Periodontal disease associated with stroke


A number of studies and reviews have suggested an association between periodontal disease and the occurrence of stroke.

The aim of this review was to evaluate the association between periodontal disease and the incidence of ischaemic and haemorrhagic strokes through a meta-analysis of cohort studies.


Searches were conducted in PubMed, Embase, ISI Web of Science and the Cochrane database with no language restrictions. Only cohort studies, evaluating of the incidence of strokes (fatal or non-fatal, ischaemic or haemorrhagic), and periodontal status (periodontitis, gingivitis, tooth loss) were considered. No restriction was applied concerning the way periodontal status was evaluated: at baseline or during follow-up, with a clinical examination or a questionnaire.

Two reviewers carried out study selection independently. Study quality was assessed. Separate analysis for the outcomes periodontitis, gingivitis and tooth loss were conducted with haemorrhagic or ischaemic and fatal or non-fatal strokes being distinguished when possible. Adjusted values of relative risks (RRs) or hazard ratios (HRs) were used to assess risk. Random effects meta-analyses were conducted when data could be pooled.


  • 9 cohort studies (8 prospective, 1 retrospective) were included.
  •  The results of the meta-analyses varied depending on the outcome considered and the type of stroke.
  •  Risk of stroke was significantly increased by the presence of periodontitis [relative risk 1.63 (95% CI; 1.25, 2.00)].
  •  Tooth loss was also a risk factor for stroke [relative risk 1.39 (95% CI; 1.13, 1.65)].
  •  The risk of stroke did not vary significantly with the presence of gingivitis.


The authors concluded

Our results are in accordance with those of previous reviews suggesting a link between stroke and periodontal diseases


This review has focused on just cohort studies to assess the relationship between these two diseases and have suggested that both periodontal disease and tooth loss are associated with stroke. However the authors highlight a number of methodological issues. Only 5 of the studies adjusted for all known risk factors with smoking being the only factor considered by all studies. There are also concerns over the way in which periodontal disease status was measured with two studies using a questionnaire only and only one study using a full clinical and radiographic assessment. While a number of potential mechanisms supporting a role in the association between periodontal and systemic disease have been suggested (Van Dyke &, van Winkelhoff 2013 ) there still appear to be more reviews than high quality clinical studies to clarify the relationship.


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