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(Stroke. 2004;35:496.)
© 2004 American Heart Association, Inc.

Original Contributions

Periodontal Disease as a Risk Factor for Ischemic Stroke

Armin J. Grau, MD; Heiko Becher, PhD; Christoph M. Ziegler, MD, DDS; Christoph Lichy, MD; Florian Buggle, MD; Claudia Kaiser; Rainer Lutz, MD; Stefan Bültmann, MD; Michael Preusch, Cand Med Christof E. Dörfer, DDS

From the Department of Neurology (A.J.G., C.L., F.B., S.B., M.P.), Department of Tropical Hygiene and Public Health (H.B.), Clinic and Policlinic for Maxillofacial Surgery (C.M.Z.), and Policlinic for Conservative Dentistry and Periodontology (C.K., R.L., C.E.D.), University of Heidelberg, Heidelberg, Germany.

Correspondence to Armin J. Grau, MD, Department of Neurology, Klinikum der Stadt Ludwigshafen a Rh, Bremserstr 79, 67063 Ludwigshafen a Rh, Federal Republic of Germany. E-mail graua{at}klilu.de

Background and Purpose— Chronic infectious diseases may increase the risk of stroke. We investigated whether periodontal disease, including periodontitis and gingivitis, is a risk factor for cerebral ischemia.

Methods— We performed a case-control study with 303 patients examined within 7 days after acute ischemic stroke or transient ischemic attack, 300 population controls, and 168 hospital controls with nonvascular and noninflammatory neurological diseases. All subjects received a complete clinical and radiographic dental examination. The individual mean clinical attachment loss measured at 4 sites per tooth served as the main indicator for periodontitis.

Results— Patients had higher clinical attachment loss than population (P<0.001) and hospital (P=0.010) controls. After adjustment for age, sex, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions, and lifestyle factors, the risk of cerebral ischemia increased with more severe periodontitis. Subjects with severe periodontitis (mean clinical attachment loss >6 mm) had a 4.3-times-higher (95% confidence interval, 1.85 to 10.2) risk of cerebral ischemia than subjects with mild or without periodontitis (3 mm). Severe periodontitis was a risk factor in men but not women and in younger (<60 years) but not older subjects. Periodontitis increased the risk of cerebral ischemia caused by large-artery atherosclerosis, cardioembolism, and cryptogenic etiology. Gingivitis and severe radiologic bone loss were also independently associated with the risk of cerebral ischemia, whereas caries was not.

Conclusions— Our study indicates that periodontal disease, a treatable condition, is an independent risk factor for cerebral ischemia in men and younger subjects.

Key Words: infection • inflammation • risk factors • stroke

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