Periodontal Disease and Stroke: An Updated Review of Their Association
Ourania Schoinohoriti *
Department of Oral and Maxillofacial Surgery, Dental School, University of Athens, Greece and Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece.
Aristeidis H. Katsanos
Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece and Department of Neurology, School of Medicine, University of Ioannina, Greece.
Ioannis Iatrou
Department of Oral and Maxillofacial Surgery, Dental School, University of Athens, Greece.
Nikos Triantafyllou
Department of Neurology, “Eginition” Hospital, School of Medicine, University of Athens, Greece.
Sokratis G. Papageorgiou
Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece.
Spyridon Vasdekis
Vascular Unit, Third Department of Surgery, “Attikon” Hospital, School of Medicine, University of Athens, Greece.
Efstathios Boviatsis
Second Department of Neurosurgery, “Attikon” Hospital, School of Medicine, University of Athens, Greece.
Konstantinos Voumvourakis
Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece.
Georgios Tsivgoulis
Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Greece and Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA and International Clinical Research Center, St. Anne’s University Hospital in Brno, Brno, Czech Republic.
*Author to whom correspondence should be addressed.
Abstract
Objective: To review the literature regarding the association of periodontal disease with stroke that has been gaining interest during the last two decades.
Methods: A search was conducted through MEDLINE and SCOPUS databases for all literature related to the combination of terms “periodontitis” or “periodontal disease” and “stroke” or “cerebrovascular diseases”. The selected articles included cross-sectional, case-control and longitudinal studies, as well as interventional trials published up to August 2014 that were classified according to their design and critically reviewed.
Findings: Periodontal disease appears to be moderately associated with stroke but the nature of their association is not fully elucidated. The great heterogeneity of the reviewed studies does not allow but a rough estimate of its significance either as a causal or risk factor for stroke. Large-scale randomized clinical trials are warranted to determine whether periodontal intervention may contribute to the primary or secondary prevention of atherosclerotic disease and stroke as its end-point.
Conclusion: The bulk of evidence from the reviewed studies suggests that periodontal disease may represent a contributing factor for stroke but further appropriately designed clinical trials, focusing on the impact of periodontal treatment on stroke are necessary.
Keywords: Stroke, periodontal disease, association, causality, risk factor