GUM DISEASE MAY INCREASE STROKE RISK

A new study further strengthens the scientific evidence that cardiovascular health is deeply connected to oral health.  It found that the more severe an individual’s gum disease, the greater their stroke risk.  The study also found a strong association between regular dental care and reduced stroke risk.

Periodontal disease is a chronic inflammatory disease caused by bacterial colonization that affects the soft and hard structures that support the teeth. Gum disease is widespread. In the U.S. more than half of adults age 30 and older have have periodontitis, the more advanced form of periodontal disease.

Previously, observational studies have found that poor gum health is associated with an increase in stroke risk. However, long-term, population-based research on this topic is lacking.  For this study, researchers used data from dental exams performed on more than 6,730 participants in the Atherosclerosis Risk in Communities study. The study enrolled more than 10,000 middle-aged adults in 1987 and 1989, and then studied their long-term health outcomes through 2012.

Researchers found participants with any form of periodontal disease, including mild periodontal disease, were significantly more likely to experience an ischemic stroke than those with healthy gums. And, the more severe the gum disease, the greater the stroke risk.  This was true even after adjusting for potential confounding variables including race, education level, smoking status, age, education, diabetes incidence, hypertension, high cholesterol, and body mass index.  Interestingly, further detailed analysis found that inflammation of the gums rather than the level of bacterial infiltration of the gums appeared to be the real driver between periodontal disease and stroke incidence.

The study also examined links between better oral care and reduced stroke rates.  The findings showed that compared with those who only had dental care when experiencing problems, regular dental care users had a significantly lower risk for ischemic stroke.  Even after the analysis controlled for known stroke risk factors, regular dental care use continued to be associated with lower rates of ischemic stroke. 

What to do:  Observational studies suggest gum disease may increase risk for a host of chronic diseases including mouth and upper GI cancers, infertility, and diabetes.  This study shows a graded association between gum disease severity and stroke risk but it does not demonstrate that gum disease causes increased stroke risk. For the definitive answer, stay tuned.  A current trial is now investigating whether increased periodontal care can reduce stroke risk. In this trial patients with gum disease who have already had a stroke are being assigned to either standard or intensive periodontal treatment.  In the meantime, you can’t go wrong by practicing good oral hygiene including having a thorough home cleaning routine with brushing and flossing and regular dentist and hygienist visits.  Not smoking, managing your weight, reducing stress, controlling chronic conditions such as diabetes, and consuming a healthy fiber rich diet also support better gum health as well as better cardiovascular health.

Information adapted from:

https://www.medscape.com/viewarticle/891550

Source:

Sen S, Giamberardino LD, Moss K et al.  Periodontal disease, regular dental care use, and incident ischemic stroke.  Stroke. 2018, originally published January 15, 2018.  Available at: https://doi.org/10.1161/STROKEAHA.117.018990