Linking Oral Disease Burden and Stroke Risk: New Evidence
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- Published: Wednesday, 29 October 2025 14:43
- Written by News Editor
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A growing body of research continues to underscore the relationship between oral health and systemic disease. A recent study published on October 22, 2025, in Neurology® Open Access, the peer-reviewed journal of the American Academy of Neurology, adds further weight to this discussion.
The study reports that individuals presenting with both dental caries and periodontal disease may be at significantly increased risk of ischemic stroke compared to those with sound oral health. While the research does not establish causation, the findings reinforce the potential systemic implications of chronic oral infection and inflammation, and highlight the role that dental teams may play in broader stroke prevention strategies.
Ischemic stroke remains the most prevalent form of cerebrovascular accident, occurring when a blood clot or arterial obstruction restricts cerebral circulation, depriving brain tissue of oxygen and essential nutrients. As the global burden of cardiovascular disease continues to rise, modifiable risk factors are subject to intense scrutiny. Oral disease—particularly advanced periodontal disease—has long been associated with systemic inflammatory responses. However, this study specifically considers the combined effect of periodontal disease and untreated caries, suggesting that cumulative oral disease burden may be clinically meaningful.
Dental caries represents a progressive demineralisation of the tooth surface due to acidogenic biofilm activity, influenced by dietary sugars, oral hygiene behaviours, saliva composition and genetic susceptibility. Although often considered preventable, untreated caries remains one of the most common chronic diseases worldwide. Periodontal disease, meanwhile, reflects chronic inflammation of the periodontal tissues, typically driven by dysbiotic plaque biofilms. Left untreated, it can progress to destruction of connective tissue attachment and alveolar bone, resulting in tooth mobility and loss. Beyond local consequences, periodontitis is known to elevate systemic inflammatory markers, with proposed downstream effects on endothelial function, atherosclerotic plaque formation and immune response modulation.
The study, led by neurologist Dr. Souvik Sen at the University of South Carolina, analysed longitudinal data from 5,986 adults with a mean age of 63 years. None had a prior history of stroke at baseline. Comprehensive dental examinations were conducted to determine the presence of periodontal disease, dental caries or both. Participants were stratified into three groups: those with healthy periodontal and dental conditions; those with periodontal disease alone; and those with both periodontitis and caries. Researchers then followed participants over a 20-year period, using structured telephone interviews and clinical record reviews to document stroke occurrence.
Among the 1,640 individuals classified as having good oral health, 4% experienced a stroke during the follow-up period. In contrast, 7% of the 3,151 individuals with periodontal disease alone suffered a stroke, and 10% of the 1,195 individuals with both periodontal disease and untreated caries experienced a stroke. After adjusting for age, body mass index, smoking status and other conventional cardiovascular risk factors, individuals with both periodontal disease and dental caries exhibited an 86% higher risk of ischemic stroke compared with those in the healthy oral health group. Those with periodontal disease alone had a 44% increased risk. These findings suggest a possible dose-response relationship, where the cumulative burden of oral pathology correlates with systemic risk.
The analysis extended beyond stroke and assessed major cardiovascular events, including myocardial infarction and fatal cardiovascular disease. Individuals with both periodontal disease and caries had a 36% increased risk of experiencing a major cardiovascular event compared with those maintaining good oral health. This broader finding aligns with other research indicating that chronic oral inflammation may contribute to endothelial dysfunction, heightened systemic inflammatory states and greater susceptibility to atherosclerotic plaque instability.
Importantly, the study also investigated preventive behaviours. Participants who reported regular dental attendance were significantly less likely to present with advanced oral disease. Regular dental visits were associated with an 81% reduction in the likelihood of having both periodontitis and dental caries, and a 29% reduction in the likelihood of presenting with periodontitis alone. For dental professionals, this reinforces a familiar but potent message: preventive dentistry and consistent patient engagement can confer benefits that extend beyond preservation of dentition and oral function.
Dr. Sen noted, “These findings suggest that improving oral health may be an important part of stroke prevention efforts.” While causal pathways remain to be fully elucidated, plausible mechanisms include systemic inflammatory responses, bacterial translocation, immune activation and vascular endothelial stress—processes well documented in periodontal science. For example, pathogenic periodontal bacteria such as Porphyromonas gingivalis have been detected in atherosclerotic plaques, suggesting possible direct microbial involvement.
However, the authors emphasise the observational nature of the study. Oral health status was assessed at baseline only, meaning that disease progression or periodontal treatment during the 20-year follow-up period was not captured. Confounding factors, such as socioeconomic status, nutrition, access to healthcare and co-morbid inflammatory conditions, may also contribute to the associations observed. Further experimental studies are required to confirm causal relationships and to determine whether targeted dental interventions can measurably reduce stroke incidence.
For dental clinicians and public health policymakers, this study contributes to a growing argument that oral health should be integrated into general health screening and risk assessment frameworks. Interdisciplinary collaboration—with general medical practitioners, neurologists and cardiologists—may help ensure early identification and management of oral disease in patients at risk of cardiovascular illness. Patient messaging may also benefit from reframing, emphasising that oral hygiene and routine dental care are not solely aesthetic or functional concerns, but integral components of systemic health maintenance.
The study also underscores the continued importance of patient education. Clear, timely communication—particularly around early signs of periodontal disease such as bleeding gums, halitosis or gingival recession—may support patients in seeking care before disease progresses. Similarly, addressing barriers to care, whether economic, behavioural or psychological, remains essential for improving long-term outcomes.
In summary, this study reinforces the growing recognition that oral and systemic health are closely interrelated. While further research is necessary to establish causality and to refine clinical guidance, the evidence suggests that comprehensive oral disease prevention and management may play a meaningful role in reducing stroke and cardiovascular risk. Dental professionals are uniquely positioned to contribute to this work, both through clinical care and through patient education, advocacy and collaboration with other healthcare disciplines.
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