Ischaemic stroke and oral inflammatory diseases

Cover Page

Abstract

The aim of this study was to establish clinical significance of oral inflammatory diseases in ischaemic stroke (IS), how aware doctors and nurses are of this problem, and the safety and possibility of performing dental hygiene in patients with acute IS.

Materials and methods. We examined 100 patients who had suffered an ischaemic stroke in the internal carotid artery territory within 6 to 48 hours. The efficacy of dental hygiene and the risk of developing chronic oral sepsis were evaluated using the Patient Hygiene Performance Index (PHP) and Chronic Oral Sepsis Risk index (COSR). Quality of life was assessed using the short version of the Oral Health Impact Profile (OHIP-14). The sociological study included 100 patients with ischaemic stroke, 38 nurses, and 18 neurologists.

Results. The severity of IS at study inclusion was 8 (3; 15) points on the NIHSS, while the Barthel Index score was 70 (45; 90) points. The modified Rankin Scale score was 1–3 points. The PHP index was 2.28 ± 0.05 and the COSR index was 20.13 ± 0.50. The OHIP-14 results (a total score of 28.1 ± 6.8 points) also indicated unsatisfactory quality of dental health. The results of sociological studies revealed low level of awareness regarding dental care during acute IS among doctors. After professional oral care, treatment of oral inflammatory diseases, and removal of significantly damaged teeth, patients with IS had a decrease in the PHP index to 1.17 ± 0.05 and the COSR index to 7.36 ± 0.50, which corresponds to a satisfactory level of dental hygiene by the end of the acute stroke period. The impact of dental health on quality of life parameters as measured by the OHIP-14 scale (22.4 ± 7.2 points) was satisfactory.

Conclusion. The most important aspect of early dental care in patients with IS is increasing the quality of oral health.

About the authors

Marina Yu. Maksimova

Research Center of Neurology; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Author for correspondence.
Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-7682-6672

D. Sci. (Med), Prof., Head, 2nd Neurology department; professor, Division of diseases of the nervous system, Department of dentistry

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80; Moscow

Nikita A. Ryazantsev

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-4071-8098

Cand. Sci. (Med.), Assoc. Prof., Department of anesthesia in dentistry

Russian Federation, Moscow

Evgenia N. Anisimova

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0001-7109-6431

Cand. Sci. (Med), Assoc. Prof., Department of anesthesia in dentistry

Russian Federation, Moscow

Natalia Yu. Anisimova

A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: ncnmaximova@mail.ru
ORCID iD: 0000-0002-3073-7041

Cand. Sci. (Med), Assoc.Prof., Department of anesthesia in dentistry

Russian Federation, Moscow

Мikhail A. Piradov

Research Center of Neurology; A.I. Evdokimov Moscow State University of Medicine and Dentistry

Email: ncnmaximova@mail.ru

D. Sci. (Med), Prof., Full Member of RAS, Director; Head, Division of diseases of the nervous system, Department of dentistry

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80; Moscow

References

  1. Aarabi G., Eberhard J., Reissmann D.R. et al. Interaction between periodontal disease and atherosclerotic vascular disease — fact or fiction? Atherosclerosis. 2015;241(2):555–560. doi: 10.1016/j.atherosclerosis.2015.04.819. PMID: 26100678.
  2. Kebschull M., Demmer R.T., Papapanou P.N. “Gum bug, leave my heart alone”—Epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010;89(9):879–902. doi: 10.1177/0022034510375281. PMID: 20639510.
  3. Reyes L., Herrera D., Kozarov E. et al. Periodontal bacterial invasion and infection: contribution to atherosclerotic pathology. J Periodontol. 2013;84(4 Suppl):S30–S50. doi: 10.1902/jop.2013.1340012. PMID: 23631583.
  4. Aarabi G., Heydecke G., Seedorf U. roles of oral infections in the pathomechanism of atherosclerosis. Int J Mol Sci. 2018;19(7):1978. doi: 10.3390/ijms19071978. PMID: 29986441.
  5. Dorn B.R., Harris L.J., Wujick C.T. et al. Invasion of vascular cells in vitro by Porphyromonas endodontalis. Int Endod J. 2002;35(4):366–371. doi: 10.1046/j.0143­2885.2001.00489.x. PMID: 12059938.
  6. Armitage G.C. Periodontal diagnoses and classification of periodontal diseases. Periodontol. 2004;34:9–21. doi: 10.1046/j.0906­6713.2002.003421.x. PMID: 14717852.
  7. König J., Holtfreter B., Kocher T. Periodontal health in Europe: Future trends based on treatment needs and the provision of periodontal services — position paper 1. Eur J Dent Educ. 2010;14(Suppl. 1):4–24. doi: 10.1111/j.1600­0579.2010.00620.x. PMID: 20415972.
  8. Petersen P.E., Ogawa H. The global burden of periodontal disease: Towards integration with chronic disease prevention and control. Periodontol. 2012;60(1):15–39. doi: 10.1111/j.1600­0757.2011.00425.x. PMID: 22909104.
  9. Rôças I.N., Siqueira J.F. Root canal microbiota of teeth with chronic apical periodontitis. J Clin Microbiol. 2008;46(11):3599–3606. doi: 10.1128/JCM.00431­08. PMID: 18768651.
  10. Eriksen H.M., Bjertness E. Prevalence of apical periodontitis and results of endodontic treatment in middle­aged adults in Norway. Endod Dent Traumatol. 1991;7(1):1–4. doi: 10.1111/j.1600­9657.1991.tb00174.x. PMID: 1915119.
  11. Abiko Y., Saitoh M., Nishimura M. et al. Role of beta­defensins in oral epithelial health and disease. Med Mol Morphol. 2007;40(4):179–184. doi: 10.1007/s00795­007­0381­8. PMID: 18085375.
  12. Chung W.O., Dommisch H., Yin L., Dale B.A. Expression of defensins in gingiva and their role in periodontal health and disease. Curr Pharm Des. 2007;13(30):3073–3083. doi: 10.2174/138161207782110435. PMID: 17979750.
  13. Fukui A., Ohta K., Nishi H. et al. Interleukin­8 and CXCL10 expression in oral keratinocytes and fibroblasts via Toll­like receptors. Microbiol Immunol. 2013;57(3):198–206. doi: 10.1111/1348­0421.12022. PMID: 23278752.
  14. Kinane D.F., Lappin D.F. Immune processes in periodontal disease: a review. Ann Periodontol. 2002;7(1):62–71. doi: 10.1902/annals.2002.7.1.62. PMID: 16013218.
  15. Forner L., Larsen T., Kilian M., Holmstrup P. Incidence of bacteremia after chewing, tooth brushing and scaling in individuals with periodontal inflammation. J Clin Periodontol. 2006;33(6):401–407. doi: 10.1111/j.1600­051X.2006.00924.x. PMID: 16677328.
  16. Tomás I., Diz P., Tobías A. et al. Periodontal health status and bacteraemia from daily oral activities: Systematic review/meta­analysis. J Clin Periodontol. 2012;39(3):213–228. doi: 10.1111/j.1600­051X.2011.01784.x. PMID: 22092606
  17. Chhibber­Goel J., Singhal V., Bhowmik D. et al. Linkages between oral commensal bacteria and atherosclerotic plaques in coronary artery disease patients. NPJ Biofilms Microbiomes. 2016;2:7. doi: 10.1038/s41522­016­0009­7. PMID: 28649401.
  18. Nakano K., Inaba H., Nomura R. et al. Detection of cariogenic Streptococcus mutans in extirpated heart valve and atheromatous plaque specimens. J Clin Microbiol. 2006;44(9):3313–3317. doi: 10.1128/JCM.00377­06. PMID: 16954266.
  19. Graunaite I., Lodiene G., Maciulskiene V. Pathogenesis of apical periodontitis: a literature review. J Oral Maxillofac Res. 2012;2(4):e1. doi: 10.5037/jomr.2011.2401. PMID: 24421998.
  20. Gomes M.S., Blattner T.C., Sant’Ana Filho M. et al. Can apical periodontitis modify systemic levels of inflammatory markers? A systematic review and meta­analysis. J Endod. 2013;39(10):1205–1217. doi: 10.1016/j.joen.2013.06.014. PMID: 24041380.
  21. Sanz M,, Marco Del Castillo A,, Jepsen S, et al. Periodontitis and cardiovascular diseases: consensus report. J Clin Periodontol. 2020;47(3):268–288. doi: 10.1111/jcpe.13189. PMID: 32011025.
  22. You Z., Cushman M., Jenny N.S. et al. Tooth loss, systemic inflammation, and prevalent stroke among participants in the reasons for geographic and racial difference in stroke (REGARDS) study. Atherosclerosis. 2009;203(2):615–619. doi: 10.1016/j.atherosclerosis.2008.07.037. PMID: 18801482.
  23. Hosomi N., Aoki S., Matsuo K. et al. Association of serum anti­periodontal pathogen antibody with ischemic stroke. Cerebrovasc Dis. 2012;34(5–6):385–392. doi: 10.1159/000343659. PMID: 23207319.
  24. Demmer R.T., Trinquart L., Zuk A. et al. The influence of anti­infective periodontal treatment on C­reactive protein: a systematic review and meta­analysis of randomized controlled trials. PLoS One. 2013;8(10):e77441. doi: 10.1371/journal.pone.0077441. PMID: 24155956.
  25. Alhadainy H.A., Keefe T., Abdel­Karim A.H. et al. Association between dental diseases and history of stroke in the United States. Clin Exp Dent Res. 2021. doi: 10.1002/cre2.416. PMID: 33797859.
  26. Maksimova M.Yu., Ryazantsev N.A., Anisimova E.N. Dental rehabilitation of patients in the complex treatment of ischemic stroke in the acute period. Part 1. Endodontics Today. 2015;13(4):3–7. (In Russ.)
  27. Maksimova M.Yu., Ryazantsev N.A., Anisimova E.N. Dental rehabilitation of patients in the complex treatment of ischemic stroke in the acute period. Part 2. Endodontics Today. 2016;14(1):8–12. (In Russ.)
  28. Leus P.A. Method for determining the risk of chronic oral sepsis. Stomatologicheskiy zhurnal. 2000;2:25–30. (In Russ.)
  29. Slade G.D., Spencer A.J. development and evaluation of the oral health impact profile. Community Dent Health. 1994;11(1):3–11. PMID: 8193981.
  30. Maksimova M.Yu., Ryazantsev N.A., Anisimova E.N. Approaches to providing dental care to patients with cerebrovascular diseases. Farmateka. 2013;7:47–51. (In Russ.)

Statistics

Views

Abstract: 152

PDF (Russian): 83

Article Metrics

Metrics Loading ...

Dimensions

PlumX


Copyright (c) 2021 Maksimova M.Y., Ryazantsev N.A., Anisimova E.N., Anisimova N.Y., Piradov М.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies