Severity of periodontitis and risk of ischemic stroke: A systematic review and meta‐analysis

Abstract

Background Periodontitis is a prevalent chronic inflammatory disease with a systemic inflammatory burden and is implicated with vascular pathology. This systematic review and meta‐analysis evaluates the association between varying severities of periodontitis and ischemic stroke with various diagnostic criteria. Methods Following PRISMA 2020 (PROSPERO:1161816), PubMed (MEDLINE), Web of Science, and Scopus were searched from January 2000 to January 2026. Studies with clinically or radiographically diagnosed adult periodontitis patients were included. Studies reporting hazard ratios (HRs) and odds ratios (ORs) for ischemic stroke or cardiovascular outcomes with clear diagnosis and outcome definition were considered eligible. Study characteristics, diagnosis methods, periodontitis severity, outcomes, outcome ascertainment, follow‐up duration, effect measures with 95% confidence intervals, and adjustment variables were extracted. The study quality was assessed using the Newcastle–Ottawa Scale (NOS). Results Fifteen studies met the inclusion criteria: seven cohorts and eight case–controls. Pooled estimates showed an increased risk of ischemic stroke with periodontitis (HR = 1.24; 95%CI, 1.11–1.38; OR = 4.59; 95%CI, 1.81–11.62). Subgroup analysis revealed that severe periodontitis (OR = 4.19; 95%CI, 3.14–5.59) confers a greater risk than moderate disease (OR = 1.63; 95%CI, 1.16–2.29). New classification diagnostic criteria (AAP/EFP, CDC/AAP) produced stronger associations, OR = 5.35 (95%CI, 3.35–8.55), and a longer follow‐up (≥ 15 years) amplified the risk (HR = 1.80; 95%CI, 1.33–2.44), supporting temporality. Conclusions Severe periodontitis is significantly associated with ischemic stroke, with a consistent severity‐related trend across studies. Therefore, meticulously diagnosed advanced periodontitis should be considered as a probable vascular risk factor and should prompt interdisciplinary management and patient education. Plain language summary Gum disease (periodontitis) is a very common long‐term inflammatory disease that affects the supporting tissue of the teeth. Increasing evidence suggests that periodontitis may also influence the general health of a person. In this study we focused particularly on ischemic stroke, the most common type of stroke. We analyzed data from multiple long‐term research studies to determine if the severity of gum disease influences the risk of a person developing ischemic stroke. We found that the severe form of gum disease is significantly associated with ischemic stroke risk compared with individuals with healthy gums or a milder form of gum disease. This association is stronger in studies that used standardized diagnostic criteria and in studies with longer follow‐up periods. This suggests that a systematically diagnosed severe gum disease is most likely to contribute to stroke development over time. These findings highlight the importance of early detection to properly manage gum disease. Closer collaboration between dental and medical professionals may improve preventive efforts and patient outcomes.