Over the past 20-plus years, research has consistently found an association between oral health and heart and arterial health, specifically the association of inflammation of the gums, infections caused by gum disease, and tooth loss with strokes and certain ischemic strokes. Two recent studies further explored these associations.

In the first study, entitled Periodontal Disease Association with Large Artery Atherothrombotic Stroke, the researchers attempted to determine whether periodontal disease (PD) had a direct association with particular subtypes of strokes. In this cross-sectional study of 265 ischemic stroke and transient ischemic attack (TIA) patients, the researchers found that one-third of the patients had PD and that the cause of strokes was large-artery atherothrombosis in 20% of the cases. Of these cases, 24% had PD compared with 12% for those without PD. Further findings were that patients with PD were almost three times more likely than those without PD to experience a stroke due to posterior circulatory disease, and patients with PD compared with those without had a significantly higher rate (20% vs. 8%; crude OD ratio 2.6, 95% CI, 1/3-5.6, P = .01) of intracranial atherosclerosis. The rate of extracranial atherosclerosis between the two groups was not significant.

In the second study, entitled Role of Periodontal Disease on Intracranial Atherosclerosis, the researchers selected 6,155 subjects from participants in the Dental Atherosclerosis Risk in Communities Study who had no previous strokes. The team identified a subset of the subjects and obtained MR angiogram and MRI images to establish and grade any asymptomatic intracranial atherosclerosis (ICAS) in the subjects. Periodontal measurements were used to determine the presence of gum disease and the severity if present. The relationship between PD status and severe asymptomatic ICAS (greater than or equal to 50% stenosis) was then evaluated. The researchers found that 10% of all subjects had severe ICAS and that subjects with gingivitis (inflammation of the gums) were two times more likely to have severe ICAS than those with no periodontal disease (crude OR 2.1, 95% Cl, 1.2-3.8, P = .015).

With an eye toward the impact on strokes of treating gum disease, Dr. Sen said in a recent interview, “We are working on a current study to evaluate if treatment of gum disease can reduce its association with stroke.” 

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