Stroke and Gum Disease: New Evidence Shows a Clearer Connection

A new systematic review finds stroke patients consistently have worse gum inflammation strengthening the case for oral health as part of stroke prevention.

Why Look at Oral Health in Stroke Patients?

Stroke remains one of the world’s leading causes of disability and death. While classic risk factors like hypertension, diabetes, and smoking are well-known, researchers have increasingly turned their attention to inflammation as a key driver of stroke.

Periodontitis a chronic inflammatory disease of the gums is one of the most common inflammatory conditions globally. Earlier studies suggested it might also be linked to cardiovascular and cerebrovascular diseases, but the evidence has been inconsistent.

This new study set out to answer a simple but important question:

Do people who experience stroke have worse periodontal inflammation than those who don’t?

What Did the Researchers Do?

A team of researchers from Italy, Spain, Brazil, India, France, Senegal, and Iran conducted a systematic review and meta-analysis following PRISMA guidelines.

They analyzed seven case-control studies involving:

• 723 stroke patients, and

• 787 non-stroke controls

From each study, they extracted key inflammatory periodontal indices:

• Clinical Attachment Loss (CAL) – loss of supporting tissues around teeth

• Probing Pocket Depth (PPD) – depth of gum pockets

• Radiological Bone Loss (RBL) – loss of bone supporting the teeth

• Additional indices when available: plaque index, gingival index, bleeding on probing

Advanced statistical tools including trial sequential analysis (TSA) were used to verify the robustness of results and reduce risk of false-positive findings.

What Did They Find?

Across all periodontal measures, stroke patients consistently showed worse gum health.

1. Clinical Attachment Loss (CAL)

Stroke patients had significantly greater tissue destruction:

+1.04 mm on average compared with controls.

2. Probing Pocket Depth (PPD)

Gum pockets were deeper in stroke patients by:

+0.68 mm on average

3. Radiological Bone Loss (RBL)

Two studies showed a tendency toward more bone loss in stroke patients, though results were less conclusive.

Overall:

The pattern was clear and consistent periodontal inflammation was more severe among people who had experienced a stroke.

Why Does This Matter?

The findings reinforce a growing body of evidence suggesting a biological connection between gum disease and stroke. Possible mechanisms include:

• Bacteria entering the bloodstream from periodontal pockets

• Systemic inflammation triggered by chronic oral infection

• Immune responses that contribute to atherosclerosis and vascular dysfunction

Importantly, stroke survivors often have reduced mobility and dexterity, making oral hygiene more challenging worsening their gum health even further.

This creates a vicious cycle:

stroke may worsen oral health, and poor oral health may increase inflammation that contributes to stroke risk.

What Should We Take From This?

This study highlights an emerging message for clinicians, caregivers, and the public: 

• Oral health is not just about teeth — it is part of systemic health.

• Integrating periodontal care into stroke rehabilitation may help improve outcomes and quality of life.

• Preventive dental check-ups and early treatment of periodontitis could play a role in reducing future stroke risk.

While more prospective studies are needed to understand causality, the evidence is strong enough to encourage closer collaboration between neurologists, dentists, and primary care providers.

Reference

Dioguardi M, Bizzoca ME, Cantore S, Caloro GA, Musella G, Mastrangelo F, Lo Muzio L, Ballini A. Impact of cerebrovascular stroke on inflammatory periodontal indices: a systematic review with meta-analysis and trial sequential analysis of case-control studies. Frontiers in Oral Health. 2024.

DOI: 10.3389/froh.2024.1473744