Oral Inflammatory Burden and Carotid Atherosclerosis Among Stroke Patients

Thayana S S Leão; Gustavo H Tomasi; Lucas P Conzatti; Luiz C P Marrone; Mark A Reynolds; Maximiliano S Gomes

doi:10.1016/j.joen.2022.01.019

Oral Inflammatory Burden and Carotid Atherosclerosis Among Stroke Patients

J Endod. 2022 May;48(5):597-605. doi: 10.1016/j.joen.2022.01.019. Epub 2022 Feb 7.

Authors

Thayana S S Leão¹, Gustavo H Tomasi², Lucas P Conzatti², Luiz C P Marrone², Mark A Reynolds³, Maximiliano S Gomes⁴

Affiliations

¹ Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland. Electronic address: thayana.leao@pucrs.br.
² Department of Neurology, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
³ Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, Maryland.
⁴ Graduate Program in Dentistry, School of Health and Life Sciences, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.

PMID: 35143813
DOI: 10.1016/j.joen.2022.01.019

Abstract

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 sociodemographic and medical covariates. Prevalence ratios (PRs) 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% men. Univariate analyses showed that AP ≥2 (PR = 1.83; 95% confidence interval [CI], 1.05-3.17) and endodontic burden (EB) (AP and/or RCT ≥ 2) (PR = 1.98; 95% CI, 1.13-3.47) were associated with CAB ≥50%. Multivariate models, adjusted for sociodemographic and medical covariates, revealed that pooled periodontal and endodontic parameters (OIB = BL ≥ 5 mm and EB ≥ 2) were 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 hospital patients with IS or TIA. 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.

Keywords: Apical periodontitis; alveolar bone loss; cardiovascular disease; periodontal disease; risk factor.

Publication types

Observational Study

MeSH terms

Aged
Atherosclerosis* / complications
Carotid Artery Diseases* / complications
Female
Humans
Ischemic Attack, Transient* / complications
Ischemic Attack, Transient* / epidemiology
Male
Middle Aged
Periapical Periodontitis* / therapy
Risk Factors
Root Canal Therapy
Stroke* / complications