Chronic Periodontal Disease Quadruples Risk of Lacunar Stroke Interview with:

Dr. Yago Leira, DDS Pre-Doc researcher at Health Research Institute of Santiago de Compostela (Spain) and Department of Periodontology, Faculty of Medicine and Dentistry University of Santiago de Compostela (Spain)

Dr. Yago Leira

Dr. Yago Leira, DDS
Pre-Doc researcher at Health Research Institute of Santiago de Compostela (Spain) and Department of Periodontology, Faculty of Medicine and Dentistry
University of Santiago de Compostela (Spain) What is the background for this study?

Response: Periodontal disease is a chronic oral inflammatory disease caused by bacterial infection, which affects 20% to 50% of the adult population. Lacunar stroke, a type of cerebral small vessel disease, is responsible for almost 25% of the ischaemic strokes. It may be hypothesized that chronic periodontitis leads to a low-grade state of systemic inflammation altering endothelial function and blood vessels health, which could be related to the onset of atherosclerosis. Moreover, lacunar stroke could be linked with an inflammation process that can be associated with endothelial dysfunction.

In the last decade, several observational studies have suggested an association between periodontal disease and ischaemic stroke. However, none of them have studied the relationship between chronic periodontitis and lacunar stroke independently of known vascular risk factors that both diseases may share (e.g., ageing, hypertension, diabetes mellitus or hypercholesterolemia). What are the main findings?

Response: In our study, we investigated whether chronic periodontitis was associated with the presence of lacunar stroke in an age- and gender- matched sample.

A total of 122 subjects (62 patients diagnosed with lacunar infarct and 60 controls) were included in a case-control study. After full-mouth periodontal examination was performed in all subjects, we observed that chronic periodontitis was associated with lacunar infarct with an odds ratio of 4.20 (95% CI 1.81-10.20), independently of vascular risk factors. What should readers take away from your report?

Response: Patients diagnosed with periodontal disease have about a 4-fold higher risk of developing lacunar stroke compared with those without periodontitis. Clinicians should be aware of this link and give adequate counsellng to their patients on the prognosis implication of periodontitis. Due to chronic periodontitis is a treatable disease; periodontal therapy could decrease systemic inflammation as well as improve endothelial function and, therefore, may play a preventive role on the onset of lacunar infarct. What recommendations do you have for future research as a result of this study?

Response: First of all, we need prospective cohort studies with a long-term follow-up as well as pathophysiological studies in order to confirm and understand our findings. When a cause-effect relation is established, interventional studies should be carried out to assess the potential benefit of periodontal therapy in patients with periodontitis and lacunar stroke. Is there anything else you would like to add?

Response: In this case-control study we demonstrated that chronic periodontitis was associated with a significantly higher risk of lacunar infarct in a Spanish population. Further longitudinal and molecular studies are warranted to confirm our findings. Thank you for your contribution to the community.


Leira, Y., López-Dequidt, I., Arias, S., Rodríguez-Yáñez, M., Leira, R., Sobrino, T., Campos, F., Blanco, M., Blanco, J. and Castillo, J. (2016), Chronic periodontitis is associated with lacunar infarct: a case–control study. European Journal of Neurology. doi: 10.1111/ene.13080

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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