title: Periodontal disease as a risk factor for ischemic stroke.
abstract: OBJECTIVE
  Chronic infectious diseases may increase the risk of stroke. We investigated whether periodontal disease, including periodontitis and gingivitis, is a risk factor for cerebral ischemia.
  
  
  METHODS
  We performed a case-control study with 303 patients examined within 7 days after acute ischemic stroke or transient ischemic attack, 300 population controls, and 168 hospital controls with nonvascular and noninflammatory neurological diseases. All subjects received a complete clinical and radiographic dental examination. The individual mean clinical attachment loss measured at 4 sites per tooth served as the main indicator for periodontitis.
  
  
  RESULTS
  Patients had higher clinical attachment loss than population (P<0.001) and hospital (P=0.010) controls. After adjustment for age, sex, number of teeth, vascular risk factors and diseases, childhood and adult socioeconomic conditions, and lifestyle factors, the risk of cerebral ischemia increased with more severe periodontitis. Subjects with severe periodontitis (mean clinical attachment loss >6 mm) had a 4.3-times-higher (95% confidence interval, 1.85 to 10.2) risk of cerebral ischemia than subjects with mild or without periodontitis (<or=3 mm). Severe periodontitis was a risk factor in men but not women and in younger (<60 years) but not older subjects. Periodontitis increased the risk of cerebral ischemia caused by large-artery atherosclerosis, cardioembolism, and cryptogenic etiology. Gingivitis and severe radiologic bone loss were also independently associated with the risk of cerebral ischemia, whereas caries was not.
  
  
  CONCLUSIONS
  Our study indicates that periodontal disease, a treatable condition, is an independent risk factor for cerebral ischemia in men and younger subjects.
authors.affiliation: Department of Neurology, University of Heidelberg, Heidelberg, Germany. graua@klilu.de
authors.forename: Armin J
authors.initials: AJ
authors.lastname: Grau
authors.forename: Heiko
authors.initials: H
authors.lastname: Becher
authors.forename: Christoph M
authors.initials: CM
authors.lastname: Ziegler
authors.forename: Christoph
authors.initials: C
authors.lastname: Lichy
authors.forename: Florian
authors.initials: F
authors.lastname: Buggle
authors.forename: Claudia
authors.initials: C
authors.lastname: Kaiser
authors.forename: Rainer
authors.initials: R
authors.lastname: Lutz
authors.forename: Stefan
authors.initials: S
authors.lastname: Bültmann
authors.forename: Michael
authors.initials: M
authors.lastname: Preusch
authors.forename: Christof E
authors.initials: CE
authors.lastname: Dörfer
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D016301:Alveolar Bone Loss / Q000000981:diagnostic imaging / Q000453:epidemiology; D002545:Brain Ischemia / Q000453:epidemiology*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D005891:Gingivitis / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D017622:Periodontal Attachment Loss / Q000000981:diagnostic imaging / Q000453:epidemiology; D010510:Periodontal Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D020521:Stroke / Q000453:epidemiology*