Young Adults with Periodontitis Face Higher Cryptogenic Stroke Risk

A recent study published in the Journal of Dental Research has connected a certain type of ischemic stroke to periodontitis, a frequent ailment.

Overview
Globally, strokes rank as the second most common cause of death. The incidence of ischemic strokes has increased in younger populations during the previous few decades, leading to a higher prevalence in this age range.

Stroke risk factors include sedentary behavior, smoking, obesity, diabetes, and hypertension; these are lifestyle-related and possibly changeable risk factors. Furthermore, a substantial Taiwanese investigation has revealed that periodontitis may raise the risk of ischemic stroke, especially in younger people.

The majority of young-onset strokes among individuals without vascular risk factors are classified as cryptogenic ischemic strokes (CIS), which are much more common and have an unknown cause.

Oral health and strokes
Factors such as lipopolysaccharides (LPS) and lipotechoic acid are released by bacteria that cause periodontitis (LTA). These are toxins found in the cell membranes of Gram-positive and Gram-negative bacteria, respectively.

Endotoxemia is the term for the release of lipopolysaccharides (LPS) into the bloodstream, primarily from the stomach, with the oral mucosa and inflammatory gums having a minor involvement. It is yet unknown what role ischemic stroke and endotoxemia played.

Bacteria from dental operations encourage clotting by entering the bloodstream, if only momentarily. Such operations may raise the risk of strokes, heart attacks, or other acute cardiovascular events due to the inflammatory response. But it’s still unclear if they’re related to ischemic stroke.

The current study investigated the relationships, in younger persons, between CIS and periodontitis or dental surgery.

Concerning the study

Using a case-control strategy, the individuals were selected from a number of sites that were part of the SECRETO investigation. Every participant ranged in age from 18 to 49.

Imaging was used to confirm that each subject had a cryptogenic ischemic stroke (CIS). Their history with CIS was zero. The patients and controls, who did not exhibit stroke symptoms, were matched for age and gender.

Confounding variables like the risk of stroke, routine dental treatment, and a patent foramen ovale (PFO) in the heart were taken into account by the researchers. PFA is linked to an increased risk of stroke and cerebral bacteremia.

What findings did the study make?

With a median age of approximately 42 years, the total number of participants consisted of 146 paired cases and controls. Compared to controls, cases had higher rates of hypertension, heavy drinking, and lower levels of education.

In addition, compared to controls, they had a greater frequency of PFO, were more likely to be using statins or anticoagulants, and had recently taken antibiotics.

Dental well-being and CIS

Oral health was worse in the CIS cases. Probing revealed more bleeding and increased periodontal inflammation, as measured by the Periodontal Inflammation Burden Index (PIBI) and gum pocket depth (BOP).

Periodontitis affected about 28% of stroke cases compared to 20% of controls. CIS patients had periodontitis at the most advanced stage (Stage IV) as opposed to controls, who did not progress past stage III. In controls, all grades of periodontitis were observed; in CIS patients, only the more severe grades (B and C) were.

Not only was periodontitis associated with moderate to severe CIS cases vs mild CIS, but the odds of more severe periodontitis were almost fourfold higher among those with moderate-to-severe CIS. CIS odds increased more than tenfold with a high PIBI. Among those with severe periodontitis, the odds were 7.5-fold higher. Moreover, stroke severity also soared with the severity of periodontitis. Moderate to severe CIS risk was increased by fivefold among those with a PIBI over 10. The odds of severe stroke were more than sixfold higher among those with severe periodontitis.

Dental treatments and CIS

Over 90% of dental treatments in CIS cases occurred within four months before the stroke. These patients had extractions, endodontic treatments, dental fillings, and chronic tooth infections at higher rates than in controls. When there was a history of invasive dental treatments within the three months preceding the stroke, the risk of CIS was more than doubled. The odds were sixfold higher among individuals with PFO.

The two groups’ LPS or LTA titers did not differ, however they did rise in proportion to the severity of periodontitis.

In conclusion
This is the biggest investigation into the relationship between dental health and young CIS. Young-onset CIS was associated with a history of recent invasive dental surgery as well as moderate to severe periodontitis with a fast-progressing profile.

The risk varies with the degree of periodontitis, with CIS becoming more prevalent as the disease worsens. More severe periodontitis was also associated with a higher stroke severity.

The results support a prior study by demonstrating a separate increase in periodontal disease-associated CIS risk, which is unaffected by other risk factors such as obesity, PFO, smoking, excessive drinking, and educational attainment.

Previous research has revealed links with bacteremia, which this study does not confirm. According to the findings, invasive dental procedures may be beneficial after six months, but there is a higher short-term risk of CIS. Further research on this has to be done.

For more information: Periodontitis, dental procedures, and young-onset cryptogenic stroke, Journal of Dental Research, https://doi.org/10.1177/00220345241232406