Periodontitis as a risk factor for cerebrovascular accident: a case-control study in the Indian population

J Periodontal Res. 2010 Apr;45(2):223-8. doi: 10.1111/j.1600-0765.2009.01220.x. Epub 2009 Sep 23.


Background and objective: Chronic infections have been reported to be risk factors for coronary heart disease and ischemic stroke. However, the association of coronary heart disease and ischemic stroke with periodontal disease, which is also a chronic inflammatory disease, needs to be evaluated. The present case-control study was designed to determine if an association exists between periodontal disease and cerebrovascular accident in the Indian population.

Material and methods: This case-control study consisted of 200 subjects (100 cases and 100 controls) who were 33-68 years of age. Cases were examined within 5 d after their first acute ischemic attack. Clinical parameters recorded included plaque index, gingival index, probing pocket depth and clinical attachment loss. The medical questionnaire collected information on family history of stroke, dietary history, history of smoking and history of alcohol consumption. Cases were additionally scrutinized for diabetes, hypertension and total serum cholesterol level. The education level of patients was also considered.

Results: The mean plaque index, gingival index, probing pocket depth and clinical attachment loss values of subjects with cerebrovascular accident were significantly higher when compared with those of the control group (p < 0.05). In fully adjusted logistic regression analysis, a probing pocket depth of > 4.5 mm was found to be the most significant factor for stroke (odds ratio = 8.5; confidence interval = 1.1-68.2) followed by hypertension (odds ratio = 7.6; confidence interval = 3.3-17.1) and smoking (odds ratio = 3.1; confidence interval = 1.3-7.4).

Conclusion: The data from this study support the proposed link between periodontitis and cerebrovascular accident in the Indian population. However, further studies are necessary to verify and quantify the role of oral infections and genetic factors in the process of atherosclerosis.

Publication types

  • Comparative Study

MeSH terms

  • Adult
  • Aged
  • Alcohol Drinking / adverse effects
  • Brain Ischemia / etiology
  • Case-Control Studies
  • Cholesterol / blood
  • Dental Plaque Index
  • Diabetes Complications
  • Diet
  • Educational Status
  • Female
  • Gingivitis / classification
  • Humans
  • Hypertension / complications
  • India
  • Ischemic Attack, Transient / etiology
  • Male
  • Medical History Taking
  • Middle Aged
  • Periodontal Attachment Loss / classification
  • Periodontal Index
  • Periodontal Pocket / classification
  • Periodontitis / classification
  • Periodontitis / complications*
  • Risk Factors
  • Smoking / adverse effects
  • Stroke / etiology*
  • Stroke / genetics


  • Cholesterol