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The Association Between Periodontitis, Gingivitis, Tooth Loss and Stroke: An Umbrella Study with Meta-Analysis
Jad El Masri1,2,3,4,5, Ahmad Al Malak6, Diala El Masri4,7
1INSERM U955-E01, Institut Mondor de Recherche Biomédicale (IMRB), Université Paris-Est Créteil, 94010 Créteil, France.
Insights
Periodontitis and tooth loss significantly increase cerebrovascular accident (CVA) risk. Gingivitis, however, shows no significant link to CVA. This highlights the impact of severe periodontal disease on vascular health.
Area of Science:
- Cardiovascular Research
- Oral Health Epidemiology
- Systemic Disease Mechanisms
Background:
- Cerebrovascular diseases (CVAs) have modifiable and non-modifiable risk factors.
- Periodontal diseases (PD) are linked to CVAs, with studies suggesting direct or indirect correlations.
- Understanding the relationship between periodontal health and CVA is crucial for public health.
Purpose of the Study:
- To systematically review and analyze existing meta-analyses on the association between periodontal disease and cerebrovascular disease.
- To evaluate the evidence for periodontitis, gingivitis, and tooth loss as risk factors for CVA.
- To synthesize findings to better understand the pathogenic pathways involved.
Main Methods:
- An umbrella review of meta-analyses was conducted using PubMed, Cochrane, Scopus, and Web of Science databases.
- Searches were performed in March 2024, adhering to Joanna Briggs Institute guidance.
- Quality assessment used AMSTAR, and pooled analysis was performed using Review Manager.
Main Results:
- Seven high-quality meta-analyses were included.
- Periodontitis significantly increased CVA risk (OR = 2.32, RR = 1.22).
- Tooth loss also showed an association with CVA, though to a lesser extent (0.78). Gingivitis did not show a significant association (RR = 1.32).
Conclusions:
- Periodontitis and tooth loss are confirmed risk factors for cerebrovascular accidents.
- Gingivitis does not appear to play a significant role in CVA development.
- Inflammatory processes in periodontal disease may contribute to the pathogenesis of atherosclerotic changes leading to CVA.
Background:
Cerebrovascular diseases (CVAs) have several risk factors that are categorized as modifiable and nonmodifiable. Periodontal diseases (PD) have a modifiable role in causing CVA, where several studies suggested direct or indirect correlations with systemic diseases. This study aims to summarize, evaluate and analyze all the evidence available in literature, to reach a better understanding of the relation between periodontitis, gingivitis, tooth loss and CVA.
Methods:
PubMed, Cochrane, Scopus and Web of Science databases were searched for all meta-analyses assessing the effect of PD on CVA in accordance with Joanna Briggs Institute guidance for umbrella reviews in March 2024. Assessment of Multiple Systematic Reviews (AMSTAR) was used for quality assessment. Pooled analysis was performed to assess the effect of periodontitis, gingivitis and tooth loss on CVA, depending on the availability of data using Review Manager Version 5.2.11.
Results:
Seven of the identified meta-analyses were of high quality, and they were distributed in different countries. Periodontitis was generally associated with a significant increase in CVA risk (OR = 2.32, 95% CI: 1.70, 3.17, p < 0.00001 and RR = 1.22, 95% CI: 1.15-1.29, p < 0.00001), same as tooth loss, but to a lower degree (0.78). However, the effect of gingivitis was insignificant in terms of CVA (RR = 1.32, 95% CI: 1.12-1.56, p = 0.0008).
Conclusions:
This study confirms the effect of periodontitis and tooth loss on CVA, disregarding any significant role for gingivitis. The relation reached favors the suggested role of some inflammatory changes in the pathogenic pathway leading to atherosclerotic changes.
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