Combined Influence of Dental Caries and Periodontal Disease on Ischemic Stroke Risk

Periodontal disease (PD) and dental caries are prevalent chronic oral inflammatory conditions associated with systemic health outcomes. Individually, both have been linked to an increased risk of ischemic stroke, a leading cause of morbidity and mortality. However, few studies have examined the combined effect of PD and dental caries on stroke, stroke subtypes, and major adverse cardiovascular events (MACEs) within US cohorts. We aimed to evaluate the individual and joint associations of PD and dental caries with incident ischemic stroke, stroke subtypes, and MACEs and assess the relationship between regular dental care utilization and oral disease status.

We analyzed data from participants in the Atherosclerosis Risk in Communities study who completed dental assessments during Visit 4 (1996-1998). Participants with previous ischemic stroke, coronary heart disease (CHD), or dental caries without PD were excluded. Oral health status was categorized as good oral health, PD only, or PD with(+) caries. Incident ischemic stroke and MACEs (ischemic stroke, myocardial infarction, or fatal CHD) were identified using adjudicated records through 2019. Cox proportional hazard models estimated hazard ratios (HRs) for outcomes, adjusting for demographics and vascular risk factors. The association of regular dental care with oral disease status was analyzed using logistic regression.

Among 5,986 participants (mean age 63 ± 5.6 years; 52% female), 1,640 had good oral health, 3,151 had PD only, and 1,195 had PD + caries. The incidence of ischemic stroke was 4.1%, 6.9%, and 10.0% across groups, respectively. In fully adjusted models, PD + caries was associated with increased risk of ischemic stroke (HR 1.86; 95% CI 1.32-2.61) and MACEs (HR 1.36; 95% CI 1.10-1.69). Elevated risk was observed for thrombotic (HR 2.27; 95% CI 1.22-4.24) and cardioembolic (HR 2.58; 95% CI 1.27-5.26) strokes. Regular dental care was associated with lower odds of PD (odds ratio [OR] 0.71; 95% CI 0.58-0.86) and PD + caries (OR 0.19; 95% CI 0.15-0.25).

Co-occurring PD and dental caries were independently associated with increased risk of ischemic stroke and MACEs. Regular dental care may reduce this risk by improving oral health. Limitations include reliance on one-time dental assessment and residual confounding.