Periodontal disease and stroke: a meta‐analysis of cohort studies

Abstract

This review aimed to determine the association between periodontal disease and stroke incidence by a meta-analysis of cohort studies. Cohort studies that evaluated the incidence of stroke (fatal or non-fatal, ischaemic or haemorrhagic) and baseline periodontal status and calculated relative risk values were included. The quality of the included studies was assessed using an evaluation grid. The analyses were conducted separately for three outcomes: periodontitis, gingivitis and loss of teeth. Adjusted values of relative risk or of hazard ratio were used to assess risk values in each study. Random effects meta-analyses were conducted when data could be pooled. From the 743 references retrieved, only nine cohort studies were suitable for inclusion in this review. Quality scores of the studies varied greatly. Three prospective studies, which used reliable indicators of periodontal disease, obtained the highest scores. Conversely, three studies that used a subjective evaluation of stroke incidence or diagnosed stroke without imaging obtained the lowest score. The results of the meta-analyses varied depending on the outcome considered and the type of stroke. The risk of stroke was significantly increased by the presence of periodontitis [relative risk 1.63 (1.25, 2.00)]. Tooth loss was also a risk factor for stroke [relative risk 1.39 (1.13, 1.65)]. The risk of stroke did not vary significantly with the presence of gingivitis. This review shows that periodontitis and tooth loss are associated with the occurrence of stroke.

Stroke and the emergency medical services – enhancing performance within the chain of survival

“…Hypertension ICH, whereas current smoking, diabetes, apolipoproteins and cardiac causes are associated with ischaemic stroke (O'Donnel et al 2016). (Seshadri & Wolf 2007) Decreased dietary vitamin D intake (Brøndum-Jacobsen et al 2013) Cardiovascular diseases (Ferro 2003, O'Donnel et al 2010 Ethnic background (Howard et al 2016) Diet (O'Donnel et al 2010) Cervical artery stenosis (Autret et al 1987) Gender (Wolf et al 1992, Traylor et al 2012 Excessive alcohol consumption (O'Donnel et al 2010, Sundell et al 2008 Diabetes (O'Donnel et al 2010) Genetics (Traylor et al 2012) Illicit drug use (Fonseca & Ferro 2013) Dyslipidemia (O'Donnel et al 2010) Inadequate physical activity (Hu et al 2005, O'Donnel et al 2010 Hormonal treatment (Farquhar et al 2009) Increased salt intake (Strazzullo et al 2009) Hypertension (Kannel et al 1970) Low level of training and low socioeconomic position (Cesaroni et al 2009) Migrane (Spector et al 2010) Obesity (Strazzullo et al 2010) Periodontal disease (Lafon et al 2014) Psychological stress (Huang et al 2015) Prothrombotic state (Ferro et al 2010) Smoking (Shinton & Beevers 1989) Snoring and sleep apnea (Dyken & Im 2009) …”

Periodontal Disease And Its Impact on Health, From Cardiovascular Diseases to Metabolic Syndrome

“…In a study by Lafon et al, gingivitis did not demonstrate the same effects. Loss of teeth, considered the last stage of periodontitis, is also considered a risk factor for heart attacks [12]. According to Lafon et al, periodontitis is associated with an increase in C-reactive protein, which is itself involved in atherosclerosis and the incidence of myocardial infarction.…”

Link between Periodontal Disease and Coronary Artery Disease: Bangladesh Perspective

“…53 Among the rural school children between 5 to 15 years, the prevalence of dental caries, plaque, gingival bleeding and bleeding on probing was 69.6%, 91.6%, 66.8 % and 64% respectively. 54 The Link between PD and CAD Periodontitis has been found to be associated with a number of systemic diseases and conditions, including stroke, 55 peripheral arterial disease, 56 type 2 diabetes, 57 rheumatoid arthritis, 58 chronic kidney disease, 59 and chronic obstructive pulmonary disease, 60 Alzheimer's disease, 61 cancers, 62 anaemia, 63 and low-birth weight baby. [64][65] Currently, however, there is a lack of consensus among experts on the nature of these associations and confusion among health care providers and the public on how to interpret this rapidly growing body of science.…”