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Young Adults Beware: Poor Oral Health Raises Risk of Stroke

A recent study reveals a significant connection between poor oral health, particularly periodontitis, and the risk of cryptogenic ischemic strokes in young adults. The findings suggest that severe periodontitis and recent invasive dental procedures can markedly increase the likelihood of stroke, underscoring the need for integrated dental and medical care to mitigate these risks.

Strokes rank as the second leading cause of death globally, with ischemic strokes increasingly affecting younger populations. This surge in young-onset strokes necessitates an exploration of both traditional and nontraditional risk factors. Traditional risk factors such as inactive lifestyles, smoking, obesity, hypertension, and diabetes are well-documented. However, recent research points to oral health, specifically periodontitis, as a potential contributor to ischemic strokes in younger individuals.

A comprehensive study published in the Journal of Dental Research delved into this emerging risk factor. The study, encompassing multiple centers, involved participants aged 18 to 49 and employed a case-control design. Each case involved a confirmed cryptogenic ischemic stroke (CIS), with no prior stroke history, and was matched with a control group based on age and sex. The researchers accounted for confounding variables, including regular dental care and the presence of a patent foramen ovale (PFO), a condition linked to higher cerebral bacteremia and stroke risk.

The analysis included 146 matched pairs of cases and controls, with a median age of around 42. Findings indicated that CIS cases were generally less educated, had higher rates of hypertension, heavy drinking, and a greater prevalence of PFO compared to controls. Additionally, these individuals were more likely to be on statins or anticoagulant medications and had recent antibiotic use.

A striking observation was the poorer oral health among CIS cases, characterized by higher periodontal inflammation (measured by the Periodontal Inflammation Burden Index, PIBI), deeper gum pockets, and increased bleeding on probing. Notably, 28% of stroke cases had periodontitis compared to 20% of controls. CIS patients predominantly exhibited more severe stages and grades of periodontitis.

The study further established that the severity of periodontitis correlated with the severity of CIS. Individuals with severe periodontitis had significantly higher odds of moderate to severe CIS. A high PIBI was associated with a tenfold increase in CIS risk, and those with severe periodontitis faced a 7.5-fold higher risk.

Moreover, the timing of dental treatments played a crucial role. More than 90% of dental procedures in CIS cases occurred within 4 months before the stroke, suggesting a temporal link. These procedures included extractions, endodontic treatments, and restorative therapy. A history of invasive dental treatments within the 3 months preceding the stroke more than doubled the CIS risk, with a sixfold increase among individuals with PFO.

This study, the largest of its kind, underscores the independent association between periodontal diseases and young-onset CIS, regardless of other risk factors. The findings emphasize the importance of integrating dental health into broader medical care strategies to mitigate stroke risks in young adults, particularly those undergoing invasive dental procedures. Future research should further investigate these associations and explore preventive measures to improve both oral and cardiovascular health outcomes. Click here to read more.

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