Several studies have described an association between periodontal disease and stroke risk, with various mechanisms proposed to explain this association. However, when these findings are compiled through meta-analyses, the correlations are not always significant.
A French research team sought to address this inconsistency by conducting an umbrella review of all existing meta-analyses on this subject. They identified 11 meta-analyses from different geographical regions, 7 of which had high methodological quality.
Their analysis concluded that periodontitis, and to a lesser extent, tooth loss, is significantly associated with an increased risk for stroke. Periodontitis was associated with a 22% higher stroke risk (relative risk [RR], 1.22; P < .00001), and the risk more than doubled (odds ratio, 2.32; P < .00001). Tooth loss showed a positive but non-significant trend, and gingivitis was not significantly associated with an increased stroke risk (RR, 1.32; P = .0008).
European Trends
According to the World Health Organization, Europe has the highest prevalence of oral diseases globally, including dental caries, tooth loss, and periodontal disease, affecting 50.1% of the adult population in 2019. The most prevalent condition was dental caries in permanent teeth, affecting 33.6% of individuals in 2019. The prevalence of periodontal disease has also increased, reaching 17.9% in 2019 among individuals aged 15 years or older, with higher rates in high-income countries. These trends are attributed to population aging and varying levels of oral hygiene and dental care.
The French 2014 Health Barometer reported that 71.1% of individuals aged 15-75 years brushed their teeth twice daily. Nearly 30% of the adult population requires encouragement to follow oral health recommendations, such as those promoted by the French Union for Oral Health, the official organisation of the French dental profession for prevention and oral health promotion.
When it comes to dental care, the frequency of forgoing treatment has increased in recent years, despite the implementation of the French government’s “100% Santé” reform (aimed at providing full reimbursement for certain healthcare services). In 2022, a study by the French Directorate for Research, Studies, Evaluation, and Statistics found that nearly 9% of individuals aged over 16 years reported forgoing dental care, primarily for financial reasons (5%). This figure was higher in the lower-income groups.
Pathophysiological Mechanisms
Inflammation associated with periodontitis contributes to an increased stroke risk due to the high vascularisation of the oral cavity, which is connected to the external carotid artery. Additionally, inflammation and poor oral health promote bacterial translocation into systemic circulation. This, combined with inflammatory mediators such as tumour necrosis factor, interleukin-1 beta, and interleukin-6, contributes to atherogenesis. Furthermore, periodontal inflammation may activate platelets, promoting atheroma formation and stabilisation.
Stroke risk adds to the established links between oral health and other conditions, including endocarditis, myocardial infarction, diabetes, rheumatoid arthritis, and chronic obstructive pulmonary disease.
This story was translated from Univadis France using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.