New evidence finds an association between periodontal disease and stroke

Researchers from Boston University investigate the relationship between periodontal disease and ischemic stroke

CHICAGO -- People missing some or all of their teeth or who have significant loss of bone and tissue surrounding their teeth may be at an increased risk for having a stroke, according to a new study that appeared in the October issue of the Journal of Periodontology (JOP).

Researchers from Boston University investigated the relationship between periodontal disease and history of stroke in patients 60 years of age and older by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III).

"We found that patients 60 years and older who were edentulous, partially edentulous and/or had significant clinical attachment loss were more likely to have a history of stroke compared to dentate adults without significant clinical attachment loss," said Dr. Martha E. Nunn, Goldman School of Dental Medicine, Boston University. "However, based on the results of this study, it is unclear whether periodontal disease is an independent risk factor for stroke or simply a risk marker that reflects negative effects of risk factors common to both periodontal disease and stroke."

Age, tobacco use, hypertension, diabetes, serum glucose, C-Reactive protein (CRP) and alcohol intake were also included as additional risk factors in this study. These confounders are independent risk factors for cardiovascular disease and if left untreated, periodontitis has been shown to have harmful effects on the control of diabetes, serum glucose levels and increases CRP levels.

Evidence continues to accumulate associating severe periodontitis with an increased risk of forming atherosclerotic plaques, which are responsible for myocardial infarction and ischemic stroke. According to past JOP studies, this relationship could be due to elevated CRP levels in patients with chronic periodontal disease.

Further investigation is needed to support periodontal treatment intervention as a means of controlling systemic inflammation. Based on findings from another study in this JOP issue, CRP levels may now be reduced by periodontal treatment such as scaling and root planing in patients with severe periodontal disease.

"Studies evaluating additional treatment methods such as repeated scaling and root planing or surgical treatment are needed to conclusively demonstrate that CRP can be improved by periodontal treatment," said Preston D. Miller, DDS and AAP president. "Until science presents a definitive direction, the periodontists ultimate goal is to lead patients to the right side of health. What we do know is that eliminating periodontal infection saves teeth."

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For more information including a referral to a periodontist or a free brochure entitled Periodontal Diseases: What You Need to Know, visit the AAP website at www.perio.org or call toll-free at 800/FLOSS-EM (800.356-7736).

The American Academy of Periodontology is an 8,000-member association of dental professionals specializing in the prevention, diagnosis and treatment of diseases affecting the gums and supporting structures of the teeth and in the placement and maintenance of dental implants. Periodontics is one of nine dental specialties recognized by the American Dental Association.

EDITOR'S NOTE: A copy of the JOP articles "The Association Between Cumulative Periodontal Disease and Stroke History in Older Adults" and "Effect of Periodontal Treatment on Serum C-Reactive Protein Levels" A Systematic Review and a Meta-Analysis" are available to the media by contacting the AAP Public Affairs Department at 312/573-3243. The public and/or non-AAP members can view a study abstract online, and the full-text of the study may be accessed online for $20.00 at http://www.joponline.org/.


Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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