Gum Disease Increases Rate of Stroke Caused by Hardening of Large Arteries

The occurrence of gum disease has been linked to a hardening of large arteries in the brain and severe artery blockages, according to research presented at the American Stroke Association’s International Stroke Conference 2020.

The preliminary research included two studies that raise the possibility that treating gum disease alongside other stroke risk factors could reduce the severity of artery plaque build-up and narrowing of the brain blood vessels that can lead to a new or a recurrent stroke.

Souvik Sen, M.D., M.S., M.P.H., author of both studies and professor and chair of the Department of Neurology at the University of South Carolina School of Medicine in Columbia said, “Gum disease is a chronic bacterial infection that affects the soft and hard structures supporting the teeth and is associated with inflammation. Because inflammation appears to play a major role in the development and worsening of atherosclerosis, or ‘hardening’ of blood vessels, we investigated if gum disease is associated with blockages in brain vessels and strokes caused by atherosclerosis of the brain vessels.”

The first of the studies looked at periodontal disease association with large artery atherothrombotic stroke. This included 265 patients who experienced a stroke between 2015 and 2017. Participants had an average age of 64. Researchers analyzed whether gum disease was associated with specific types of stroke.

It was found that large artery stoke due to intracranial atherosclerosis was twice as common in patients with gum disease as in those without gum disease. Also, patients with gum disease were three times as likely to have a stroke involving blood vessels in the back of the brain, which controls vision, coordination, and other vital bodily functions. Gum disease was more common in patients who had a stroke involving large blood vessels within the brain, but not more common among those who had a stroke due to blockage in blood vessels outside the skull.

The second study examined the role of periodontal disease on intracranial atherosclerosis. This involved 1,145 patients who had not experienced a stroke. Researchers used two magnetic resonance images to measure blockages in arteries inside the brain, and periodontal examinations were used to classify the presence and severity of gum disease.

It was found that the arteries in the brain were categorized as severely blocked by 50% or more in 10% of participants. People with gingivitis were twice as likely to have moderately severe narrowed brain arteries from plaque build-up compared to those with no gum disease. After adjusting for risk factors such as high blood pressure, high cholesterol, and age, people with gingivitis were 2.4 times as likely to have severely blocked brain arteries.

“It’s important for clinicians to recognize that gum disease is an important source of inflammation for their patients and to work with patients to address gum disease,” Sen said

The study did not include people who had gum disease serious enough to have resulted in tooth loss.

“We are working on a current study to evaluate if treatment of gum disease can reduce its association with stroke,” Sen said.

This important research could help physicians evaluate brain health and early detection of stroke through gum disease evaluation. Sen and his team do stress that these studies could not conclusively confirm a cause-and-effect relationship between gum disease and artery blockage or stroke risk, but with more information and research, it could lead the way to conclusive evidence.