Are Periodontitis, Stroke, and Alzheimer’s Disease Linked?

MADRID – Recent research confirms the impact of periodontitis on the risk of neurological diseases, specifically increasing the risk of stroke and Alzheimer's disease.

The Spanish Society of Dentistry and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN) recently published a report containing the latest data on this topic. This report reviews, updates and presents the latest scientific evidence on this link. It also provides practical, evidence-based recommendations that should be applied in dental offices and neurology centers.

As Dr. Yago Leira, periodontist and coordinator of the SEPA-SEN Working Group says Medscape Spanish version“, “The main conclusion of this scientific report is that people with periodontitis have almost twice the risk of developing Alzheimer's disease and three times the risk of ischemic stroke.

Report data shows that people with periodontitis have a 2.8 times higher risk of ischemic stroke. However, the available evidence regarding hemorrhagic stroke is conflicting.

How does this dental condition affect the progression of cardiovascular disease? Observational studies indicate that patients with ischemic stroke and confirmed periodontitis are at greater risk for recurrent vascular events, more severe neurological deficits, and postictal depression than patients without periodontitis.

immune-mediated inflammation

In terms of its association with Alzheimer's disease, a meta-analysis of epidemiological studies showed that periodontitis is associated with a 1.7-fold increased risk of this type of dementia, with patients with more severe periodontitis having an increased risk. three times.

Likewise, research shows that people with dementia or neurocognitive impairment are at greater risk of developing periodontitis. Other studies have shown that patients with periodontitis have worse outcomes on various neuropsychological tests of cognitive function.

This report presents evidence from three clearly defined perspectives: the epidemiological association between periodontitis and these neurological diseases, the biological mechanisms that may explain this association, and the role of dental treatment in preventing stroke and Alzheimer's disease Interventional research on disease approaches.

“These epidemiological findings may have biological explanations. The report concludes that a low-grade chronic, systemic, immune-mediated inflammatory response caused by bacteria and their endotoxins and pro-inflammatory mediators circulating in the blood contributes to a variety of Biological processes related to neurological damage and cerebral ischemia,” said Leila, one of the report's authors.

Another author of the study, Dr. Ana Frank, is director of the Department of Neurology at the University Hospital of La Paz in Madrid and a member of the SEPA-SEN team.she explained to me Medscape Spanish version The primary biological mechanism underlying stroke and Alzheimer's disease is chronic exposure of the entire brain (vasculature, neurons, and stellate cells) to the deleterious effects of periodontal infection. “Although the intensity is low, this [exposure] Sufficient to trigger a cascade of events that ultimately leads to vascular endothelial damage, neuronal and astrocyte changes, and neuropil damage.

As for the evidence for an epidemiological link between periodontitis and these two neurological diseases, Frank cited the exponentially increased risk posed by periodontitis. She said further epidemiological studies are necessary to better understand the extent of the problem.

Preventive alternative?

Leila cites evidence that periodontal treatment can offer a way to prevent stroke and dementia. He noted that large population studies have observed various oral health interventions (such as regular dental prophylaxis or periodontal treatment) and regular dental visits to reduce the risk of dementia and stroke. “However, we currently have no randomized clinical trials investigating whether periodontal treatment is a primary or secondary preventive measure against these neurological diseases.”

“There are currently several research groups in the United States and Europe, including ours, conducting clinical trials to evaluate the impact of periodontal treatment on recurrent vascular events in patients with cerebrovascular disease,” Leira said.

“On the other hand, various interventional studies are ongoing to assess the potential impact of periodontal treatment on cognitive function in patients with dementia. Along these lines, the 1-year follow-up of GAIN appears to have yielded encouraging results. The study is one of the first A Phase 2/3 clinical trial testing atuzaginstat as an inhibitor of gingipains (the endotoxin produced by gingipains). Porphyromonas gingivalis, This is one of the bacteria thought to cause periodontitis. The drug reduces neurocognitive impairment in patients with higher levels of antibodies against this periodontal pathogen.

Towards clinical practice

The report has a practical focus. The intention is that this evidence will serve as recommendations for dentists to implement in clinical practice, particularly in older patients or those with risk factors for stroke.

“On the one hand, dentists have to know how to approach patients who have already had a stroke (most of whom have vascular risk factors such as diabetes and hypertension), many of whom take multiple medications and are taking Multiple medications. [taking] Certain medications, such as blood thinners, may negatively affect various dental procedures. In this case, it is important to maintain direct contact with the neurologist, as these patients should be treated with a multidisciplinary approach.

“On the other hand, every patient who comes to a dental clinic and is diagnosed with periodontitis could be screened to identify potential vascular risk factors, although the final diagnosis would need to be given by a specialist. To this end, the National Environmental Protection Agency The Department is working on the Promosalud (“Health Promotion”) project, which will soon be implemented in a large number of dental clinics in Spain.

“Finally, dental professionals must understand the potential positive benefits surrounding systemic vascular inflammation that periodontal treatment can provide, including, for example, metabolic control and lowering blood pressure.”

For patients with cognitive impairment, the report's authors recommend following these steps during dental visits: Inform patients and the patient's caregivers about the importance of good dental hygiene and monitor for any signs of infection or dental disease; address each Pain in patients with cognitive impairment and dental problems, especially those with agitation, even if the patient does not specifically complain of pain (also, try not to give opioids); Finally, avoid sedation if possible and use minimum if necessary effective dose.

Maintain oral hygiene

Given the link between these diseases and periodontitis, recommendations that neurologists should follow during consultations, Frank said, “No matter what age our patients are, I think it's important to emphasize the importance of maintaining good oral and dental hygiene. This is a Very good method.

Frank said the connection between periodontitis and neurological disease is largely unknown to the public. “We still have a long way to go before we can say that the public is aware of this potential link. And it's not just the public. I think we have to stress the importance of promoting dentistry to our colleagues and to healthcare professionals at large. .

In this regard, Leira emphasizes that the authors aim to provide this report not only to oral health and neurological care professionals, but also to primary care physicians and nurses, for patients with cerebrovascular disease or Alzheimer's disease and their care Personnel can increase awareness and understanding thereby improving prevention levels.

“This study will also provide a scientific basis to support the SEPA-SEN working group in implementing future activities and programs,” Leira concluded.

Leila and Frank have disclosed no relevant financial relationships.

This article is translated from the Spanish version of Medscape.

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