THE ASSOCIATION BETWEEN PERIODONTAL DISEASE AND STROKE RISK: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Objective

The prevention of stroke is of paramount importance, and periodontal disease may play an important role in this process. This study aims to evaluate the association between periodontal disease and stroke risk.

Methods

The study was conducted in accordance with the PRISMA 2020 guidelines. We comprehensively searched PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library from inception to December 2024 to identify relevant studies. Quality assessment was conducted using both the original and modified versions of the Newcastle-Ottawa Scale as appropriate. Data such as sample size, region, age, and gender of participants were extracted. Odds ratios (OR) were pooled using a random-effects model, and 95% confidence intervals (CI) were calculated. Sensitivity analysis, cumulative meta-analysis, multiple subgroup analyses, and publication bias assessments were also performed to assess the stability of the results.

Results

A total of 36 studies, including 7,665,431 participants, were included in the meta-analysis, consisting of 20 cohort studies, 9 case-control studies, and 7 cross-sectional studies. The findings indicate that individuals with periodontal disease have a significantly higher risk of stroke compared to the healthy population (OR: 1.724, 95% CI: 1.481-2.008). This conclusion holds across different regions, genders, and age groups. Periodontitis patients exhibited a higher risk of stroke compared to those with gingivitis (OR: 2.008 vs 1.673), and the risk of ischemic stroke was higher in individuals with periodontal disease than the risk of hemorrhagic stroke (OR: 1.846 vs 1.476). Sensitivity analysis, cumulative meta-analysis, and publication bias detection further confirm that the conclusion remains stable (Egger’s tests, P = .280 and Begg’s tests P = .703), even after imputing missing studies using the trim-and-fill method. Meta-regression analysis suggested that age may contribute to the heterogeneity observed in the studies.

Conclusions

Periodontal disease has been identified as an independent risk factor for stroke. Regular and effective dental biofilm control may help reduce the risk of stroke in patients with periodontal disease. The underlying mechanisms by which periodontal disease increases stroke risk warrant further investigation.