Periodontitis as a risk factor for cerebrovascular accident: a case-control study in the Indian population

• Published in: Journal of periodontal research Vol. 45; no. 2; pp. 223 - 228
• Main Authors: Pradeep, A. R., Hadge, P., Arjun Raju, P., Shetty, S. R., Shareef, K., Guruprasad, C. N.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-04-2010; Blackwell
• Subjects: Adult; Aged; Alcohol Drinking - adverse effects; Biological and medical sciences; Brain Ischemia - etiology; Case-Control Studies; cerebrovascular disease; Cholesterol - blood; Dental Plaque Index; Dentistry; Diabetes Complications; Diet; Educational Status; Facial bones, jaws, teeth, parodontium: diseases, semeiology; Female; Gingivitis - classification; Humans; Hypertension - complications; India; Ischemic Attack, Transient - etiology; Male; Medical History Taking; Medical sciences; Middle Aged; Neurology; Non tumoral diseases; Otorhinolaryngology. Stomatology; Periodontal Attachment Loss - classification; Periodontal Index; Periodontal Pocket - classification; periodontitis; Periodontitis - classification; Periodontitis - complications; risk factor; Risk Factors; Smoking - adverse effects; Stroke - etiology; Stroke - genetics; Vascular diseases and vascular malformations of the nervous system; Asia; India; Vascular disease; Periodontal disease; Nervous system diseases; Stroke; Periodontitis; Stomatology; Central nervous system disease; Risk factor; Cardiovascular disease; Case control study; Cerebrovascular disease; Cerebral disorder
• ISSN: 0022-3484; 1600-0765
• DOI: 10.1111/j.1600-0765.2009.01220.x

Pradeep AR, Hadge P, Arjun Raju P, Shetty SR, Shareef K, Guruprasad CN. Periodontitis as a risk factor for cerebrovascular accident: a case–control study in the Indian population. J Periodont Res 2010; doi: 10.1111/j.1600‐0765.2009.01220.x. © 2009 John Wiley & Sons A/S
Background and Objective:  Chronic infections have been reported to be risk factors for coronary heart disease and ischemic stroke. However, the association of coronary heart disease and ischemic stroke with periodontal disease, which is also a chronic inflammatory disease, needs to be evaluated. The present case–control study was designed to determine if an association exists between periodontal disease and cerebrovascular accident in the Indian population.
Material and Methods:  This case–control study consisted of 200 subjects (100 cases and 100 controls) who were 33–68 years of age. Cases were examined within 5 d after their first acute ischemic attack. Clinical parameters recorded included plaque index, gingival index, probing pocket depth and clinical attachment loss. The medical questionnaire collected information on family history of stroke, dietary history, history of smoking and history of alcohol consumption. Cases were additionally scrutinized for diabetes, hypertension and total serum cholesterol level. The education level of patients was also considered.
Results:  The mean plaque index, gingival index, probing pocket depth and clinical attachment loss values of subjects with cerebrovascular accident were significantly higher when compared with those of the control group (p < 0.05). In fully adjusted logistic regression analysis, a probing pocket depth of > 4.5 mm was found to be the most significant factor for stroke (odds ratio = 8.5; confidence interval = 1.1–68.2) followed by hypertension (odds ratio = 7.6; confidence interval = 3.3–17.1) and smoking (odds ratio = 3.1; confidence interval = 1.3–7.4).
Conclusion:  The data from this study support the proposed link between periodontitis and cerebrovascular accident in the Indian population. However, further studies are necessary to verify and quantify the role of oral infections and genetic factors in the process of atherosclerosis.