Introduction:
Periodontal disease (PD) is a chronic inflammatory process that affects gum and teeth. Due to the role of inflammation on atherosclerosis, we assessed the hypothesis that PD is associated with asymptomatic intracranial atherosclerosis (ICAS) in the Atherosclerosis Risk In Communities (ARIC) study.
Methods:
Full-mouth clinical periodontal measurements (7-indices) collected at 6 sites per tooth from 6155 subjects from the Dental Atherosclerosis in Communities Study (DARIC) without prior stroke were used to differentiate seven periodontal profile classes (PPCs). Of this cohort, a stratified subset underwent 3D time-of-flight MR angiogram and 3D high-isotropic resolution black blood MRI. ICAS was graded according to the criteria established by the Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) trial. In this study, we evaluated the relationship between PD status and severe asymptomatic ICAS, defined as ≥50% stenosis.
Results:
Among dentate subjects who underwent vascular imaging, 1033 (90%) had 0-50% ICAS and 112 (10%) had ≥50% ICAS. Compared to participants without gum disease (PPC-A), participants with gingivitis (PPC-C) had significantly higher odds of having ≥50% ICAS (Figure 1; Crude OR 2.1, 95% CI 1.2-3.8, p=0.015). This association strengthened after adjusting for the significant confounding variables: age, hypertension, and LDL cholesterol (Adjusted OR 2.4, 95% CI 1.3-4.5, p=0.006).
Conclusion:
We report a significant association between inflammatory PD class and ≥50% asymptomatic ICAS. Because gingivitis is reversible, future studies are needed to determine if treatment of gingivitis can prevent the development and progression of ICAS, thus reducing the risk of stroke.
Intracranial arterial wall imaging using three-dimensional high isotropic resolution black blood MRI at 3.0 Tesla