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.
Abolfazli, Nadar., et al., “Periodontal disease and risk of cerebral ischemic stroke,” Journal of Neurological Sciences (Turkish) 28, No. 3, (2011): 307-316.
Australian Government, Australian Institute of Health and Welfare., Stroke and its management in Australia: an update, 2013, Cardiovascular Disease Series No.37, Canberra: Australian Institute of Health and Welfare, 2013, p. 1.
British Dental Health Foundation, “Strokes- gum disease more harmful than diabetes,” April 5, 2011, http://www.dentalhealth.org/news/details/457, (accessed July 28, 2014).
Colella, Matthew. “Stroke signs: can dental health predict stroke?,” Stroke Smart, April 16, 2013, http://www.strokesmart.org/new?id=100, (accessed July 28, 2014).
Dental Health Services Australia, “Links between oral health and general health; the case action,” November 7, 2011, https://www.dhsv.org.au/__data/assets/pdf_file/0013/2515/links-between-oral-health-and-general-health-the-case-for-action.pdf, (accessed August 4, 2014).
Dorfer, Christof E. et al., “The association of gingivitis and periodontics with ischemic stroke,” Journal of Clinical Periodontology 31, No 5, (2004): 396-401.
Douglas, David. “Gum disease may raise stroke risk in the elderly,” Medicine Line, 2006, http://www.medicineonline.com/news/12/6650/Gum-disease-may-raise-stroke-risk-in-the-elderly.html, (accessed July 28, 2014).
Dumitrescu, A. L., and Inagaki, K. “Interrelationships between periodontal disease and mortality, cardiovascular disease, metabolic syndrome, diabetes mellitus,” in Etiology and pathogenesis of periodontal disease, ed Alexandrina L. Dumitrescu (Berlin: Springer, 2010).
Gomes, Joao and Wachsman, Ari Marc. “Types of stroke,” in Handbook of Clinical Nutrition and Stroke, ed. Mandy L. Corrigan., Arlene A Escuro., and Donald F. Kirby (New York: Springer, 2013): 15-31.
Grau, A. J. et al., “Periodontal disease as a risk factor for ischemic stroke,” Stroke 35, (2004):496-501.
Jeffcoat, M. et al., “Impact of periodontal therapy on general health,” American Journal of Preventive Medicine 47, Issue 2, (2014): 166-174.
Joshipura, K. J. “Periodontal disease, tooth loss, and incidence of ischemic stroke,” Stroke 34, (2003):47-52.
Kim, Hyun-Duck., et al., “Association between periodontitis and hemorrhagic stroke among Koreans: a case-control study,” Journal of Periodontology 81, Issue 5, (2010): 658-665.
Lafon, A., et al., “Association between periodontal disease and non-fatal ischemic stroke: a case-control study,” Acta Odontologica Scandinavica 72, No. 3, (2014): 1-7.
Lazare, Marc. Dr. Lazare’s the patients guide to dentistry. USA: Trafford Publishing, 2011.
Lee, Hyo-Jung., et al., “The association between cumulative periodontal disease and stroke history in older adults,” Journal of Periodontology 77, Issue 10, (2006):1744-1754.
Lee, Ya-Ling et al., “Dental prophylaxis and periodontal treatment are protective factors to ischemic stroke,” Stroke 44, Issue 4, (2013): 1026-1030.
Lehman, Shereen. “Treating gum disease linked to improvements in other conditions,” June 27, 2014, http://www.reuters.com/article/2014/06/27/us-gum-disease-health-costs-idUSKBN0F21IC20140627, (accessed July 28, 2014).
Loe, Harald, “Periodontal disease: the sixth complication of diabetes mellitus,” Diabetes Care 16, no. 1 (1993): 329-334.
Matsuyama, Yusuke. “Association between periodontitis and stroke – a meta-analysis based on periodontal measurement characteristics,” Journal of Dental Health 64, (2014): 2-9.
Morgan, Mike and Dashper, Stuart. “Health check: why do my gums bleed and should I be worried?,” The Conversation, July 21, 2014, http://theconversation.com/health-check-why-do-my-gums-bleed-and-should-i-be-worried-28456, (accessed July 25, 2014).
Nield-Gehrig, Jill S., and Villmann, Donald E. Foundations of periodontics for the dental hygienist, 2nd ed. (Baltimore: Lippincott Williams & Wilkins, 2008), 41-47.
Obiechina, Nkem. Understanding periodontitis: a comprehensive guide to periodontal disease for dentists, dental hygienists and dental patients. Bloomington: Author House, 2011.
Palm, Frederick. “Biomarkers of periodontitis and inflammation in ischemic stroke: a case-control study,” Innate Immunity 20, No. 5, (2014): 511-518.
Senzon, Sandra. Reversing gum disease naturally: a holistic home care program. New Jersey: John Wiley & Sons, Inc, 2003.
Simpson, T. C., et al., “Treatment of periodontal disease for glycaemic control in people with diabetes,” Australian Dental Journal 55, (2010):472-474.
Sfyroeras, George, S. et al., “Association between periodontal disease and stroke,” Journal of Vascular Surgery 55, Issue 4, (2012):1178-1184.
United Concordia Dental. “New research continues to show medical cost savings and reduced hospitalizations possible with gum disease treatment,” March 21, 2014, http://unitedconcordia.mediaroom.com/2014-03-21-New-Research-Continues-to-Show-Medical-Cost-Savings-and-Reduced-Hospitalizations-Possible-with-Gum-Disease-Treatment, (accessed July 29, 2014).
Watt, Sheiham A. et al., “The common risk factor approach: a rational basis for promoting oral health,” Community Dentistry and Oral Epidemiology 28 (2000): 399-406.
Whiteman, Honor. “Alzheimer’s disease linked to poor dental health,” Medical News Today, July 31, 2013, http://www.medicalnewstoday.com/articles/264164.php (accessed March 14, 2014).
Willey, Jo. “Keep your teeth clean to cut the risk of stroke,” Express, April 1, 2013, http://www.express.co.uk/life-style/health/388391/Keep-your-teeth-clean-to-cut-the-risk-of-a-stroke, (accessed July 29, 2014).
The content on the LifeCare Dental website is provided for education and information purposes only. Information about therapy, service, product or treatment does not imply endorsement and is not intended to replace advice received from your dentist, doctor or other registered health professionals. LifeCare Dental makes no claim as to the accuracy or authenticity of this content.
Additionally, LifeCare Dental does not accept liability to any person for the information or advice provided on this website or incorporated into it by reference. Content has been prepared for Western Australian residents and wider Australian audiences, and was accurate at the time of publication. Readers should note that, over time, currency and completeness of the information may change. All users are urged to always seek advice from a registered health care professional for diagnosis and answers to their medical questions.