Like many other systemic health conditions, strokes are directly connected to poor oral health. For example, one indication of poor oral health is the presence of bacteria and plaque that causes periodontal disease, also called gum disease. The effects of having active and untreated gum disease lead to a higher risk of stroke.
MOUTH BODY CONNECTION
Poor Oral Health And Its Connection To Strokes
In This Article
The connection between tooth infection and the brain is part of an area of oral health we call the Mouth-Body Connection®. The Mouth-Body Connection explains how oral cavity diseases, like periodontal disease, affect the whole body. To put it another way, gum disease and the bacteria that cause it have adverse effects on the rest of your body.
For decades, science has collected evidence about the link between oral health and overall health. In 2000, the US Surgeon General acknowledged the correlation between periodontal disease and various systemic conditions, such as cardiovascular health, diabetes, adverse pregnancy outcomes, and strokes. [1]
Subsequent research has consistently reinforced this connection, including the one between arterial stroke and oral health. Per the American Dental Association (ADA), scientists propose a couple of potential explanations, which include:[2]
Chronic inflammation within the oral cavity may release inflammatory markers into the bloodstream, impacting the patient's immune response or exacerbating their overall "burden of disease."
Pathogenic bacteria in the oral cavity can enter the bloodstream and potentially affect other body areas or contribute to systemic pathologies.
Curious to know more about the Mouth-Body Connection? Come read more about Periodontal Disease and its effects on your overall health
What Is the Link Between Oral Health and Stroke?
Gum disease's connection to strokes has been known for around 20 years. The link lies in the shared presence of inflammation and the subsequent arterial hardening, also observed in heart disease.
When the oral bacteria causing gum disease enter your bloodstream, they travel. These bacteria can cause C-reactive protein levels to increase, which indicates the blood vessels are inflamed. [3] Inflammation of the blood vessels leads to blood clots, which can block the blood flow to the brain and increase the risk of heart disease and stroke. [4]
The arterial hardening is associated with a specific type of stroke. A 2004 German research study revealed that individuals — particularly men and people under 60 — with severe periodontitis and gum disease had an increased risk of experiencing an ischemic stroke, which occurs when a blood vessel supplying the brain becomes blocked. [5]
A 2012 study out of Greece confirmed this research regarding gum disease and stroke. Researchers at the Attikon University Hospital in Athens also suggest that patients with periodontitis have a higher risk of stroke. [6]
Later, at the American Stroke Association conference in Dallas, TX, in early 2020, presenters addressed two studies that indicated treating gum disease can prevent artery blockage and reduce stroke risk. The research also revealed that patients with gum disease were twice as likely as those without to have a stroke caused by hardening of the arteries in the brain. Gingivitis, which is an early form of gum disease, was linked to a higher risk of arteries in the brain with severe blocks, and many hadn't had any symptoms yet. [7]
Moreover, ischemic strokes are the more common type. Per the CDC, 85% of patients who have strokes have ischemic ones. [8]
Earlier this year, the American Stroke Association International presented further connections between oral health and stroke. Research from a comprehensive study conducted from 2014 to 2021 involving around 40,000 adults from the UK Biobank, with an average age of 57 and no history of stroke discovered: [9]
- Individuals genetically disposed to cavities, missing teeth, or needing dentures were more likely to have silent cerebrovascular disease, evident through a 24% increase in white matter hyperintensities visible on MRI images.
- People who are more likely because of heredity to have poor oral health showed more damage to the “fine architecture of the brain” and had a 43% variance in microstructural damage scores visible on MRI scans. [10]
Cyprien Rivier, MD, MS, a researcher involved in the study, said while it looks like poor oral health causes declines in brain health, they needed to confirm whether improving oral health can benefit brain health with more studies. Dr. Rivier also emphasized the importance of maintaining good oral hygiene because there are implications “far beyond the mouth.” [11]
Having a Stroke Increases Inflammation and Contributes to Gum Disease
Medical researchers learned that after a patient has a stroke, the injured brain signals activate an inflammatory response throughout the body. This response starts elements of the body's healing process and defense cells by increasing blood supply to the area[12] and protecting the body from other damaging events by activating the healing process. [13] Some researchers believe that long after this response has done that job, this inflammation can linger and become chronic, leading to cognitive decline. [14]
However, while these inflammatory responses protect the body in some ways, they also reduce the patients' immunity to bacterial infection. This response leaves stroke patients more susceptible to secondary complications, such as infections or cardiovascular pathologies. Researchers suggest addressing inflammation after stroke can improve patient outcomes. [15]
In addition to the body's inflammatory reaction to the stroke, the effects of the stroke on brain health can also inhibit patients from addressing their oral health. Whether from cognitive decline or physical disabilities, patients not keeping their teeth and oral cavity clean increase the risk of gum disease progression. However, consistent home care and regular visits to the dentist are essential parts of treating gums and teeth after a stroke.
Learn more about inflammation and its overall effects on the body!
Preventing Gum Disease Can Lower Your Risk of a Stroke
With such a clear connection between the effects of oral health on your brain health, experts agree that by preventing gum disease, you can effectively reduce the risk of certain types of strokes. Therefore, preventing gum disease and arterial issues before they occur is an excellent strategy to reduce the risk of ischemic stroke.
However, many adults already have gum disease. That's because gum disease is a common occurrence among a significant number of adult patients. Per the Centers for Disease Control and Prevention (CDC) study "Prevalence of Periodontitis in Adults in the United States: 2009 and 2010," approximately 65 million individuals are affected by periodontal disease. Additionally, the CDC estimates that 47% of adults aged 30 and above have this condition, while a staggering 70% of adults over the age of 65 are affected by it. [16]
Gum disease is a bacterial infection that affects the soft tissue surrounding your teeth. If left untreated, it can result in gum deterioration and various symptoms, such as swollen, red gums that bleed during brushing or flossing. Gum disease initially presents as gingivitis, but it progresses into periodontitis without proper treatment. This advanced stage leads to gum tissue loss (called gum recession), bone loss, and, ultimately, tooth loss. [17]
If you are part of a group that already has gum disease, don't panic. Your dental team can help you improve your gum health before it gets to the tooth-loss stage:
- Scaling and Root Planing: This deep cleaning treatment helps clear out the bacteria and plaque below the gum line and makes it harder for them to assemble there.
- Antibiotics: In some cases, your dentist might also use a topical antibiotic to eliminate the bacteria there.
- Gum Recession Treatment: Dentists also have ways to address gum tissue loss to protect the roots from decay or to surgically graft tissue from other parts of your mouth to cover roots and protect your teeth.
However, it is also essential to maintain a consistent and thorough oral hygiene home care routine to keep your gums healthy. Brushing your teeth twice daily for at least two minutes with fluoride toothpaste is a great start. Also, flossing at least once daily is vital to clear out bacteria and food particles hiding where the toothbrush doesn't reach. Furthermore, cleaning your tongue and rinsing the mouth with either water or mouthwash after cleaning your teeth is essential. Moreover, avoiding sugary drinks and snacks is necessary to keep your teeth healthy, and if you can't avoid them, ensure that you clean your teeth after consuming them. [18]
In addition to a renewed vigor for your home care, visiting your dental team regularly to have your teeth cleaned and your gum health assessed is essential. Once every six months is what many people do, but there are some cases where your dental team would like to see you more often.
These visits also present an opportunity to get more information. If you have concerns about your oral health or whether you have a higher risk for stroke, talk to your dentist during the appointment. They can assess your risk and devise a plan to keep your mouth as healthy as possible and any related oral health risks for a stroke to a minimum.
So, it is clear that your oral health is connected to your overall health. It is also apparent that the pathogens that cause gum disease and inflammation travel throughout the body, affecting other distant-site diseases or systemic conditions and can increase your risk for stroke. However, we believe that through our understanding of the Mouth-Body Connection, our experienced clinicians can help you maintain your best oral health and eliminate some of the risks of developing these conditions.
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Do you want to know more about the Mouth-Body Connection? Our Smile Generation team can help with answers and provide care and advice on what you need for optimal oral healthcare.
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Sources
[1] US Department of Health and Human Services. Oral Health in America: A Report of the Surgeon General. Rockville, MD: US Department of Health and Human Services, National Institute of Dental and Craniofacial Research, National Institutes of Health, 2000. (Accessed: 10 May 2023).
[2] Ada.org. 2019. Oral Systemic Health. [online] Available at: <https://www.ada.org/resources/research/science-and-research-institute/oral-health-topics/oral-systemic-health> [Accessed 10 May 2023].
[3] The Connection Between Oral Health And Strokes | Colgate® (2023). Available at: https://www.colgate.com/en-us/oral-health/threats-to-dental-health/the-connection-between-oral-health-and-strokes# (Accessed: 9 May 2023).
[4] The Link Between Oral Health & Strokes | ProHealth Dental™ (2022) Available at: https://www.phdental.com/oral-health-news/2022/april/the-link-between-oral-health-strokes/ (Accessed: 9 May 2023)
[5] Grau, MD, Armin J.; Becher, Ph.D., Heiko; Christoph M. Ziegler, MD et al. "Periodontal Disease as a Risk Factor for Ischemic Stroke." Stroke (2004) 35: 496-501. Web Stroke.ahajournals.org. < http://stroke.ahajournals.org/content/35/2/496.full> (Accessed: 12 May 2023).
[6] Sfyroeras, GS; Roussas, N., Saleptsis, VG, et al. "Association between periodontal disease and stroke." J Vasc Surg. 2012 Apr;55(4):1178-84. doi: 10.1016/j.jvs.2011.10.008. Epub 2012 14 January. Web. www.ncbi.nlm.nih.gov. < http://www.ncbi.nlm.nih.gov/pubmed/22244863>. (Accessed: 12 May 2023).
[7] Gum disease, inflammation, and hardened arteries may be linked to stroke risk (2020). Available at: https://newsroom.heart.org/news/gum-disease-inflammation-hardened-arteries-may-be-linked-to-stroke-risk#:~:text=Gum%20disease%20was%20more%20common,blood%20vessels%20outside%20the%20skull. (Accessed: 10 May 2023).
[8] Types of Strokes. www.cdc.gov. Web. 4 May 2016. < https://www.cdc.gov/stroke/about.htm. The article refers to: Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics—2013 update: a report from the American Heart Association. Circulation. 2012:e2–241. (Accessed: 12 May 2023).
[9,10,11] Poor oral health may contribute to declines in brain health (2023). Available at: https://newsroom.heart.org/news/poor-oral-health-may-contribute-to-declines-in-brain-health (Accessed: 8 June 2023).
[12] Dr. Sanchari Sinha Dutta, P. (2018) Inflammation and Stroke, News-Medical.net. Available at: https://www.news-medical.net/health/Inflammation-and-Stroke.aspx (Accessed: 12 May 2023).
[13, 15] Systemic Inflammation after stroke: implications for post-stroke comorbidities. (2022) EMBO Mol Med 14: e16269. Available at: https://www.embopress.org/doi/full/10.15252/emmm.202216269 (accessed 12 May 2023)
[14] Identifying how inflammation affects stroke recovery (2022). Available at: https://www.uc.edu/news/articles/2022/10/identifying-how-inflammation-affects-stroke-recovery.html (Accessed: 12 May 2023).
[16] Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of Periodontitis in Adults in the United States: 2009 and 2010. Journal of Dental Research. 2012;91(10):914-920. doi:10.1177/0022034512457373 (Accessed: 12 May 2023).
[17] Gum Disease Information - American Academy of Periodontology (2023). Available at: https://www.perio.org/for-patients/gum-disease-information/ (Accessed: 10 May 2023).
[18] Looking after your mouth and teeth (oral hygiene). Stoke Association. Available at: https://www.stroke.org.uk/effects-of-stroke/looking-after-your-mouth-and-teeth-oral-hygiene#:~:text=Tips%20for%20good%20oral%20hygiene,your%20teeth%2C%20tongue%20and%20mouth. (accessed: 12 May 2022).
Smile Generation blog articles are reviewed by a licensed dental professional before publishing. However, we present this information for educational purposes only with the intent to promote readers’ understanding of oral health and oral healthcare treatment options and technology. We do not intend for our blog content to substitute for professional dental care and clinical advice, diagnosis, or treatment planning provided by a licensed dental professional. Smile Generation always recommends seeking the advice of a dentist, physician, or other licensed healthcare professional for a dental or medical condition or treatment.
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