Number of teeth is independently associated with ischemic stroke: A case-control study

Association between severity of dental caries and the risk of stroke

OBJECTIVE

The relationship between dental caries and stroke remains inconclusive. The aim of this study is to investigate whether different severities of dental caries affect the risk of stroke.

METHODS

This retrospective cohort study was conducted using the 2000-2013 Taiwan National Health Insurance Database. We selected 23,662 patients with advanced/severe dental caries and 23,662 patients with incipient/moderate dental caries between 2000 and 2006. These patients were followed to the occurrence of stroke or to the end of the study in 2013. Hazard ratios (HRs) and 95% confidence intervals (CIs) derived from the Cox proportional hazards models were calculated to assess the association between severity of dental caries and the risk of stroke.

RESULTS

The advanced/severe dental caries group had a significantly higher risk of stroke compared with incipient/moderate dental caries group (adjusted HR, 1.16; 95% CI, 1.03-1.31). Stratified analyses showed that advanced/severe dental caries was positively associated with the risk of ischemic stroke in patients aged ≥40 years and with the risk of hemorrhagic stroke in patients aged <40 years.

CONCLUSION

There is a severity-dependent association between dental caries and stroke in an Asian population.

Phenotypic Analysis, Molecular Characterization, and Antibiogram of Caries-Causing Bacteria Isolated from Dental Patients

Dental caries is a biofilm-mediated, sugar-driven, multifactorial, dynamic disease that results in the phasic demineralization and remineralization of dental hard tissues. Despite scientific advances in cariology, dental caries remains a severe global concern. The aim of this study was to determine the optimization of microbial and molecular techniques for the detection of cariogenic pathogens in dental caries patients, the prevalence of cariogenic bacteria on the basis of socioeconomic, climatological, and hygienic factors, and in vitro evaluation of the antimicrobial activity of selected synthetic antibiotics and herbal extracts. In this study, oral samples were collected from 900 patients for bacterial strain screening on a biochemical and molecular basis. Plant extracts, such as ginger, garlic, neem, tulsi, amla, and aloe vera, were used to check the antimicrobial activity against the isolated strains. Synthetic antimicrobial agents, such as penicillin, amoxicillin, erythromycin, clindamycin, metronidazole, doxycycline, ceftazidime, levofloxacin, and ciprofloxacin, were also used to access the antimicrobial activity. Among 900 patients, 63% were males and 37% were females, patients aged between 36 and 58 (45.7%) years were prone to disease, and the most common symptom was toothache (61%). For oral diseases, 21% used herbs, 36% used antibiotics, and 48% were self-medicated, owing to sweets consumption (60.66%) and fizzy drinks and fast food (51.56%). Staphylococcus mutans (29.11%) and Streptococcus sobrinus (28.11%) were found as the most abundant strains. Seven bacterial strains were successfully screened and predicted to be closely related to genera S. sobrinus, S. mutans, Actinomyces naeslundii, Lactobacillus acidophilus, Eubacterium nodatum, Propionibacterium acidifaciens, and Treponema Pallidum. Among plant extracts, the maximum zone of inhibition was recorded by ginger (22.36 mm) and amla (20.01 mm), while among synthetic antibiotics, ciprofloxacin and levofloxacin were most effective against all microbes. This study concluded that phyto extracts of ginger and amla were considered suitable alternatives to synthetic antibiotics to treat dental diseases.

Tooth Loss and the Incidence of Ischemic Stroke and Transient Ischemic Attack: A Systematic Review and Meta-Analysis

Generally, as the population is aging, ischemic stroke is imposing rising social and economic burdens. On that basis, the early intervention and prevention of ischemic stroke turns out to be a major public health issue. Extensive studies have reached mixed conclusions regarding the correlation between tooth loss and ischemic stroke, as well as transient ischemic attack (TIA). In this paper, a systematic review and meta-analysis is presented where we have aimed to examine whether tooth loss is correlated with a higher incidence of ischemic stroke and TIA in adults. The systematical search was conducted in PubMed, Web of Science, Embase, and The Cochrane library from the inception dates to September 23, 2021, by employing the keywords (i.e., tooth loss and ischemic stroke). Observational studies conducted in adults were included, in which people with and without tooth loss (Exposition and Comparison) were observed to determine the incidence of ischemic stroke/TIA (Outcome). The data were extracted, and the study quality was assessed by two reviewers independently. Moreover, a meta-analysis was conducted to obtain the risk ratios (RRs) and 95% CIs by adopting random-effects models. The major outcome was the incidence of ischemic stroke/TIA in adults with and without tooth loss. On the whole, four cohort studies and three case-control studies were covered, which involved 4,625,514 participants with 33,088 ischemic stroke/TIA cases. In cohort (adjusted RR = 2.58, 95% CI: 2.39-2.79, P < 0.00001, I ² = 31%) and case-control studies (adjusted MD = -4.15, 95% CI: -6.09-(-2.22), P < 0.001, I ² = 77%), a significant correlation was identified between tooth loss and ischemic stroke. The subgroup analyses reported that the results in case-control studies were generally consistent regardless of the selection of controls. This meta-analysis indicated a certain correlation between tooth loss and ischemic stroke.

Oral inflammatory burden and carotid atherosclerosis among stroke patients

INTRODUCTION

This study aimed to test the hypothesis that oral inflammatory burden (OIB) is independently associated with the carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA).

METHODS

This cross-sectional observational study included 240 hospital patients with the diagnosis of IS or TIA. The main exposures were apical periodontitis (AP), root canal treatment (RCT), and crestal alveolar (periodontal) bone loss (BL), and the main outcome was the CAB. Exposure and outcome variables were measured through a head and neck multidetector computed tomography angiography and CAB was dichotomized in <50% and ≥50% vessel occlusion. OIB scored as a composite measure of the endodontic and periodontal disease exposure. Hospital health records provided information on socio-demographic and medical covariates. Prevalence ratios (PR) were calculated through Poisson regression models, estimating the relationship between the oral exposures and CAB, with =5%.

RESULTS

Mean age was 62.15 ± 13.1 years, with 56.7% males. Univariate analyses showed that AP≥2 (PR=1.83,95%CI=1.05-3.17) and endodontic burden (EB) (AP &/or RCT≥2) (PR=1.98,95%CI=1.13-3.47) were associated with CAB ≥50%. Multivariate models, adjusted for socio-demographic and medical covariates, revealed that pooled periodontal and endodontic parameters (OIB= BL ≥5mm & EB ≥2) was independently associated with CAB ≥50% (PR=2.47,95%CI= 1.04-5.87).

CONCLUSION

A higher OIB was independently associated with increased levels of CAB among IS or TIA hospital patients. The combination of endodontic and periodontal parameters strengthened the observed association and should be evaluated in future studies on the relationship between oral health and cardiovascular outcomes.