Link Between Gum Disease and Strokes - Brief Article

Investigators at the Columbia Presbyterian Center of New York Presbyterian Hospital have discovered a link between periodontal disease and atherosclerosis (thickened carotid arteries), a condition that puts people at increased risk for stroke and heart disease. They examined data from the Northern Manhattan Stroke Study, one of the first population-based surveys to compare stroke incidence among Caucasians, African-Americans, and Hispanics living in the same community. Seventy-eight strokefree individuals received a detailed oral examination, which included measurement of probing depth and attachment loss at six sites for each tooth, and ultrasound measurement of their carotid arteries, the two main neck arteries that supply blood to the brain. Mean patient age was 66, and about 59% of the study participants were women.

Patients were divided into two groups, depending on their dental status. "We found that patients with the most severe periodontal disease had the most thickening of the arteries," notes Mitchell Elkind, assistant attending neurologist, Columbia Presbyterian Center. "On average, the carotid artery wall thickness was about one-half millimeter thicker among the patients with more gum disease." These results held true even when controlled for known cardiovascular risk factors, such as hypertension, cholesterol levels, diabetes, age, gender, and race/ethnicity.

"Periodontal disease as a potential risk factor for cardiovascular disease makes sense because it's an ongoing, long-term infection, and it's been shown that many people have some sort of infection shortly before they have a stroke," notes Elkind. The full relationship between periodontal disease and atherosclerosis remains to be determined. The researchers hypothesize that infection, such as periodontal disease, may cause chronic inflammation and activation of white blood cells. This metabolic process ultimately may cause lesions and plaque formation in the walls of arteries that bring nutrient-rich blood to the brain and heart. The subsequent thickening of the arterial walls reduces blood flow and increases the likelihood of stroke or heart disease.

This may mean that dentists one day might have to treat periodontal disease more aggressively and refer patients with severe disease to physicians for a full evaluation of their risk for cardiovascular disease, while physicians who treat stroke patients may have to refer them to dentists for treatment of their periodontal disease. "Preventive care for cardiovascular disease in the future might include the use of antibiotics, extraction of infected teeth, or more frequent teeth cleaning," predicts Moise Desvarieux, assistant clinical professor of public health, Columbia University College of Physicians & Surgeons.

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