Count your teeth to know risk of stroke

Saturday, December 14, 2002

Tooth loss and periodontal disease may increase the risk of ischemic stroke, which is caused due to a blockage in an artery leading to the brain. This is a most common type of stroke, according to a new study.

Men who had fewer than 25 teeth when they entered the study had a 57 percent higher risk of ischemic stroke than those with 25 or more teeth. The link between ischemic stroke and periodontal disease, which is caused by bacterial infections, adds another piece to the growing body of evidence that infection plays a role in stroke and heart disease.

However, the new study presents a surprising finding about tooth loss. "The association of ischemic stroke with tooth loss persisted even after we controlled for periodontal disease history, which could reflect severe periodontal disease in the extracted teeth", said Kaumudi J Joshipura, an associate professor of epidemiology at Harvard School of Dental Medicine and Harvard School of Public Health in Boston.

Another unexpected - and unexplained - finding was that the association between tooth loss and stroke risk was higher among non-smokers than smokers. Smoking tobacco is a risk factor for both ischemic stroke and periodontal disease. The researchers also found that the risk of stroke was mainly related to the number of missing teeth at entry into the study, rather than teeth lost recently during the follow-up phase.

"This is possibly because only a few teeth were lost during follow-up or may imply that tooth loss takes many years to impact ischemic stroke risk", Joshipura noted. This study is the first to examine the timing of tooth loss and the effect on stroke risk.

Periodontal disease, tooth loss and ischemic stroke share about a dozen risk factors, including age, smoking, diabetes and some socio-economic factors such as low income. Researchers studied 41,380 men, aged between 40 to 75 at the start of the 12-year study.

The men completed questionnaires mailed to them every two years about their medical history, health behaviours and the occurrence of cardiovascular problems or other adverse health events. Participants with fewer teeth were generally older, drank more alcohol, were less physically active and were more likely to smoke.

Researchers documented 349 ischemic strokes in the entire group. Compared to men with 25 to 32 teeth, those with 17 to 24 teeth had a 50 percent higher risk of stroke. Men with 11 to 16 teeth had a 74 percent higher risk and men with 10 or fewer teeth had a 76 percent higher risk of stroke compared to men with the most teeth.

Researchers studied whether the association between tooth loss and ischemic stroke could partly be the differences in diet, such as the amount of fruits and vegetables consumed. "When people loose teeth, they may eat fewer fruits and vegetables. And that, in turn, might affect their stroke risk. However, the results suggested that dietary factors evaluated did not seem to play an important role in the association between tooth loss and stroke found in this study", Joshipura added.