Association between Ischemic Stroke and Periodontitis in Thai Adults

Objective:  The association between periodontal inflammation and stroke is still controversial and limited to evidence from Western countries. The aim of this study was to investigate whether periodontitis was associated with ischemic stroke among Thai adults. Methods: A 1:2 matched case-control study was conducted on 96 acute ischemic stroke cases. These cases were individuals aged 45 years or older who were first hospitalized at the stroke unit of Srinagarind Hospital, Khon Kaen. Medical specialists diagnosed stroke by using brain imaging from magnetic resonance imaging and/or computerized tomography. There were 2 groups of controls, the first group consisted of community-dwelling people and the second group was hospital controls with nonvascular and noninflammatory neurological diseases with age- and sex-matched to cases. Before clinical examinations, each individual was interviewed using a standardized questionnaire to assess potential confounders. A calibrated dentist recorded clinical attachment level (CAL), using a periodontal probe right after stroke attack. All subjects were assessed for other systemic diseases, and other cardiovascular risk factors which were generally recorded in patients’ medical records. Conditional logistic regression analysis was used to evaluate the association between periodontitis and ischemic stroke while controlling for possible confounders. Subgroup analyses according to age groups were also performed. Results: Ischemic stroke was strongly associated with periodontitis (tertiary percentage of CAL ≥5 mm) mm with five times higher odds ratio for cerebral ischemia (OR, 5.88; 95% confidence interval, 2.33 to 14.83) after controlling for all possible confounders. The association also had a dose-response effect (P for trend <0.001 by Chi-square Test). The association between periodontitis and stroke was higher among adults younger than age 60. Conclusions:  Our data suggested that periodontitis is associated with ischemic stroke, and its impact seems to be greater among younger Thai adults.