Periodontal disease: An independent risk factor in the occurrence of ischaemic stroke?

Strokes are the second leading cause of death in Australia and a leading cause of disability worldwide. A stroke occurs when blood supply to the brain is restricted due to a blockage (ischaemic stroke) or rupturing and bleeding (haemorrhagic stroke) of a blood vessel. Both forms of stroke result in a lack of oxygen and nutrients to the brain, subsequently causing damage which is often irreversible. Consequently, when part of the brain is damaged or dies, rapid impairment to speech, motor skills, thought and communication can occur. Ischaemic strokes are accountable for approximately four out of five strokes in Australia, with many studies identifying periodontal disease as an independent risk factor in their occurrence.

Periodontal (gum) disease (PD) is the term ascribed to the systematic breakdown of the tissue and bone supporting and surrounding the teeth. This process occurs when the immune system responds to excess bacterial build-up within the mouth, usually from lack of oral hygiene. PD’s are categorized into two principal stages – gingivitis and periodontitis. Furthermore, additional studies have identified PD as a risk factor for a number of other life threatening diseases such as diabetes, pancreatic cancer, oral cancer, cardio vascular disease and Alzheimer’s.

The association between PD and stroke is a significant finding as majority of individuals will suffer with some level of PD during their lifetime. PD and stroke share a number of common risk factors such as hypertension, tobacco use, diabetes, age, alcohol consumption and serum glucose to name a few. Moreover, both are associated with elevated markers of inflammation such as C-reactive protein (CRP), which in itself is an indication of stroke risk. Due to these common risk factors, many studies have faced difficulty isolating PD as an independent risk factor in the occurrence of ischaemic strokes.

Recent research by, Dr Marjorie Jeffcoat at the University of Pennsylvania School of Dental Medicine, illustrates that individuals who had PD treated, significantly lowered their healthcare costs and had less hospitalisations for additional medical conditions than individuals who left PD untreated. Outcomes from an additional study established that individuals are two times more likely to experience a non-fatal stroke as a consequence of PD than one related to diabetes. The same study also proposed that PD and hypertension are equal risk factors in developing a stroke. A similar outcome was established from a 10 year follow up study published in Stroke: journal of the American Heart Association. The results of the study illustrated that the incidence of ischaemic stroke is increased when PD is present, particularly within the younger cohort.

Although a number of studies have identified an association between ischaemic strokes and PD, additional research is necessary to ascertain a definitive independent connection between the two. Annually PD is responsible for 9% of deaths worldwide, yet good oral health and the prevention and cure of PD are nearly always achievable. It is recognised that treating periodontal disease is the most effective method of preventing and improving a number of diseases and conditions, therefore, oral health should be made a priority for individuals of all ages. By raising community awareness and adopting healthy dental practices and regular dental treatment, the incidence and risks associated with PD can be lowered.

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