Keywords
Ischemic stroke
Atherosclerosis
Pathophysiology
Dental health
Categories
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Abstract
Periodontitis has been linked to ischemic stroke (IS) and has been described as a risk factor for developing IS, however, the evidence on its relationship is controversial. The objective of this review is to describe the epidemiological impact, pathophysiological mechanisms, and clinical relevance of the relationship between periodontal disease and IS. Epidemiological studies show that periodontitis increases the risk of developing IS; effect produced through the systemic pro-inflammatory state as a consequence of periodontitis, favoring the formation of atheromatous plaques in large arteries. Furthermore, the bacterial DNA of periodontitis-causing pathogens has been identified in atheromatous plaques of patients with IS. Recent studies suggest that the Intima Media Thickness (IMT) measured by ultrasound is largely related to cardiovascular risk factors and recently to periodontitis. Finally, treatment of periodontitis has been shown to reduce the risk of IS. The relationship between periodontitis and IS is clear. However, it is necessary to develop randomized studies to measure its relationship more precisely and to implement effective strategies for the detection and timely treatment of periodontitis to reduce the burden of disease represented by stroke.
References
Johnson W, Onuma O, Owolabi M, Sachdev S. Stroke: A global response is needed. B World Health Organ. 2016; 94(9): 634-634A. doi: http://dx.doi.org/10.2471/BLT.16.181636
Mohr JP, Albers GW, Amarenco P, et al. American Heart Association Prevention Conference. IV. Prevention and Rehabilitation of Stroke. Etiology of stroke. Stroke. 1997;28(7):1501-1506. doi: 10.1161/01.str.28.7.1501
Bongers TN, de Maat MP, van Goor ML, et al. High von Willebrand factor levels increase the risk of first ischemic stroke: influence of ADAMTS13, inflammation, and genetic variability. Stroke. 2006;37(11):2672-2677. doi: 10.1161/01.STR.0000244767.39962.f7
Straka M., Trapezanlidis M. Periodontitis and stroke. Neuro Endocrinol Lett. 2013;34 (3):200-206
Aarabi G, Eberhard J, Reissmann DR, Heydecke G, Seedorf U. Interaction between periodontal disease and atherosclerotic vascular disease--Fact or fiction?. Atherosclerosis. 2015;241(2):555-560. doi: 10.1016/j.atherosclerosis.2015.04.819
Nagpal R, Yamashiro Y, Izumi Y. The Two-Way Association of Periodontal Infection with Systemic Disorders: An Overview. Mediators Inflamm. 2015;2015: 793898.
Hasturk H, Kantarci A. Activation and resolution of periodontal inflammation and its systemic impact. Periodontol 2000. 2015;69(1):255-273. doi: 10.1111/prd.12105
Nazir MA. Prevalence of periodontal disease, its association with systemic diseases and prevention. Int J Health Sci. 2017;11(2):72-80.
Syrjänen J, Peltola J, Valtonen V, Iivanainen M, Kaste M, Huttunen JK. Dental infections in association with cerebral infarction in young and middle-aged men. J Intern Med. 1989;225(3):179-184. doi: 10.1111/j.1365-2796.1989.tb00060.x
Lafon A, Pereira B, Dufour T, et al. Periodontal disease and stroke: a meta-analysis of cohort studies. Eur J Neurol. 2014;21(9):1155-e67. doi: 10.1111/ene.12415
Jimenez M, Krall EA, Garcia RI, Vokonas PS, Dietrich T. Periodontitis and incidence of cerebrovascular disease in men. Ann Neurol. 2009;66(4):505-512. doi: 10.1002/ana.21742
Hashemipour MA, Afshar AJ, Borna R, Seddighi B, Motamedi A. Gingivitis and periodontitis as a risk factor for stroke: A case-control study in the Iranian population. Dent Res J. 2013;10(5):613-619.
Sanossian N, Gatto NM, Ovbiagele B. Subpar utilization of dental care among Americans with a history of stroke. J Stroke Cerebrovasc Dis. 2011;20(3):255-259. doi: 10.1016/j.jstrokecerebrovasdis.2009.12.007
Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008;117(24):3118-3125. doi: 10.1161/CIRCULATIONAHA.107.758524
McNicol A, Israels SJ. Mechanisms of oral bacteria-induced platelet activation. Can J Physiol Pharmacol. 2010;88(5):510-524. doi: 10.1139/y10-029
Dörfer CE1, Becher H, Ziegler CM, et al. The association of gingivitis and periodontitis with ischemic stroke. J Clin Periodontol. 2004;31(5):396-401
Tuttolomondo A1, Di Raimondo D, Pecoraro R, Arnao V, Pinto A, Licata G. Atherosclerosis as an inflammatory disease. Curr Pharm Des. 2012;18(28):4266-4288.
Black S, Kushner I, Samols D. C-reactive Protein. J Biol Chem. 2004;279(47):48487-90
Zeng XT, Li N, Zhang LJ, Rong R, Liu MY. Periodontal disease and cardiovascular disease: A native review. Heart and Mind, 2017;1(3):97-101
Marcelino SL, Gaetti-Jardim E Jr, Nakano V, et al. Presence of periodontopathic bacteria in coronary arteries from patients with chronic periodontitis. Anaerobe. 2010;16(6):629-632. doi: 10.1016/j.anaerobe.2010.08.007
Palm F, Urbanek C, Grau A. Infection, its treatment and the risk for stroke. Curr Vasc Pharmacol. 2009;7(2):146-152. doi: 10.2174/157016109787455707.
Cavrini F, Sambri V, Moter A, et al. Molecular detection of Treponema denticola and Porphyromonas gingivalis in carotid and aortic atheromatous plaques by FISH: report of two cases. J Med Microbiol. 2005;54(Pt 1):93-96. doi: 10.1099/jmm.0.45845-0
Gaetti-Jardim E, Marcelino SL, Feitosa ACR, Romito GA, Avila-Campos MJ. Quantitative detection of periodontopathic bacteria in atherosclerotic plaques from coronary arteries. J Med Microbiol. 2009;58(Pt 12):1568-1575. doi: 10.1099/jmm.0.013383-0
Lourbakos A, Yuan YP, Jenkins AL, et al. Activation of protease-activated receptors by gingipains from Porphyromonas gingivalis leads to platelet aggregation: a new trait in microbial pathogenicity. Blood. 2001;97(12):3790-3797. doi: 10.1182/blood.v97.12.3790
Hayashi C, Viereck J, Hua N, et al. Porphyromonas gingivalis accelerates inflammatory atherosclerosis in the innominate artery of ApoE deficient mice. Atherosclerosis. 2011;215(1):52-59. doi: 10.1016/j.atherosclerosis.2010.12.009
Velsko IM, Chukkapalli SS, Rivera MF, et al. Active invasion of oral and aortic tissues by Porphyromonas gingivalis in mice causally links periodontitis and atherosclerosis. PLoS One. 2014;9(5):e97811. doi: 10.1371/journal.pone.0097811
Ebersole JL, Cappelli D, Mott G, Kesavalu L, Holt SC, Singer RE. Systemic manifestations of periodontitis in the non-human primate. J Periodontal Res. 1999;34(7):358-362. doi: 10.1111/j.1600-0765.1999.tb02266.x
Sun HT, Zhang J, Hou N, Zhang X, Wang J, Bai Y. Spontaneous periodontitis is associated with metabolic syndrome in rhesus monkeys. Arch Oral Biol. 2014;59(4):386-392. doi: 10.1016/j.archoralbio.2014.01.004
Jeon SB, Chun S, Choi-Kwon S, et al. Biomarkers and location of atherosclerosis: matrix metalloproteinase-2 may be related to intracranial atherosclerosis. Atherosclerosis. 2012;223(2):442-447. doi: 10.1016/j.atherosclerosis.2012.04.013
Söder PO, Meurman JH, Jogestrand T, Nowak J, Söder B. Matrix metalloproteinase-9 and tissue inhibitor of matrix metalloproteinase-1 in blood as markers for early atherosclerosis in subjects with chronic periodontitis. J Periodontal Res. 2009;44(4):452-458. doi: 10.1111/j.1600-0765.2008.01145.x
Leira Y, Seoane J, Blanco M, et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol. 2017;32(1):43-53. doi: 10.1007/s10654-016-0170-6
Lee YL, Hu HY, Huang N, Hwang DK, Chou P, Chu D. Dental prophylaxis and periodontal treatment are protective factors to ischemic stroke. Stroke. 2013;44(4):1026-1030. doi: 10.1161/STROKEAHA.111.000076
Darabian S, Hormuz M, Latif MA, Pahlevan S, Budoff MJ. The role of carotid intimal thickness testing and risk prediction in the development of coronary atherosclerosis. Curr Atheroscler Rep. 2013;15(3):306. doi: 10.1007/s11883-012-0306-4
Devine PJ, Carlson DW, Taylor AJ. Clinical value of carotid intima-media thickness testing. J Nucl Cardiol. 2006;13(5):710-718. doi: 10.1016/j.nuclcard.2006.07.007
Orlandi M, Suvan J, Petrie A, et al. Association between periodontal disease and its treatment, flow-mediated dilatation and carotid intima-media thickness: a systematic review and meta-analysis. Atherosclerosis. 2014;236(1):39-46. doi: 10.1016/j.atherosclerosis.2014.06.002
Leira Y, RodrÃguez-Yáñez M, Arias S, et al. Periodontitis as a risk indicator and predictor of poor outcome for lacunar infarct. J Clin Periodontol. 2019;46(1):20-30. doi: 10.1111/jcpe.13032
Lee YL, Hu HY, Chou P, Chu D. Dental prophylaxis decreases the risk of acute myocardial infarction: a nationwide population-based study in Taiwan. Clin Interv Aging. 2015;10:175-182. doi: 10.2147/CIA.S67854
Dai R, Lam OL, Lo EC, Li LS, Wen Y, McGrath C. A systematic review and meta-analysis of clinical, microbiological, and behavioural aspects of oral health among patients with stroke. J Dent. 2015;43(2):171-180. doi: 10.1016/j.jdent.2014.06.005
Sen S, Giamberardino LD, Moss K, et al. Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke. 2018;49(2):355-362. doi: 10.1161/STROKEAHA.117.018990
Li C, Lv Z, Shi Z, et al. Periodontal therapy for the management of cardiovascular disease in patients with chronic periodontitis. Cochrane Database Syst Rev. 2014;(8):CD009197. Published 2014 Aug 15. doi: 10.1002/14651858.CD009197.pub2
Teeuw WJ, Slot DE, Susanto H, et al. Treatment of periodontitis improves the atherosclerotic profile: a systematic review and meta-analysis. J Clin Periodontol. 2014;41(1):70-79. doi: 10.1111/jcpe.12171
Holmlund A, Lampa E, Lind L. Poor Response to Periodontal Treatment May Predict Future Cardiovascular Disease. J Dent Res. 2017;96(7):768-773. doi:10.1177/0022034517701901
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