Periodontal Disease and Stroke: An Updated Review of Their Association

Objective: To review the literature regarding the association of periodontal disease with stroke that has been gaining interest during the last two decades.
Methods: A search was conducted through MEDLINE and SCOPUS databases for all literature related to the combination of terms “periodontitis” or “periodontal disease” and “stroke” or “cerebrovascular diseases”. The selected articles included cross-sectional, case-control and longitudinal studies, as well as interventional trials published up to August 2014 that were classified according to their design and critically reviewed.
Findings: Periodontal disease appears to be moderately associated with stroke but the nature of their association is not fully elucidated. The great heterogeneity of the reviewed studies does not allow but a rough estimate of its significance either as a causal or risk factor for stroke. Large-scale randomized clinical trials are warranted to determine whether periodontal intervention may contribute to the primary or secondary prevention of atherosclerotic disease and stroke as its end-point.
Conclusion: The bulk of evidence from the reviewed studies suggests that periodontal disease may represent a contributing factor for stroke but further appropriately designed clinical trials, focusing on the impact of periodontal treatment on stroke are necessary.