title: Periodontal disease, tooth loss, and incidence of ischemic stroke.
abstract: OBJECTIVE
  Periodontal and other infections have been suggested as potential risk factors for stroke. This study evaluates periodontal disease and tooth loss as risk factors for ischemic stroke.
  
  
  METHODS
  The study population consisted of 41 380 men who were free of cardiovascular disease and diabetes at baseline. Periodontal disease history was assessed by mailed validated questionnaires. During 12 years of follow-up, stroke incidence was assessed and subclassified by use of medical history, medical records, and imaging reports. Hazard ratios (HRs) were adjusted for age, amount smoked, obesity, alcohol, exercise, family history of cardiovascular disease, multivitamin use, vitamin E use, profession, baseline reported hypertension, and hypercholesterolemia. Sex and socioeconomic status were inherently controlled for by restriction. Confounding variables were updated in the analyses for each 2-year follow-up interval.
  
  
  RESULTS
  We documented 349 ischemic stroke cases during the follow-up period. Men who had < or =24 teeth at baseline were at a higher risk of stroke compared to men with > or =25 teeth (HR=1.57; 95% CI, 1.24 to 1.98). There was little evidence of an increased risk with recent tooth loss during follow-up. A modest association was seen between baseline periodontal disease history and ischemic stroke (HR=1.33; 95% CI, 1.03 to 1.70). Addition of dietary factors to the model changed the HR only slightly.
  
  
  CONCLUSIONS
  Our results suggest that periodontal disease and fewer teeth may be associated with increased risk of ischemic stroke.
authors.affiliation: Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Boston, Mass 02115, USA. Kaumudi_Joshipura@hsdm.harvard.edu
authors.forename: Kaumudi J
authors.initials: KJ
authors.lastname: Joshipura
authors.forename: Hsin-Chia
authors.initials: HC
authors.lastname: Hung
authors.forename: Eric B
authors.initials: EB
authors.lastname: Rimm
authors.forename: Walter C
authors.initials: WC
authors.lastname: Willett
authors.forename: Alberto
authors.initials: A
authors.lastname: Ascherio
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010510:Periodontal Diseases / Q000150:complications*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D016388:Tooth Loss / Q000150:complications*