Periodontitis, Dental Procedures, and Young-Onset Cryptogenic Stroke

Abstract

Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls ( P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18–34.5) and severe periodontitis with an OR of 7.48 (1.24–44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87–23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01–6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72–40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

Shotgun metagenomic analysis of the oral microbiome in gingivitis: a nested case-control study

“…A total of 329 subjects were enrolled in the SECRETO Oral study [ 24 ], and out of these, 120 participants were included in the present study. To be eligible for participation, individuals had to meet specific criteria: (1) undergo clinical oral examinations; (2) exhibit no radiographic bone loss; (3) refrain from antibiotic usage within one-month preceding saliva sampling; and (4) provide comprehensive information on gingivitis risk factors, such as smoking, alcohol consumption, and antibiotic use.…”

“…Oral examinations for this study were conducted at the University of Helsinki and the University of Turku, Finland between April 2014 and February 2020. The examinations are described in detail elsewhere [ 24 ]. A standard dental office setting was used for clinical examinations that were conducted by the same periodontal specialist (SP).…”

Multikingdom oral microbiome interactions in early-onset cryptogenic ischemic stroke

“…Oral examinations for SECRETO Oral study were performed during April 2014 to February 2020 at the University of Helsinki and the University of Turku, Finland [ 37 ]. Clinical oral examination was performed in a standard dental office setting by the same periodontal specialist (SP) to avoid inter-examiner differences.…”