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Open Access 01-10-2024 | Nitrate | Review

Current clinical framework on nitric oxide role in periodontal disease and blood pressure

Authors: Leonel Lima, Sara Gaspar, Bárbara S. Rocha, Ricardo Alves, M. Gabriela Almeida

Published in: Clinical Oral Investigations | Issue 10/2024

Abstract

Objectives

In this review, we explored potential associations between NO and its derivatives, nitrite and nitrate, with periodontal and cardiovascular diseases, with special emphasis on the former. By providing a state-of-the-art and integrative understanding of this topic, we aimed to shed light on the potential role of these three nitrogen oxides in the periodontitis-hypertension nexus, identify knowledge gaps, and point out critical aspects of the experimental methodologies.

Materials and methods

A comprehensive literature review was conducted on human salivary and plasma concentrations of nitrate and nitrite, and their impact on periodontal and cardiovascular health.

Results

A nitrate-rich diet increases nitrate and nitrite levels in saliva and plasma, promoting oral health by favorably altering the oral microbiome. Chlorhexidine (CHX) mouthrinses disrupt the nitrate-nitrite-NO pathway, reducing NO bioavailability, and potentially affecting blood pressure. This is because CHX eliminates nitrate-reducing bacteria, which are essential for NO production. Although endogenous NO production may be insufficient, the nitrate-nitrite-NO pathway plays a critical role in maintaining appropriate endothelial function, which is balanced by the microbiome and dietary nitrate intake. Dietary nitrate supplementation may lead to beneficial changes in the oral microbiome, thereby increasing the NO bioavailability. However, NO bioavailability can be compromised by reactive oxygen species (ROS) and the uncoupling of endothelial nitric oxide synthase (eNOS), leading to further ROS generation and creating a detrimental cycle. Studies on NO and periodontal disease have shown increased nitrite concentrations in patients with periodontal disease, although these studies have some methodological limitations. In terms of blood pressure, literature suggests that CHX mouthrinses may reduce the capacity of nitrate-reducing bacteria, potentially leading to an increase in blood pressure.

Conclusions

Several studies have suggested an association between NO levels and the development of cardiovascular and periodontal diseases. However, the exact mechanisms linking these diseases remains to be fully elucidated.

Clinical relevance

Nitric oxide (NO) is a signaling molecule that plays a crucial role in several physiological processes such as vascular homeostasis, inflammation, immune cell activity, and pathologies such as hypertension and periodontitis.

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Title: Current clinical framework on nitric oxide role in periodontal disease and blood pressure
Authors: Leonel Lima
Sara Gaspar
Bárbara S. Rocha
Ricardo Alves
M. Gabriela Almeida
Publication date: 01-10-2024
Publisher: Springer Berlin Heidelberg
Keywords: Nitrate
Gingival Diseases
Hypertension
Hypertension
Published in: Clinical Oral Investigations / Issue 10/2024
Print ISSN: 1432-6981
Electronic ISSN: 1436-3771
DOI: https://doi.org/10.1007/s00784-024-05913-x

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Current clinical framework on nitric oxide role in periodontal disease and blood pressure

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

Keynote webinar | Spotlight on modern management of frailty

Springer Medicine

Abstract

Objectives

Materials and methods

Results

Conclusions

Clinical relevance

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