Periodontitis: an unknown risk factor for dementia and stroke

The relationship between periodontal disease and dementia and stroke has been the subject of research in recent years. Although it cannot be categorically stated that periodontitis is an unknown risk factor for these conditions, certain associations and possible mechanisms that could be involved have been found. According to a scientific report jointly prepared by the Spanish Society of Neurology (SEN) and the Spanish Society for Periodontology and Osseointegration (SEPA), it was found that periodontitis is on the rise 2.8 times higher risk of ischemic stroke, although there are no consistent data on the risk of hemorrhagic stroke. In addition, this report reveals that periodontal disease doubles the probability of developing the disease Alzheimer’s.

Periodontitis is a chronic inflammatory disease that affects the tissues that surround and support the teeth. It is characterized by gingivitis, destruction of the bone that supports the teeth and, in advanced stages, tooth loss. Periodontal disease is associated with high bacterial load in the mouth and chronic inflammatory reaction.

This pathology is mainly manifested by gingivitis, the formation of periodontal pockets and the loss of periodontal attachment and alveolar bone support. If periodontitis is not treated, it can lead to premature tooth loss that affects chewing and aesthetics, negatively affecting the patient’s quality of life,” write the authors of the consensus prepared by the SEPA-SEN working group formed by José Vivancos, Ana Frank and Ángel Martín, on behalf of SEN; and Yago Leira, Miguel Carasol and Pedro Diz from SEPA.

In this regard, several epidemiological studies have observed an association between periodontitis and an increased risk of developing dementia and cerebrovascular accident (stroke). For example, another study published in 2019 in the journal Journal of the American Geriatrics Society found that people over 50 with periodontitis had a higher risk of developing dementia compared to those without periodontitis. But, What are the theories behind this relationship?

theory

exist different theories about possible mechanisms that could explain the link between periodontitis and dementia and stroke. One of them is theory systemic inflammatory response. It is thought that the chronic inflammation caused by periodontitis can trigger a systemic inflammatory response throughout the body, including the brain. This chronic inflammatory response could contribute to the development and progression of dementia and stroke.

It was further suggested that periodontal bacteria could enter into bloodstream through inflamed gums and into the brain, where they could trigger an inflammatory reaction and damage brain tissue. This cascade contributes to the development of neurodegenerative processes associated with cognitive dysfunction, such as e.g neuroinflammation and death neurons, the formation of senile plaques due to the accumulation of beta amyloid peptides and the appearance of neurofibrillary tangles caused by hyperphosphorylation of the tau protein.

On the other hand, as reported by Diario Médico, v autopsy study performed on patients diagnosed with Alzheimer’s disease, it was observed that Alzheimer’s disease does not occur exclusively in all cases. In many of them, combined factors contributing to the development of dementia are identified, including the presence of cerebral vascular pathology.

These findings suggest that various factors are interrelated and may cause persistent chronic inflammation changes in vasculature and brain tissue. In this sense, indicate experts, if inflammatory gum disease is not treated, it is likely that dementia manifests itself more aggressively or at an earlier stage.

The association of periodontitis and coronary artery disease shares this initial mechanism and bacteremia and a state of chronic low-grade inflammation generated “contribute to the emergence endothelial dysfunction; disruption of the blood-brain barrier and activation of microglia, leading to a prothrombotic or hypercoagulable state and even rupture of the atherosclerotic plaque“, Yago Leira, periodontist and coordinator of the SEPA-SEN working group, explained to Diario Médico.

In addition to Alzheimer’s disease and ischemic stroke, scientific evidence has been presented indicating the effect of periodontitis on other neurological diseases such as Parkinson’s disease, multiple sclerosis headache – migraine.

However, it is important to emphasize that the relationship between periodontitis and dementia and stroke is not yet fully understood and further research is needed to confirm and better understand this association. Although periodontitis can be considered a possible risk factor for these conditions, there are other well-established risk factors such as high blood pressure, diabetes, smoking and obesity that also play an important role in the development of dementia and stroke.

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