Scientists in South Carolina have tied periodontal disease to cerebral small vessel disease and stroke, reports Medpage Today, with data from the Atherosclerosis Risk in Communities (ARIC) cohort linking gum disease with white matter hyperintensities, an imaging marker of cerebral small vessel disease.
Among 1 143 ARIC participants, periodontal disease was associated with the highest quartile of white matter hyperintensity volume (adjusted OR 1.56, 95% CI 1.01-2.40), reported Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia, and co-authors in Neurology Open access.
In a parallel study of 5 986 ARIC participants, the incidence of ischaemic stroke over a 21-year follow-up period was 4.1% for people with oral health, 6.9% for people with periodontal disease, and 10.0% for people with concurrent periodontal disease and dental caries. Periodontal disease with caries was associated with an increased risk of ischaemic stroke (HR 1.86, 95% CI 1.32-2.61) and major adverse cardiovascular events (HR 1.36, 95% CI 1.10-1.69) compared with oral health.
“The most obvious implication of these data is that oral health plays a role in stroke risk, an already well-documented association, and may contribute to white matter hyperintensity pathogenesis, a relationship that is less well explored,” observed Leonardo Pantoni, MD, PhD, of the University of Milan.
White matter hyperintensities are a silent expression of cerebrovascular disease, Pantoni noted in an accompanying editorial.
“However, they are in no way a benign neuroimaging finding,” he said. “A large body of evidence has shown that severe white matter hyperintensities are associated with an increased risk of dementia, mortality, and various functional deficits.”
These two studies strongly suggest that good oral health may help prevent white matter hyperintensity burden and reduce stroke risk, Pantoni added.
“Neurologists, like many other specialists, are probably not accustomed to considering oral health as part of cerebrovascular disease prevention,” he said. “But these observations suggest that they should, in fact, consider incorporating lifestyle interventions such as oral health into stroke prevention strategies, as an adjunct to pharmacologic approaches.”
The ongoing ARIC study began in 1987, enrolling nearly 16 000 people aged 45 to 65 in four US communities. Participants have had multiple consecutive follow-up visits since the study began. The Dental ARIC ancillary study was conducted from 1996 to 1998.
In the white matter hyperintensity analysis, 800 ARIC participants were classified as having periodontal disease and 343 had periodontal health.
Sen and co-authors divided participants into quartiles based on white matter hyperintensity volume. Those in the highest quartile had a volume of more than 21.36 cm³; those in the lowest quartile had a volume of less than 6.41 cm³.
Imaging measures of cerebral small vessel disease included white matter hyperintensity volume, cerebral microbleeds, and lacunar infarcts. Cerebral microbleeds or lacunar infarcts were not associated with periodontal disease, which “may be explained by a lack of statistical power or by different pathogenetic aspects among these features of cerebral small vessel disease”, Pantoni suggested.
In the ischaemic stroke analysis, 1 640 people had oral health, 3 151 had periodontal disease only, and 1 195 had concurrent periodontal disease and dental caries. This analysis also showed that regular dental care was tied to lower odds of periodontal disease (OR 0.71, 95% CI 0.58-0.86) and periodontal disease with caries (OR 0.19, 95% CI 0.15-0.25).
The findings suggest that mechanisms involving systemic inflammation from dental disease may play a role in brain health, Sen and colleagues noted. If future studies confirm a link between gum disease and white matter hyperintensities, “it could offer a new avenue for reducing cerebral small vessel disease by targeting oral inflammation”, Sen said.
A limitation of both studies is that oral health was assessed once, and changes in dental health over time weren’t captured, the researchers acknowledged.
Medpage Today article – Bad Gums Tied to Big Brain Risks (Open access)
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