Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke

Souvik Sen, Lauren D. Giamberardino, Kevin Moss, Thiago Morelli, Wayne D. Rosamond, Rebecca F Gottesman, James Beck, Steven Offenbacher

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE: Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.

METHODS: In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs).

RESULTS: In the ARIC study 10 362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63-0.94).

CONCLUSIONS: We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.

Original languageEnglish (US)
Pages (from-to)355-362
Number of pages8
JournalStroke
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2018
Externally publishedYes

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Dental Care
Periodontal Diseases
Stroke
Atherosclerosis
Tooth
Confidence Intervals
Cardiovascular Diseases
Odds Ratio

Keywords

  • atherosclerosis
  • dental care
  • gingivitis
  • risk factors
  • stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Sen, S., Giamberardino, L. D., Moss, K., Morelli, T., Rosamond, W. D., Gottesman, R. F., ... Offenbacher, S. (2018). Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke, 49(2), 355-362. https://doi.org/10.1161/STROKEAHA.117.018990

Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. / Sen, Souvik; Giamberardino, Lauren D.; Moss, Kevin; Morelli, Thiago; Rosamond, Wayne D.; Gottesman, Rebecca F; Beck, James; Offenbacher, Steven.

In: Stroke, Vol. 49, No. 2, 01.02.2018, p. 355-362.

Research output: Contribution to journalArticle

Sen, S, Giamberardino, LD, Moss, K, Morelli, T, Rosamond, WD, Gottesman, RF, Beck, J & Offenbacher, S 2018, 'Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke', Stroke, vol. 49, no. 2, pp. 355-362. https://doi.org/10.1161/STROKEAHA.117.018990
Sen S, Giamberardino LD, Moss K, Morelli T, Rosamond WD, Gottesman RF et al. Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke. 2018 Feb 1;49(2):355-362. https://doi.org/10.1161/STROKEAHA.117.018990
Sen, Souvik ; Giamberardino, Lauren D. ; Moss, Kevin ; Morelli, Thiago ; Rosamond, Wayne D. ; Gottesman, Rebecca F ; Beck, James ; Offenbacher, Steven. / Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. In: Stroke. 2018 ; Vol. 49, No. 2. pp. 355-362.
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abstract = "BACKGROUND AND PURPOSE: Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.METHODS: In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs).RESULTS: In the ARIC study 10 362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (χ2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95{\%} confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95{\%} confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95{\%} confidence interval, 0.63-0.94).CONCLUSIONS: We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.",
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