The relationship between oral conditions and ischemic stroke and peripheral vascular disease.
BACKGROUND
This article is a critical review of the epidemiologic studies linking or disassociating oral conditions with stroke and peripheral vascular disease, or PVD. It also describes possible causal and non-causal pathways for these associations.


METHODS
The author reviewed studies that evaluated the oral conditions of periodontal disease or tooth loss as risk factors for arterial disease and stroke.


RESULTS
Seven of nine studies evaluating tooth loss and periodontal disease as risk factors for stroke or PVD showed some significant associations. The studies varied in the exposures and outcomes evaluated; therefore, the associations were not consistently replicated. It is unclear whether the associations found between these oral conditions and cardiovascular disease had any causal component. In the absence of any causal relationship, the associations may be explained by common risk factors. Alternatively, there may be a causal relationship that may be explained by one or more potential causal pathways. Further epidemiologic studies are needed, and the role of nutrition and other inflammatory mediators needs to be explored further in this context.


CONCLUSIONS
It is recommended that clinicians continue to provide standard professional care, as well as nutritional counseling to help patients maintain a healthy diet after extractions. Clinicians are cautioned against suggesting extractions as a means of preventing cardiovascular disease.
Joshipura
Kaumudi
K
Harvard School of Dental Medicine, Department of Oral Health Policy and Epidemiology, 188 Longwood Ave., Boston, Mass. 02115, USA. kjoshipura@hms.harvard.edu
D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D009748:Nutrition Disorders / Q000209:etiology; D010510:Periodontal Diseases / Q000150:complications*; D016491:Peripheral Vascular Diseases / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000150:complications*; D014081:Tooth Extraction; D016388:Tooth Loss / Q000150:complications
D018836:Inflammation Mediators