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Periodontal disease is an inflammatory condition associated with heart disease and stroke. Specific bacteria and widespread and vascular inflammation are key connecting factors therefore good dental hygiene is even more important than thought before.

Gum disease facts

Gum disease, also known as periodontal disease, is an inflammatory condition affecting the hard and soft tissues that surround and support the teeth. The prevalence of periodontal disease is high: it is reported that up to 50% of the population worldwide may have periodontal disease; and approximately half of all Americans aged 30 years or older have periodontitis which is the more advanced form of periodontal disease.

Typically it is poor oral hygiene that causes this infection of the gums. The process begins with gingivitis, which is the mildest form of periodontal disease. This causes gums to redden, become swollen, and bleed when being brushed and if not treated, gingivitis will progress to periodontitis. When the bacteria associated with periodontitis progresses below the gum line, it releases toxins into the bloodstream which create inflammation in the body. This can degrade mouth tissue and bone and cause gums to detach from the teeth which enable bacteria to infect the gums. Over time this can result in loss of teeth.

What do we know about strokes?

There are three different types of strokes:

  • Ischemic,
  • Hemorrhagic and
  • Transient ischemic attacks (TIA).

When a blood vessel that delivers blood to the brain is blocked this is known as an ischemic stroke and when a blood vessel bursts in the brain, this is known as a hemorrhagic stroke. TIAs are regarded as mini-strokes and this is where there is a temporary loss of blood flow that resolves by itself but over time can have a cumulative effect in terms of damage and also increase the risk of an ischemic or hemorrhagic stroke. Both the two main types of stroke prevent blood supply and thus oxygen from getting to the brain and over time those parts of the brain then die which is known as infarction. Ischemic strokes are the most commonly occurring strokes with estimated figures of 87 percent of strokes being ischemic.

Anyone may experience a stroke at any age, but the risk increases with age, sex (males are more likely to have a stroke), and ethnicity (Afro-Caribbeans are more likely to have strokes and earlier). Some risks can be attributed to lifestyle factors, such as smoking, excessive alcohol consumption and lack of exercise; and social deprivation also increases risk. Other health conditions, like heart disease, hypertension, high cholesterol or diabetes can also make it more likely you may suffer a stroke.

It can be difficult to prevent a stroke taking place. However, acting quickly when you suspect a stroke is occurring can reduce permanent widespread damage.

Periodontal disease is associated with heart disease and stroke

It may be surprising to know that gum disease and heart health are related but the root cause is inflammation or the swelling of infected tissues. Inflammation causes atherosclerosis (hardening of the arteries) which restricts blood flow to and from your heart, leading to heart disease and stroke.

Research has found one specific bacteria that is linked to periodontitis, Streptococcus sanguis. This travels to the heart once it enters the body and also plays a role in strokes. When gums are healthy, this bacteria experiences more resistance from the body and so has a harder time getting to the heart.

Further research has identified a relationship between s. sanguis and other periodontal disease bacteria, and the size of your carotid (neck) arteries. The more bacteria are present, the thicker your carotids are, and so the more difficult it is for your blood to flow to your brain, leading to a stroke. 

In summary, bacteria that enter through your gums can move to your heart and thicken arteries, damaging your cardiovascular health and increasing the likelihood of stroke.

In addition, periodontal disease can also worsen pre-existing cardiac problems. Those at risk for infective endocarditis (infection of the endocardial surface of the heart) may need antibiotics before any dental procedures. Your periodontist and cardiologist can assess if your heart condition necessitates the prescribing of antibiotics prior to any procedure.

How are stroke and gum disease connected?

Strokes and gum disease have much in common, not least as both diseases have serious health implications. They are both widespread in the US: it is thought that as many as 64 million Americans are affected by gum disease; and that, on average, every four minutes one American dies as a result of a catastrophic stroke. The key is that both conditions are connected with vascular inflammation.

The most important similarity between the two conditions might be this inflammation. Research suggests that there may be some connection between strokes and gum disease: for example, one study identified that patients that had experienced acute cerebrovascular ischemia had a greater likelihood of also having an oral infection when compared to those who had not.

Periodontal inflammation has associations with many systemic diseases, including breast cancer, diabetes, and heart disease, according to research. This is perhaps more correlation owing to inflammation rather than causation by gum disease; so far no study has been able to prove gum disease is a causative factor.

Studies identifying a link between periodontitis and stroke

In 2004, researchers in Germany identified that patients who were experiencing severe periodontitis (especially men and those under the age of 60) had an increased risk for an ischemic stroke. This was supported by another study in 2012 which had the same findings.

In 2018 a further study reinforced links between increased risk of future stroke and gum disease and demonstrated that stroke risk increased proportionately to the extent of gum disease, finding in addition that regular dental care and lower stroke risk were linked:
  • Individuals attending the dentist regularly had half the stroke risk of those not in receipt of regular dental care.

  • The risk of future stroke was higher in relation to the severity of periodontal disease.

This most recent study argued that their findings proved that periodontal disease with increased inflammation was the most strongly associated with stroke risk, and claimed that the risk caused by gum disease would be comparable to that of high blood pressure (two to three times increased risk).

Final thoughts

Current thinking would indicate that the role of good dental hygiene is about more than just keeping your teeth and gums healthy, it may also reduce the risk of heart disease and stroke. Research results emphasize the importance of good regular dental care to include good oral hygiene habits at home such as brushing and flossing, in conjunction with regular dentist and hygienist visits.

Stroke and gum disease appear to have much in common, especially in terms of the inflammation that co-occurs. With so many Americans being afflicted by both conditions, recognizing that the two might have connections is crucial to enable both you and your medical and dental professionals make truly informed decisions and reduce your risk of both conditions.

  • Photo courtesy of SteadyHealth.com
  • www.cdc.gov/stroke/facts.htm
  • https://www.perio.org/consumer/gum-disease-and-heart-disease
  • https://www.cdc.gov/stroke/about.htm
  • https://www.ncbi.nlm.nih.gov/pubmed/22244863
  • https://www.ahajournals.org/doi/abs/10.1161/STROKEAHA.117.018990

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