Periodontitis not only increases the risk of ischemic stroke and Alzheimer’s dementia, but different oral health interventions are also considered to reduce the risk of these neurological disorders.
These are the main conclusions drawn from a rigorous and exhaustive consensus report carried out by the joint working group of the Spanish Society of Periodontics and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN). In addition, some practical recommendations for both dentists and neurologists are noted.
In recent years, new studies have accumulated that point to a suggestive link between periodontitis and some neurological diseases. As Dr. Miguel Carasol, coordinator of the SEPA working groups, points out, “hence arises the need to review the scientific evidence of this relationship, as well as the interest in drawing some conclusions and advice on how to act with patients with periodontitis and neurological diseases, which are useful for both the dentist and the neurologist and, ultimately, for the general population”.
As the vice-president of SEPA, Dr. Paula Matesanz, concludes: “the result of the report shows that periodontitis increases the risk of suffering from ischemic stroke and Alzheimer’s-type dementia”. According to Dr. José Miguel Láinez, president of the Spanish Society of Neurology (SEN), “risk markers such as periodontitis are of great help in trying to avoid, reduce or minimize the impact of these neurological disorders”.
Of all the neurological diseases, this report has analyzed the two for which there is the greatest scientific evidence of their relationship with periodontitis: cerebrovascular disease and dementia. As revealed by Dr. José Vivancos, a neurologist and member of the SEPA-SEN working group, “the main difficulty in preparing the report has been to synthesize all the available literature on the subject, as well as to include, to the extent possible, studies with good methodological quality”.
The report reports the evidence from 3 clearly defined points: the epidemiological association between periodontitis and these 2 neurological diseases, the biological mechanisms that may explain these associations and intervention studies on the effect of periodontal treatment, as a primary or secondary preventive measure, for stroke and dementia.
Periodontitis is common in adulthood
Neurological diseases, among which cerebrovascular diseases and dementias stand out due to their frequency and morbidity and mortality, constitute a serious public health problem, with the enormous disability problems that they entail being highly relevant. In recent years, given the known risk factors in the onset and progression of these diseases, it has been assessed that periodontitis may somehow influence the etiopathogenesis of these neurological conditions.
Based on the epidemiological data extracted from studies evaluated in this report, “it is estimated that people with periodontitis have a 1.7 times greater risk of suffering from Alzheimer’s dementia and a 2.8 times greater risk of suffering an ischemic stroke than periodontally healthy people”, highlights Dr. YagoLeira, periodontist and coordinator of the SEPA-SEN working group, who recalls that “periodontal disease is very frequent among the adult population (it is estimated that 8 out of 10 Spaniards have some degree or type of disease periodontitis)”.
Inflammation: A presumed ‘culprit’
Now, as Dr. Frank advises, “it would be very important to have epidemiological studies that confirm this relationship and, above all, studies that help us to know in detail the mechanisms involved”. In this sense, the suspicions revolve, fundamentally, on the inflammatory hypothesis; Specifically, as this expert explains, “it is speculated that this link may be due to the inflammatory effect produced by periodontitis, a chronic, low-grade but persistent inflammation in the body that triggers an inflammatory cascade, which ends up not only causing negative consequences at a neurological level but also in other target organs, which would also explain its incidence in cardiovascular health or diabetes”.
Ischemic cerebrovascular disease, there is experimental evidence on how the chronic immunoinflammatory response of periodontitis would trigger a prothrombotic state of hypercoagulability and vascular endothelial dysfunction that may increase the risk of cerebral embolism/thrombosis.
In the case of Alzheimer’s disease, according to the periodontistYagoLeira, “a multitude of animal studies have shown that the bacteremia and endotoxemia that occur in periodontitis, together with a state of chronic low-grade inflammation, contribute significantly to significantly to the development of neurodegenerative processes involved in cognitive dysfunction, such as neuroinflammation and neuronal death, the formation of senile plaques due to deposits of amyloid beta peptides, as well as the appearance of neurofibrillary tangles due to hyperphosphorylation of the Tau protein”.
Therefore, as explained in this report, there are different pathophysiological mechanisms studied in experimental models that support the biological plausibility of the epidemiological association.