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Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke.

J Leskelä¹, J Putaala², N Martinez-Majander²

¹Department of Oral and Maxillofacial Diseases, University of Helsinki, Helsinki, Finland.

Journal of Dental Research

|April 16, 2024

Summary

Periodontitis significantly increases the risk of cryptogenic ischemic stroke (CIS) in young adults. Recent invasive dental procedures also heighten CIS risk, particularly in those with patent foramen ovale.

Keywords:

cardiovascular disease dental treatment embolism endotoxemia ischemic stroke thrombosis

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Area of Science:

Neurology
Periodontology
Public Health

Background:

Periodontitis is a known risk factor for ischemic stroke.
The association between periodontitis and cryptogenic ischemic stroke (CIS) in young adults requires further investigation.

Purpose of the Study:

To examine the association between periodontitis, recent invasive dental treatments, and young-onset CIS.
To explore the role of serum biomarkers and patent foramen ovale (PFO) in this association.

Main Methods:

A multicenter case-control study (SECRETO) involving 146 case-control pairs of CIS patients and controls aged 18-49.
Clinical and radiographic oral examinations, serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) measurements.
Multivariate conditional regression models adjusted for stroke risk factors, dentist visits, and PFO status.

Main Results:

Periodontitis was diagnosed in 27.5% of CIS patients vs. 20.1% of controls (P < 0.001).
CIS was strongly associated with high periodontal inflammation (OR 10.48) and severe periodontitis (OR 7.48).
Invasive dental treatments within 3 months prestroke showed an OR of 2.54 for CIS, significantly higher with PFO (OR 6.26).

Conclusions:

Periodontitis and recent invasive dental procedures are significant risk factors for young-onset CIS.
Stroke severity correlates with periodontitis severity.
Bacteremia (LPS/LTA) did not appear to mediate the observed risk.