Table 1.

Intervention studies to assess the effect of periodontitis treatment on blood pressure

Author, year	Study design	Population characteristics	Intervention	Follow-up	Impact of periodontitis therapy on BP levels
Seinost et al., 2005 [36]	Non-RCT	N =61 30 patients with severe periodontitis 31 healthy people—control group	Non-surgical treatment (2 sessions) and pharmacological methods (antibiotic therapy; 7 days)	3 months	No changes in blood pressure. There was no statistically significant change in SBP (p = 0.68) and DBP (p = 0.2) at follow-up
D’Aiuto et al., 2006 [37]	RCT	40 subjects with chronic periodontitis - Standard periodontal therapy (SPT)= 20 subjects - Intensive therapy (IPT)= 20 subjects	SPT—non-surgical treatment (1 session) IPT—non-surgical treatment (1 session) and LDA (locally delivered antimicrobials): minocycline microspheres	1, 2, 6 months	Transient reduction in systolic blood pressure in IPT that returned to baseline after 6 months (135±14mmHg → 129±17mmHg; p = 0.04) No effect on diastolic blood pressure
Tonetti et al., 2007 [38]	RCT	120 subjects with severe periodontitis - 59 intervention - 61 control	Intervention group: oral hygiene instruction (OHI), single session of NST + LDA (microspheres of minocycline) and extraction of hopeless teeth Control group: OHI, single session of supra-gingival scaling and polishing	Days 1, 7, 30, 60,180	Mean difference in SBP/DBP in the test group versus control (day 1). SBP= 4.60 mmHg (1.07–8.13); p=0.01, DBP= 2.95 mmHg (0.42–5.49); p=0.02 No effect after 6 months
Higashi et al., 2008 [39]	RCT	Protocol 1: n=52 Groups: - 32 subjects with periodontitis randomly allocated to periodontal therapy (16) or no intervention (16) - 20 healthy controls (periodontally and systemically) Protocol 2: n=64 Groups: - 26 subjects with periodontitis randomly allocated to periodontal therapy (17) or no intervention (9) - 38 periodontally-healthy individuals The study included people with arterial hypertension	Protocol 1 + 2: Periodontal therapy group: OHI, NST and 4–7 days of systemic antibiotic and mouthwash for 24 weeks - Control group, and no intervention group did not receive periodontal therapy	Protocol 1 and 2: 24 weeks	Slight decrease in blood pressure
					Protocol 1
						Before	After
					SBP [mmHg]	115.1±10.9	114.6±10.4
					DBP [mmHg]	66.1±7.4	67.4±7.9
					Protocol 2
						Before	After
					SBP [mmHg]	140.1±20.3	141.3±20.3
					DBP [mmHg]	89.2±14.1	88.7±13.7
					However, the results obtained in both protocols were not statistically significant
Higashi et al., 2009 [40]	RCT	N=101 subjects with coronary artery disease randomly allocated to treatment or control groups: - 48 subjects with chronic periodontitis - 53 controls (no periodontitis)	- Periodontitis subjects randomly allocated to periodontal therapy that was NST and 4 to 7 days of antibiotic and mouthwash for 24 weeks (24) or no intervention (24) - Control group: no periodontitis treatment both groups: intra-arterial infusion of acetylcholine and to sodium nitroprusside before periodontal therapy in 48 subjects with periodontitis and 53 control subjects, and in 24 patients who were treated periodontitis and 24 untreated subjects before and after 24 weeks of follow-up	24 weeks	Slight decrease in blood pressure
					Study group
						Before	After
					SBP [mmHg]	141.3±20.2	140.3±19.3
					DBP [mmHg]	82.5±13.3	80.7±12.9
					Control group
						Before	After
					SBP [mmHg]	141.3±19.8	140.8±19.1
					DBP [mmHg]	82.3±12.7	81.9±12.1
					However, the results obtained in both protocols were not statistically significant
Taylor et al., 2010 [41]	RCT	N=125 subjects with periodontitis Groups: - Randomly allocated to - Test (61) - Control group (64)	- Test OHI, extractions of hopeless teeth, NST - control dental extractions to alleviate pain No periodontitis treatment	3 months	No effect on blood pressure (data obtained from authors by Aguilera E. et al. [17••])
Graziani et al., 2010 [42]	Non-RCT	N=14 subjects with severe chronic periodontitis Groups: only intervention group	OHI, scaling and root planing (SRP) in 2 visits within 24 hours, Widman flap procedure 180 days after completion of NST	Days 1, 7, 30, 90, 180, 181, 187, 200, 201, 207, 270	No effect on blood pressure
López et al., 2012 [43]	RCT	N=165 subjects with periodontitis and metabolic syndrome Groups: - Experimental treatment group = 82 - Control group = 83	- Experimental group: received plaque control and NST plus amoxicillin and metronidazole - Control group: received plaque control instructions, supragingival scaling, and two placebos	12 months	Not statistically significant effect on blood pressure
Vidal et al., 2013 [44]	Non-RCT	N=26 subjects with chronic periodontitis and refractory hypertension. Groups: only intervention group	-OHI, NST no time limit Blood pressure was assessed using an ambulatory blood pressure monitoring (ABPM)	6 months	Statistically significant reduction in systolic and diastolic blood pressure by 12.5 mmHg and 10 mmHg, respectively
Hada et al., 2015 [45]	RCT	N=70 subjects with coronary heart disease and periodontitis Groups: - Experimental: 35 - Control: 35	- Experimental group—non-surgical periodontal treatment in the form of scaling and root planing - Control group—no periodontitis therapy	1, 3, 6 months	Highly statistically significant reduction was observed in systolic BP Systolic and diastolic blood pressure: baseline: 130.80±22.58 mmHg and 82.24±11.68 mmHg after 6 months: 123.70±15.72 mmHg and 80.07±9.12 mmHg
Houcken et al., 2016 [46]	Pilot study	N=45 subjects with periodontitis out of 109 that participated in the cross sectional study groups: only intervention group	Treatment: OHI + NST in 2 sessions. Twenty patients (randomly assigned) received a systemic antibiotic therapy adjunctive to the scaling and root planning (combination of Amoxicillin 375mg t.i.d. and Metronidazole 500mg t.i.d. for 7 days)	6 months	Decrease of blood pressure Statistically significant reduction in systolic blood pressure (119.8±14.6 mmHg is 116.9±15.1 mmHg; p=0.04). Reduction in diastolic blood pressure (74.9±11.8 mmHg to 73.1±10.6 mmHg; p=0.05)
Zhou et al., 2017 [47]	RCT	N=95 subjects with periodontitis, pre-hypertension Groups: Randomly assigned to test and control groups: - Intensive treatment group: 48 - Control treatment group: 47	Intensive treatment group: OHI, NST+ locally delivered minocycline hydrochloride ointment (once a week for 4 weeks). Additionally, teeth that could not be saved were extracted - Control treatment group only supragingival ultrasonic scaling and polishing at baseline	6 months	Significant reduction in systolic and diastolic blood pressure in the intensive care group compared to the control group: (systolic blood pressure/diastolic blood pressure: 12.57 mmHg/9.65 mmHg, 95% CI 10.45–14.69 mmHg and 06–12.24 mmHg; p < 0.05)
D’Aiuto et al., 2018 [48]	RCT	N=264 subjects with moderate-severe periodontitis and at least 15 teeth and diabetes type 2 Groups: - Intensive therapy: 133 - Control therapy: 131	Intensive therapy—initial single session of whole mouth scaling of the root surfaces. 2 months after patients with (plaque scores of ≤ 20%) and at least one PPD⩾6 mm had periodontal surgical therapy followed by repeated scaling every 3 months. Control therapy - cleaning and polishing the part of the tooth that is visible above the gingiva of all dentition at the same time-points as the IPT group (after baseline and at 2, 6, 9, and 12 months after the completion of the first session of periodontal therapy)	12 months	Blood pressure change was not statistically significant in both groups
Czesnikiewicz-Guzik et al., 2019 [49••]	RCT	N=101 subjects with arterial hypertension and periodontitis Groups: - Intensive therapy: 50 - Control therapy: 31	Intensive therapy—sub- and supragingival scaling/chlorhexidine Control therapy—supragingival scaling Blood pressure was assessed using an ambulatory blood pressure monitoring (ABPM)	2 months	Statistically significant reduction in blood pressure Systolic blood pressure: −11.1 mmHg (95% CI 6.5–15.8 mmHg) after 2 months of intensive therapy (p <0.01) Diastolic blood pressure: −8.3 mmHg (95% CI 4.0–12.6 mmHg) after 2 months of intensive therapy (p <0.01)