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. 2024 Jan;55(1):40-49.
doi: 10.1161/STROKEAHA.123.042528. Epub 2023 Nov 29.

Dental Caries, Race and Incident Ischemic Stroke, Coronary Heart Disease, and Death

Souvik Sen  1 , Lawson Logue  1 , Makenzie Logue  1 , Elizabeth A L Otersen  1 , Emma Mason  1 , Kevin Moss  2 , James Curtis  3 , David Hicklin  3 , Cynthia Nichols  3 , Wayne D Rosamond  2 , Rebecca F Gottesman  4 , James Beck  2
Affiliations

Dental Caries, Race and Incident Ischemic Stroke, Coronary Heart Disease, and Death

Souvik Sen et al. Stroke. 2024 Jan.

Abstract

Background: Dental caries is a highly prevalent disease worldwide. In the United States, untreated dental caries is present in >1 in 5 adults. The objective of this study was to determine the relationship between dental caries and incident ischemic stroke, coronary heart disease (CHD) events, and death.

Methods: The dental cohort (n=6351) of the ARIC study (Atherosclerosis Risk in Communities) was followed for incident ischemic stroke, CHD event, and all-cause mortality. Of all the participants at visit 4 (n=11 656), those who were unable to go through dental examination, or with prevalent ischemic stroke and CHD events, were excluded. The full-mouth dental examination was conducted at visit 4 (1996-1998), assessing dental caries. The dose response of decayed, missing, and filled surfaces due to caries was assessed and related to the outcome. Outcomes were assessed through the end of 2019. Additionally, the effect of regular dental care utilization on dental caries was evaluated.

Results: Participants with ≥1 dental caries had an increased risk of stroke (adjusted hazard ratio [HR], 1.40 [95% CI, 1.10-1.79]) and death (adjusted HR, 1.13 [95% CI, 1.01-1.26]) but not for CHD events (adjusted HR, 1.13 [95% CI, 0.93-1.37]). The association of dental caries and ischemic incident stroke was significantly higher in the African American population compared with the White subgroup (interaction term P=0.0001). Increasing decayed, missing, and filled surfaces were significantly associated with stroke (adjusted HR, 1.006 [95% CI, 1.001-1.011]) and death (adjusted HR, 1.003 [95% CI, 1.001-1.005]) but not CHD (adjusted HR, 1.002 [95% CI, 1.000-1.005]). Regular dental care utilization lowered (adjusted odds ratio, 0.19 [95% CI, 0.16-0.22]; P<0.001) the chance of caries.

Conclusions: Among the cohort, dental caries was independently associated with the risk of ischemic stroke and death, with the effect higher in African American participants. Regular dental care utilization was associated with a lower chance of caries, emphasizing its relevance in the prevention of these events.

Keywords: adult; coronary disease; dental caries; periodontal diseases; stroke.

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Conflict of interest statement

Disclosures Dr Gottesman previously received grants from the National Institutes of Health (NIH)/National Institute on Aging, NIH/National Heart, Lung and Blood Institute, and NIH/National Institute of Neurological Disorders and Stroke. The other authors report no conflicts.

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