Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

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.