Multiple studies have described an association between periodontal disease and stroke risk, and various mechanisms have been proposed to explain this association. However, when these findings are pooled through meta-analysis, the association is not always significant.
To address this inconsistency, a French research team conducted an overall review of all existing meta-analyses on this topic. They identified 11 meta-analyses from different geographic regions, 7 of which were of high methodological quality.
Their analysis concluded that periodontitis and, to a lesser extent, tooth loss were significantly associated with an increased risk of stroke. Periodontitis was associated with a 22% increased risk of stroke (relative risk [RR], 1.22; P < .00001), more than doubling the risk (hazard ratio, 2.32; P < .00001). There was a positive trend for tooth loss, but it was not significant, and gingivitis was not significantly associated with an increased risk of stroke (RR, 1.32; P = .0008).
According to the World Health Organization, Europe has the highest rates of oral diseases in the world, including caries, tooth loss and periodontal disease, which affected 50.1% of the adult population in 2019. The most common disease is caries of permanent teeth, which affected 33.6% of the population in 2019. The incidence of periodontal disease has also increased, reaching 17.9% in 2019 among people aged 15 years and over, with higher rates in high-income countries. These trends are attributed to an aging population and uneven levels of oral hygiene and dental care.
The French Health Barometer 2014 reported that 71.1% of people aged 15-75 years brushed their teeth twice a day. Nearly 30% of the adult population needs encouragement to follow oral health recommendations, such as those promoted by the French Oral Health Union (the official organization of the French dental community for the prevention and promotion of oral health).
In terms of dental care, despite the French government’s “100% health” reform, which aims to provide full reimbursement for certain medical services, the frequency of abandoned treatment has increased in recent years. In 2022, a study by the French Agency for Research, Studies, Evaluation and Statistics found that nearly 9% of people aged 16 and over reported forgoing dental care, mainly for financial reasons (5%). This number was higher in low-income groups.
Since the mouth is richly vascularized and connected to the external carotid artery, inflammation associated with periodontitis increases stroke risk. In addition, inflammation and poor oral health promote bacterial translocation into the systemic circulation. This, combined with inflammatory mediators such as tumor necrosis factor, interleukin-1β and interleukin-6, can lead to atherogenesis. In addition, periodontal inflammation may activate platelets and promote the formation and stabilization of atherosclerosis.
The stroke risk adds to the known links between oral health and other diseases such as endocarditis, myocardial infarction, diabetes, rheumatoid arthritis and chronic obstructive pulmonary disease.
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