Hypertension may result from changes in dietary quality and nutrient intake. We therefore sought to determine the epidemiological association between tooth loss and hypertension in South African adults.This is a secondary data analysis of a cross-sectional survey of a nationally representative sample of adults aged 25 - 70 years who participated in the South African Demographic and Health Survey during 1998 (N = 9 098). The primary data were collected using a validated questionnaire, which included information on past experience of tooth loss (partial or complete), use of dental services, tobacco use and other known risk factors for hypertension. Hypertension was defined as having a measured average blood pressure (BP) > or = 160/95 mmHg and/or taking antihypertensive medication.The prevalences of hypertension, any tooth loss and complete edentulousness were 18.1%, 72.2% and 9.4% respectively. Tooth loss was more common among overweight/obese respondents than among those with a normal body mass index (76.7% v. 66.7%; p < 0.01). Compared with the fully dentate respondents, the completely edentulous respondents had mean systolic and diastolic BPs that were respectively 12 mmHg and 5 mmHg higher. After adjusting for known risk factors for hypertension in a multiple logistic regression model, being completely edentulous remained significantly associated with hypertension (odds ratio 1.35, 95% confidence interval 1.02 - 1.78). The estimated population-attributable fraction of hypertension resulting from complete edentulousness was 10%.The findings suggest that complete edentulousness is a risk indicator for hypertension in South Africa and highlights the importance of primary care practitioner involvement in oral health promotion.