period on tit is as a risk factor for cerebrovascular accident

8/3/2019 Period on Tit Is as a Risk Factor for Cerebrovascular Accident

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Periodontitis as a risk factor for

cerebrovascular accident: a case-control study in the Indian population

A.R. Pradeep,

P. Hedge,

P. Arjun Raju, S.R. Shetty,

K. Shareef,

C.N. Guruprasad.

J Periodont Res 2010; 45: 223228Presented by: Date:

G. Srinivas, 30/12/11

2nd year PG,

Department of Periodontics


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Introduction

Periodontitis Periodontitis a risk factor for various systemic diseases

Cerebrovascular accident:

The traditional definition of stroke, devised by the WorldHealth Organization in the 1970s is a "neurological deficit ofcerebrovascular cause that persists beyond 24 hours or isinterrupted by death within 24 hours".


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Aim

The present case-control study was designed todetermine if an association exists between

periodontal disease and cerebrovascular accidentin the Indian population.


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Material and methods

Total sample size 200

cases 100 controls 100

56 M 56 M

44 F 44 F

Age ranging from 33 to 68 years of age.


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Inclusion criteria

Patients diagnosed assuffering from acutecerebral ischemia fromtheir medical records and

Having an ischemic lesionon brain imaging (n=76)

A neurological deficitlasting for more than 24

hrs, Or if they were suffering

from transient ischemicattach (n=24).

Exclusion criteria

History of previous attackof stroke(i.e. more thanone attack.

Being completely

edentulous Receipt of periodontal Rx

in the prev 12 months

Being diagnosed as

suffering from hemorrhagicstroke on neuroimaging.


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Medical health questionnaire

Included :

dietary history

a history of smoking

a history of alcohol consumption being literate/illiterate

Individuals were also scrutinized for

hypertension (systolic, > 140 mm of Hg; diastolic,

> 90 mm of Hg) diabetes (RBS level 126 mg/dL)

total serum cholesterol level (SCL of 220 mg/dL)

history of stroke from their medical records.


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Dental examination

The calibration was performed approximately 4 wk beforethe start of the study.

The periodontal variables were recorded using a sterilemouth mirror and with a UNC 15 periodontal probe.

Measurements of PPD and CAL were performed in all teethat four sites.

Plaque index (PI)

Loe & Silness gingival index


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Statistical analysis

The design, coding and debugging of thedatabase and its statistical analysis werecarried out using the spss-pc/Windowsversion 10.5 software package (SPSS Inc.,

Chicago, IL, USA).

Logistic regression analysis was used toanalyze the association of periodontitis with

cerebrovascular accident.


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Results

In subjects with cerebrovascular accident values of PI,GI, PPD were significantly higher.

Stroke cases exhibited a higher prevalence ofhypertension, diabetes mellitus and smoking, and ahigher SCL compared with controls.

more stroke cases had a family history of stroke and anon vegetarian diet.

Literacy was also lower among stroke cases.

odds ratio (OR) is higher for CVA than a status withoutperiodontitis.

Patients suffering from CVA had a higher CAL (> 4.5 mm)than controls.


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Discussion

The study clearly showed that CVA subjects had worseperiodontal status than the controls

the means of characteristics for CVA or stroke subjectswere significantly higher than those of the control group(p< 0.05).

These results are in agreement with the results of previousstudies done by Grau AJ, Wu T.

These studies found that patients with cerebrovascularischemia had significantly more severe periodontalinfection, worse dental status and a greater number ofperiapical lesions than patients of the control group.

---- Grau AJ, Wu T.


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A similar study showed that older patients withcerebrovascular ischaemia tended to have significantlyworse dental status and had more severe periodontitis and

periapical lesions than control subjects--- Ziegler CM.

Several causal and noncausal pathways have beenpostulated to explain the observed association ofperiodontitis (or other chronic infections) with

atherosclerosis and coronary heart disease----- HaraszthyVI, Beck J, Braunwald E.

Causal pathways may involve direct and indirect effects ofthe periodontal infection,

whereas genetic and other host factors that increase thesusceptibility to both atherosclerosis/thrombosis andchronic periodontitis would be an alternative noncausalpathway -----------Dietrich T.


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Oral microorganisms, including periodontal pathogens, enter thebloodstream during transient bacteremias, where they play a role in the

development and progression of atherosclerosis leading to CVA orstroke---- Haraszthy VI.

Braunwaldsuggested that certain infections, including perio-dontaldisease, may play a significant role in the process of atherosclerosis.

Beck et al. hypothesized that subjects with a genetically determined

strong monocytic response to bacterial antigen could be at high risk fordeveloping both periodontal disease and atherosclerosis.

Deshpande et al. suggested that organisms such as Pg,Tf, and Aaappear to be common in periodontitis atherosclerosis syndrome.

These organisms interact with the neutrophil and monocyte T-cell axis

to elicit an acute and chronic inflammatory response--- Deshpande RG Dorfer et al. reported that patients suffering from cerebral ischemia

had higher CAL than population controls (p< 0.001).


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Drawbacks

The study had restricted to patients with transient

ischemic attack and mild to moderately severe stroke.Therefore, the results cannot be extrapolated to severeand fatal stroke or hemorrhagic stroke.

Patients suffering from CVA had a higher CAL (> 4.5 mm)

than controls, but this did not reach significance in a fullyadjusted model.

Although a blinded observer method is preferred forclinical examinations, the fact that the stroke patients and

controls were in different sections of the department madethis impractical, potentially leading to an ascertainmentbias.

Residual confounding by factors not adjusted for in the

multivariate analysis (e.g. physical activity) may be afurther limitation.


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Conclusion

The data from this study support the proposed linkbetween periodontitis and cerebrovascular accident inthe Indian population. However, further studies are

necessary to verify and quantify the role of oralinfections and genetic factors in the process ofatherosclerosis.


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period on tit is as a risk factor for cerebrovascular accident

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