Dental Caries Associated with Incident Ischemic Stroke: Atherosclerosis Risk In Communities Study
Souvik Sen1, James Curtis2, David Hicklin2, Cynthia Nichols2, Wayne Rosamond3, Rebecca Gottesman4, Kevin Moss3, Kimon Divaris3, James Beck3, Steven Offenbacher3
1USC Neurology, Prisma Health USC, 2Prisma Health USC, 3UNC, 4Johns Hopkins University
Objective:

We assessed the hypothesis that dental caries is associated with ischemic stroke and specific ischemic stroke subtypes in the Atherosclerosis Risk In Communities (ARIC) study.


Background:
Periodontal disease (PD) is an independent risk factor for ischemic stroke. Dental Caries is an infection of the teeth, characterized by de-mineralization and destruction of the teeth that is pathophysiologically distinct from PD. Limited data is available linking dental caries with ischemic stroke.
Design/Methods:
Full-mouth clinical examination was performed to assess presence of dental caries in 6326 subjects from the dental cohort of the ARIC study without prior stroke. Additional risk factors such as age, gender, race, smoking status, diabetes, socioeconomic status, and PD status. All stroke diagnoses were based on computer-derived diagnosis and physician medical record review, with differences adjudicated by a second physician reviewer. Strokes were further classified according to etiologic subtype as thrombotic, lacunar and cardioembolic stroke.
Results:
At the fourth ARIC study visit, 18% (1146) of the 6326 participants had evidence of coronal dental caries. A total of 393 ischemic strokes occurred from 1996-98 to 2016, of which 52% (153) were thrombotic, 20% (80) were cardioembolic, and 17% (67) were lacunar stroke. Participants with ≥1 coronal dental caries (HR 1.9 95% CI 1.5-2.4) had an increased risk of incident ischemic stroke, compared with participants without dental caries. The association remained significant (HR 1.4 95% CI 1.1-1.8) after adjustment for Age, Race, Gender, BMI, Diabetes, Smoking status, education (3-levels) and presence of PD. There remained an independent association (HR 2.2 95% CI 1.3-3.6) with cardioembolic, but not with thrombotic or lacunar stroke.
Conclusions:
Results from this prospective cohort demonstrate an independent association between dental caries and ischemic stroke. The association was independent of PD. Further, we report a stronger and independent association with the cardioembolic stroke subtype.