7)
33.2 (0.9)
43.5 (1.0)
7.4 (0.3)
25.6 (0.5)
67.0 (0.6)
4.6 (0.3)
18.7 (0.7)
76.7 (0.8)
<0.0001
<0.0001
<0.0001
<0.0001
<0.0001
Volume 86 Number 7
Table 2.
Prevalence
30.6
27.6
26.4
22.8
29.0 (0.6)
20.7 (0.7)
18.0 (1.3)
Control
<0.0001
Periodontitis (yes)
<0.0001
0.0627
(1.2)
(0.8)
(0.8)
(0.7)
26.6
30.4
32.4
30.9
(1.7)
(1.4)
(1.4)
(1.7)
<0.0001
31.5
31.0
28.8
25.2
(1.3)
(0.9)
(0.9)
(0.8)
<0.0001
0.0231
31.4 (1)
26.6 (1.7)
32.7 (3.5)
30.9 (0.8)
24.9 (0.9)
20.3 (1.4)
Table 3.
Hypertension Prevalence (OR [95% CI]) Multivariate Logistic Regression Model for Oral
Hygiene Behaviors
Variable
Prevalence
1
1.137 (1.000 to 1.297)
1.195 (1.033 to 1.383)
1
0.947 (0.753 to 1.191)
1.010 (0.811 to 1.258)
Control
0.0217
P
0.0507
1
1.148 (0.92 to 1.232)
0.863 (0.708 to 1.011)
0.4819
0.0258
1
0.712 (0.469 to 1.081)
0.626 (0.421 to 0.929)
Adjusted for age, sex, total body fat percentage, smoking, drinking, exercise, education, income, total energy intake, fat intake, and periodontitis.
Figure 1.
Figure 2.
with those who cleaned their teeth less than once a day
or never.35 Toothbrushing is an effective healthy behavior that reduces the amount of bacterial plaque and
gingivitis.
The CPI, which was used as an index of periodontitis in the present study, is widely used to
measure the level of periodontal disease and define
periodontitis.21,23 However, there is a limitation because the index does not reflect oral hygiene; therefore, it is suggested that the combined use of an oral
hygiene index and the CPI should be recommended to
assess oral health.36
Currently, many studies recommend lifestyle
modifications such as weight reduction, smoking
cessation, and exercise to decrease the prevalence of
hypertension and improve BP control. If a simple
871
Volume 86 Number 7
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