The role of a previous febrile infection, mostly bacterial infections of the respiratory tract, was also demonstrated by the Finnish doctors (Syrjanen et al. 1989) as a risk factor for ischemic brain infarction or stroke. Subsequently in a subset of the same subjects, dental infections, primarily periodontal disease, could also be associated with a cerebral vascular accident (CVA). The linking of dental infections with a CVA is novel, as previously the only connection had been the indirect one in which dental infections, and treatment of such, had been associated with bacterial endocarditis, and patients with endocarditis have a 20% chance of developing a CVA during the course of their illness. In a 1997 case-control study in which dental, respiratory and ear, nose and throat infections were evaluated in age-adjusted multiple logistic regression analysis, poor dental status was independently associated with cerebral vascular ischemia.

This finding that dental disease was associated with CVA, after adjusting for other chronic infections, lends credence to other studies in which the effect of chronic infections were not accounted for. In a prospective study of United States veterans participating in a longitudinal aging study, the presence of alveolar bone loss about the teeth was associated with the subsequent diagnosis of a stroke. Individuals with a “high” bone loss were 2.8 times more likely to develop a stroke than individuals with a “low” bone loss, even when such known risk factors for stroke such as age, smoking, non-insulin dependent diabetes, elevated diastolic blood pressure, family history of stroke and education were included in the multivariate analysis.

We have been recording a large number of oral/dental variables in a group of elderly veterans, so as to study the relationship between oral/dental health and systemic diseases among older individuals.16,17  We report here information obtained from a cross-sectional study of 401 veterans, who were at least 60 years of age, that shows that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. Among these certain oral hygiene parameters such as, “needing help in brushing one’s teeth” and the reported annual visit to the dentist/hygienist for a tooth cleaning were significant in the multivariate models involving the dependent-living subjects. The need for help in brushing one’s teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, to find in the dependent-living dentate subjects, that those individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended, as the data were obtained from a convenience sampling of older veterans and may not be generalized to other populations.   

Dental Infections and CRP

         Many medical/laboratory studies have implicated lipopolysaccharide (LPS) as a potent stimulator of  CRP in animals and in tissue cultures. LPS is a component of the surface of gram negative bacteria, many types of which live on our body surfaces. While  most of the attention with gram negative bacteria has been on those like E. coli,and  H. pylori that live in the intestinal tract, there are many species of gram negative bacteria that live in the oral cavity. These bacteria increase in periodontal disease, and increased serum antibody levels to organisms such as P. gingivalis , T. denticola and T. forsythensis  are found in patients with cardio-vascular disease. DNA from these bacteria have also been found in atheromas removed by surgical procedures. Several studies have shown that CRP levels are significantly elevated in heart patients with periodontal disease as compared to heart patients without periodontal disease.  Two studies have shown that periodontal treatment consisting of mechanical cleaning of the teeth will reduce CRP levels. More impressively, at the 2005  IADR meeting, there was a preliminary report that the use of statins in cardiovascular patients not only reduced serum cholesterol and CRP levels, but actually reduced the depths of the patients' periodontal pockets!

            These studies suggest that it is the LPS and other products produced by oral bacteria such as the BANA positive species that may be contributing to the elevated CRP levels in patients with cardio-vascular disease. If so, then this link between dental disease and cardio-vascular disease is  important because dental health can be improved or modified. If individuals with poor dental health can be identified early, it is possible that by instituting  good dental health this might reduce or delay a subsequent onset of heart disease. Also if a person has a stroke or a heart attack ,it is possible that by promptly treating any dental problems such as decay or periodontal disease, a second attack could be delayed or prevented. These are exciting new possibilities, but need to be substantiated  using the appropriate scientific criteria.

 

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