Stroke risks for the patient with periodontitis

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  Posted by: Dental Design      14th April 2024

As a hygienist, where does your influence on a patient’s health end? You can transform a smile, prevent excessive oral pain, improve confidence in everyday life, and as research has shown, have a wider impact on a patient’s general well-being.

The care provided at recurrent appointments, along with the reiteration of smile-saving advice, is key to helping patients pick up a dedicated oral care routine. Without it, they may succumb to gingivitis or periodontitis, amongst a host of other oral health issues.

Periodontal disease has been closely linked with systemic conditions such as diabetes and cardiovascular disease,[i] but it’s important that clinicians understand its particular association with stroke risks.

A known concern

A stroke is a life-threatening medical condition when the blood supply to part of the brain is cut off.[ii] Current knowledge amongst the public may be largely based around the Act FAST campaigns run throughout the country, most recently relaunched in 2021 following a fall in hospital admissions for stokes during the coronavirus pandemic. This drop was as significant as a 12% decline in cases between March and April 2020.[iii]

The Act FAST campaign aims to equip the general population with the ability to recognise the tell-tale signs of a stroke and call 999 in good time, before the condition deteriorates completely. It stands for Face, Arms, Speech, and Time[iv] and a 2015 randomised survey indicated 70% of participants knew of the campaign itself, and 90% knew to call emergency services when suspecting a stroke.[v]

What may not be common knowledge is the relationship between strokes and gingival disease. Research suggests there is an increased risk of the condition in patients with periodontitis, especially in ischaemic events.[vi] These are attacks on the brain caused by blood clots, which are typically a result of atherosclerosis.[vii]

The key link

The connection between oral health and stroke risk lies mostly with inflammation. Dental infections such as gingivitis and periodontitis can spread to other regions of the mouth and create an inflammatory response,[viii]as is already seen in the gingiva.[ix]

If the bacteria that makes up the biofilm of dental plaque reaches the blood stream, it may slowly effect the rest of the body, releasing a variety of inflammatory mediators.viii A widespread inflammatory condition can increase the risk of a stroke episode, with markers such as C-Reactive protein, IL-6 and lipoprotein associated phospholipase A2 identified in the literature as key indicators for increased stroke risk.vi Both C-Reactive Protein[x] and IL-6[xi] have been positively correlated with the presence of periodontitis.

Therefore, for patients that are already susceptible to plaque build-up in the arteries, the inflammation from periodontal disease could be enough to provoke an ischaemic stroke. Patients with increased risk of atherosclerosis could include smokers, those with high cholesterol and high blood pressure, as well as those over the age of 65.[xii]

However, once a patient has already suffered a stroke, the presence of periodontitis could serve to worsen the condition. The penumbra tissue that surrounds an infarcted area is also damaged without neurological communication, but it is salvageable.[xiii] It is predisposed to a greater chance of secondary cell death if it undergoes oxidative stress, reperfusion of tissue or microglial activity. Unfortunately, these can be triggered by systemic inflammation which, again, may present because of a periodontal infection.vi

Minimising risks

Preventative actions for stroke risks generally include encouraging patients to limit salt in a well-balanced diet, undertaking regular exercise and smoking cessation.[xiv] It’s particularly important to reiterate to those most at risk the importance of looking after their oral health to prevent excessive inflammation.

An effective oral hygiene routine could be the simplest way to do this. This includes brushing twice a day to remove food and plaque trapped at the gumline, with either a manual or power tooth brush, as well as dedicated cleaning for interdental spaces.[xv]

As a dental professional, you are in the best possible position to recommended effective solutions that fit into this routine. The simplest change could be using the 100% Natural Baking Soda Toothpaste for Gum Protection from Arm & Hammer™, an excellent option that is clinically proven to improve gingival health and remove more plaque than non-baking soda toothpastes. The specialised formula contains 1450 ppm of fluoride to maximise protection for your patients, and its completely natural properties with 100% recyclable packaging makes the toothpaste a brilliantly sustainable option too.

Severe health issues such as strokes are difficult to predict, but the help of a dental professional could go far to minimising the risk of a severe incident. With healthier gums thanks to their clinician, patients could go on to live longer and happier lives.

 

For more information about the carefully formulated Arm & Hammer™ toothpaste range, please visit https://www.armandhammer.co.uk/ or email: ukenquiries@churchdwight.com

 Arm & Hammer™ oral healthcare products can now be purchased from Boots, Amazon, Superdrug, ASDA, Sainsbury’s, Tesco, Morrison’s, Waitrose & Partners and Ocado.

Sharon Kidd

GDC – 4566Diploma in Dental Hygiene 1993Hygienist 

Sharon qualified as a dental nurse in The Royal London Dental Hospital in 1988. She trained as a dental hygienist in the Royal Army Dental Corps in 1993. 

Sharon has experience working as a hygienist in a variety of different settings including dental hospital, domiciliary home visits, military, private and general practice. She works with specialists and general dental practitioners to support patients with different needs including those who are nervous to visit the dentist. 

Sharon is also a professional educator for Waterpik, water flosser .

And enjoy family time at home with my husband two teenage daughters and family pets

[i] European Federation of Periodontology, (N.D.). Oral health and general health. (Online) Available at: https://www.efp.org/for-patients/gum-disease-general-health/oral-health-and-systemic-health/ [Accessed December 2023]

[ii] NHS, (2022). Stroke. (Online) Available at: https://www.nhs.uk/conditions/stroke/ [Accessed December 2023]

[iii] Public Health England, (2021). Relaunch of the Act FAST campaign to improve stroke outcomes. GOV.UK. (Online) Available at: https://www.gov.uk/government/news/relaunch-of-the-act-fast-campaign-to-improve-stroke-outcomes [Accessed December 2023]

[iv] NHS England, (N.D.). Act FAST. (Online) Available at: https://www.england.nhs.uk/actfast/ [Accessed December 2023]

[v] Dombrowski, S. U., White, M., Mackintosh, J. E., Gellert, P., Araujo-Soares, V., Thomson, R. G., … & Sniehotta, F. F. (2015). The stroke ‘Act FAST’campaign: Remembered but not understood?. International Journal of Stroke, 10(3), 324-330.

[vi] Fagundes, N. C. F., Almeida, A. P. C. P. S. C., Vilhena, K. F. B., Magno, M. B., Maia, L. C., & Lima, R. R. (2019). Periodontitis as a risk factor for stroke: a systematic review and meta-analysis. Vascular Health and Risk Management, 519-532.

[vii] NHS, (2022). Stroke, Causes (Online) Available at: https://www.nhs.uk/conditions/stroke/causes/ [Accessed December 2023]

[viii] Shahi, S., Farhoudi, M., Dizaj, S. M., Sharifi, S., Sadigh-Eteghad, S., Goh, K. W., … & Salatin, S. (2022). The Link between Stroke Risk and Orodental Status—A Comprehensive Review. Journal of Clinical Medicine, 11(19), 5854.

[ix] Hersh, E., Archibald, J., (2023). Gingivitis (Gum Disease) Overview. Healthline. (Online) Available at: https://www.healthline.com/health/gingivitis [Accessed December 2023]

[x] Bansal, T., Pandey, A., Deepa, D., & Asthana, A. K. (2014). C-reactive protein (CRP) and its association with periodontal disease: a brief review. Journal of clinical and diagnostic research: JCDR, 8(7), ZE21.

[xi] Noh, M. K., Jung, M., Kim, S. H., Lee, S. R., Park, K. H., Kim, D. H., … & Park, Y. G. (2013). Assessment of IL‑6, IL‑8 and TNF‑αlevels in the gingival tissue of patients with periodontitis. Experimental and therapeutic medicine, 6(3), 847-851.

[xii] NHS, (2023). Atherosclerosis. (Online) Available at: https://www.nhs.uk/conditions/atherosclerosis/ [Accessed December 2023]

[xiii] Liu, S., Levine, S. R., & Winn, H. R. (2010). Targeting ischemic penumbra: part I-from pathophysiology to therapeutic strategy. Journal of experimental stroke & translational medicine, 3(1), 47.

[xiv] NHS, (2022). Stroke, Prevention. (Online) Available at: https://www.nhs.uk/conditions/stroke/prevention/ [Accessed December 2023]

[xv] Chapple, I. L., Van der Weijden, F., Doerfer, C., Herrera, D., Shapira, L., Polak, D., … & Graziani, F. (2015). Primary prevention of periodontitis: managing gingivitis. Journal of clinical periodontology, 42, S71-S76.

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