Annals of Clinical and Experimental NeurologyAnnals of Clinical and Experimental NeurologyАнналы клинической и экспериментальной неврологии2075-54732409-2533Eco-Vector75810.54101/ACEN.2021.3.3Original articlesОригинальные статьиResearch ArticleIschaemic stroke and oral inflammatory diseasesИшемический инсульт и воспалительные заболевания полости ртаhttps://orcid.org/0000-0002-7682-6672MaksimovaMarina Yu.МаксимоваМарина Юрьевна
Russian Federation

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

д.м.н., профессор, руководитель 2-го неврологического отделения; профессор кафедры нервных болезней

ncnmaximova@mail.ruhttps://orcid.org/0000-0002-4071-8098RyazantsevNikita A.РязанцевНикита Андреевич
Russian Federation

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

к.м.н., доцент кафедры обезболивания в стоматологии

ncnmaximova@mail.ruhttps://orcid.org/0000-0001-7109-6431AnisimovaEvgenia N.АнисимоваЕвгения Николаевна
Russian Federation

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

к.м.н., доцент кафедры обезболивания в стоматологии

ncnmaximova@mail.ruhttps://orcid.org/0000-0002-3073-7041AnisimovaNatalia Yu.АнисимоваНаталия Юрьевна
Russian Federation

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

к.м.н., доцент кафедры обезболивания в стоматологии

ncnmaximova@mail.ruPiradovМikhail A.ПирадовМихаил Александрович
Russian Federation

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

д.м.н., профессор, академик РАН, директор; зав. каф. нервных болезней стоматологического факультета

ncnmaximova@mail.ruResearch Center of NeurologyФГБНУ «Научный центр неврологии»A.I. Evdokimov Moscow State University of Medicine and DentistryФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова»0410202115326340310202103102021Copyright ©; 2021, Maksimova M.Y., Ryazantsev N.A., Anisimova E.N., Anisimova N.Y., Piradov М.A.Copyright ©; 2021, Максимова М.Ю., Рязанцев Н.А., Анисимова Е.Н., Анисимова Н.Ю., Пирадов М.А.2021Maksimova M.Y., Ryazantsev N.A., Anisimova E.N., Anisimova N.Y., Piradov М.A.Максимова М.Ю., Рязанцев Н.А., Анисимова Е.Н., Анисимова Н.Ю., Пирадов М.А.https://creativecommons.org/licenses/by/4.0https://annaly-nevrologii.com/pathID/article/view/758

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.

Цель работы — определить клиническое значение воспалительных заболеваний полости рта при ишемическом инсульте (ИИ), уровень информированности врачей и медицинских сестёр об этой проблеме, безопасность и возможность стоматологической санации полости рта у пациентов в остром периоде ИИ.

Материалы и методы. Обследовано 100 пациентов с ИИ в бассейне внутренней сонной артерии давностью 6–48 ч. Эффективность гигиены полости рта и риск развития хронического орального сепсиса оценивали с помощью индексов эффективности гигиены полости рта (РНР) и риска развития хронического орального сепсиса (РХОС). Анализ качества жизни проводили с помощью Краткой версии опросника стоматологического здоровья (OHIP-14). В социологическом исследовании участвовали 100 пациентов с ИИ, 38 медицинских сестер, 18 врачей-неврологов.

Результаты. При включении пациентов в исследование тяжесть ИИ составляла по шкале NIHSS 8 (3; 15) баллов, индекс Бартела — 70 (45; 90) баллов. Оценка функциональных нарушений по шкале Рэнкина соответствовала 1–3 баллам. Индекс РНР составил 2,28 ± 0,05; индекс РХОС — 20,13 ± 0,50. Результаты тестирования с помощью шкалы OHIP-14 (суммарная оценка — 28,1 ± 6,8 балла) также свидетельствовали о неудовлетворительном качестве стоматологического здоровья. Результаты социологических исследований показали низкий уровень информированности врачей о стоматологической помощи в остром периоде ИИ. После профессиональной гигиены полости рта, лечения воспалительных заболеваний полости рта, удаления разрушенных зубов у пациентов с ИИ отмечено снижение индекса РНР до 1,17 ± 0,05 и индекса РХОС до 7,36 ± 0,50, что соответствует удовлетворительному состоянию гигиены полости рта к концу острого периода ИИ. Оценка воздействия стоматологического здоровья на показатели качества жизни по шкале OHIP-14 (22,4 ± 7,2 балла) соответствовала удовлетворительным показателям.

Заключение. Наиболее важным аспектом ранней стоматологической помощи пациентам с ИИ является увеличение качества стоматологического здоровья.

ischaemic strokeoral inflammatory diseasesdental careишемический инсультвоспалительные заболевания полости ртастоматологическая помощь1. 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.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.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.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.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.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.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.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.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.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.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: 1915119.111. 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.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.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.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.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.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: 22092606Tomás 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: 2209260617. 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.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.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.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.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.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.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.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.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.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.)Максимова М.Ю., Рязанцев Н.А., Анисимова Е.Н. Стоматологическая реабилитация пациентов в комплексе лечения ишемического инсульта в остром периоде. Часть 1. Эндодонтия Today. 2015;13(4):3–7.27. 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.)Максимова М.Ю., Рязанцев Н.А., Анисимова Е.Н. Стоматологическая реабилитация пациентов в комплексе лечения ишемического инсульта в остром периоде. Часть 2. Эндодонтия Today. 2016;14(1):8–12.28. Leus P.A. Method for determining the risk of chronic oral sepsis. Stomatologicheskiy zhurnal. 2000;2:25–30. (In Russ.)Леус П.А. Патогенетические взаимосвязи хронического орального сепсиса с общими заболеваниями. Стоматологический журнал. 2000;2:25–30.29. 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.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.)Максимова М.Ю., Рязанцев Н.А., Анисимова Е.Н. Подходы к оказанию стоматологической помощи больным с нарушениями мозгового кровообращения. Фарматека. 2013;7:47–51.