Tooth Infections: Stroke Risk And Prevention

Oral health is often overlooked, but it can have serious implications for overall health. Research has found that bacteria commonly found in the mouth can cause infections if they enter the bloodstream, which can lead to cardiovascular issues and even strokes. Tooth loss and periodontal disease have been linked to an increased risk of ischemic stroke, which is caused by a blockage in an artery leading to the brain. Gum disease has also been found to double the risk of stroke. These findings highlight the importance of regular dental check-ups and maintaining good oral hygiene to reduce the risk of potential health complications.

Gum disease and tooth loss

Gum disease, also known as periodontal disease, is an infection of the tissues that hold your teeth in place. It is typically caused by poor oral hygiene, which allows bacteria to build up and form a sticky film called plaque on the teeth. If left untreated, gum disease can lead to swelling, redness, pain, and eventually tooth loss.

The early stage of gum disease is called gingivitis, which is characterised by swollen, red, and bleeding gums. If gingivitis is not treated, it can progress to periodontitis, where the inner layer of the gum and bone pull away from the teeth and form pockets that can become infected. As the disease worsens, these pockets deepen, and more gum tissue and bone are destroyed, causing teeth to become loose and eventually fall out.

According to the Centers for Disease Control and Prevention, about 47% of adults aged 30 and older have some form of periodontal disease, with about 9% having severe gum disease. Gum disease is the leading cause of tooth loss in adults.

Tooth loss has been linked to an increased risk of ischemic stroke, according to a report by the American Heart Association. Ischemic strokes are the most common type of stroke and are caused by a blockage in an artery leading to the brain. In the study, men who had fewer than 25 teeth had a significantly higher risk of ischemic stroke than those with 25 or more teeth. The link between tooth loss and ischemic stroke persisted even after controlling for periodontal disease history, indicating that severe periodontal disease in the extracted teeth may be a contributing factor.

The researchers also found that the association between tooth loss and stroke risk was higher among nonsmokers than smokers, which supports the argument that the link is not solely due to smoking. However, it is important to note that the study did not establish a causal relationship between tooth loss and stroke, and further research is needed to confirm these findings.

Oral bacteria and blood clots

Oral bacteria are a normal component of the mouth. However, if oral bacteria enter the bloodstream, they can cause blood clots and lead to endocarditis, a life-threatening disease. Endocarditis is an infection of the lining, valves, or muscles of the heart.

Research by the Royal College of Surgeons in Ireland (RCSI) and the University of Bristol has discovered that Streptococcus gordonii, a common oral bacteria, can produce a molecule that mimics fibrinogen, a human blood-clotting factor. This activation of platelets causes them to cluster inside blood vessels, forming blood clots. These clots can then encompass the bacteria, protecting them from the immune system and antibiotics.

The study found that 84% of participants who had suffered an ischemic stroke had bacterial DNA in their blood clots. Of these, 59 had a strain of streptococci commonly found in the mouth, known as viridans streptococci, which can cause infections if they enter the bloodstream.

Good oral hygiene is essential to keeping these bacteria in check. This includes brushing twice a day for two minutes each session, reaching the gum line; flossing after brushing to remove debris that can form bacteria between teeth; using mouthwash, preferably alcohol-free, at bedtime; and cleaning the tongue at least once a day after brushing.

By maintaining proper oral hygiene, you can help reduce the risk of oral bacteria entering the bloodstream and potentially causing blood clots or other serious health issues.

Cardiovascular disease

While a tooth infection may not be a direct cause of cardiovascular disease, there is a link between oral health and cardiovascular issues.

Poor oral health, including gum disease, causes bacteria to grow in the mouth. These bacteria can enter the bloodstream and travel to other parts of the body, including the heart and brain. Oral bacteria have been linked to dangerous conditions affecting cardiovascular and brain health.

The common denominator for all the risk factors for cardiovascular disease is chronic inflammation of the arteries. It is understood that heart attacks and strokes are triggered when a diseased, plaque-filled artery becomes so inflamed that the vessel wall is breached, leading to the creation of a clot that obstructs blood flow to the heart or brain.

Dental infections have been proven to be caused by specific bacterial pathogens. Five of these pathogens have now been demonstrated to also cause heart attacks and strokes by creating inflammation within the arteries. Research has shown that people with poor oral health have higher rates of cardiovascular problems such as heart attacks and strokes than people with good oral health.

Tooth loss and periodontal disease may also increase the risk of ischemic stroke. Men who had fewer than 25 teeth when they entered a study had a 57% higher risk of ischemic stroke than those with 25 or more teeth.

Atherosclerosis

Males and people with a family history of premature cardiovascular disease have an increased risk of atherosclerosis. Other risk factors include high blood pressure, high blood cholesterol and triglycerides, cigarette smoking, exposure to tobacco smoke, unhealthy eating habits, and older age.

Cerebral small vessel disease

The exact pathophysiological mechanisms of CSVD are not yet fully understood, but it is believed to result from reduced cerebral blood flow, impaired cerebral autoregulation, and increased blood-brain barrier permeability. CSVD can be caused by various factors, including arteriolosclerosis, cerebral amyloid angiopathy, genetic small vessel angiopathy, inflammation, immune-mediated small vessel diseases, and venous collagenosis.

The clinical manifestations of CSVD vary depending on the specific cause and the affected brain regions. Common symptoms include stroke, cognitive decline, dementia, gait disorders, and psychiatric disorders. Diagnosis of CSVD is typically done using neuroimaging techniques, such as MRI scans, which can reveal evidence of bleeding, damage to white matter, and small strokes.

There is currently no cure or specific preventive measures for CSVD. Treatment focuses on managing risk factors and delaying complications such as stroke and dementia. This includes medications to reduce cholesterol, regulate glucose levels, and lower blood pressure, as well as lifestyle changes such as regular exercise, a healthy diet, and quitting smoking.

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