Better oral hygiene is associated with lower risk of stroke

Yoonkyung Chang; Ho Geol Woo; Ji Sung Lee; Tae Jin Song

doi:10.1002/JPER.20-0053

Better oral hygiene is associated with lower risk of stroke

Yoonkyung Chang, Ho Geol Woo, Ji Sung Lee, Tae Jin Song

Department of Neurology

Research output: Contribution to journal › Article › peer-review

52 Scopus citations

Abstract

Background: Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. Methods: From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. Results: The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73–0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13–1.44). Conclusions: Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.

Original language	English
Pages (from-to)	87-94
Number of pages	8
Journal	Journal of Periodontology
Volume	92
Issue number	1
DOIs	https://doi.org/10.1002/JPER.20-0053
State	Published - Jan 2021

Bibliographical note

Funding Information:
This project was supported by grant (2018R1D1A1B07040959) from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. Drs. Chang, Woo, Lee and Song report no other conflicts of interest related to this study. The authors have no conflicts of interest to declare. Yoonkyung Chang,, Ho Geol Woo and Tae‐Jin Song, contributed to conception and design of the study, data acquisition, analysis and interpretation of results, and drafted and critically revised the manuscript; Ji Sung Lee, contributed to design of the study, data acquisition and interpretation, and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work.

Publisher Copyright:
© 2020 American Academy of Periodontology

Keywords

cerebral hemorrhage
cerebral infarction
oral hygiene
stroke
subarachnoid hemorrhage
toothbrushing

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10.1002/JPER.20-0053

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@article{867dccc6c9df415c9dd4c321f5ba4ec0,

title = "Better oral hygiene is associated with lower risk of stroke",

abstract = "Background: Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. Methods: From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. Results: The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73–0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13–1.44). Conclusions: Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.",

keywords = "cerebral hemorrhage, cerebral infarction, oral hygiene, stroke, subarachnoid hemorrhage, toothbrushing",

author = "Yoonkyung Chang and Woo, {Ho Geol} and Lee, {Ji Sung} and Song, {Tae Jin}",

note = "Funding Information: This project was supported by grant (2018R1D1A1B07040959) from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. Drs. Chang, Woo, Lee and Song report no other conflicts of interest related to this study. The authors have no conflicts of interest to declare. Yoonkyung Chang,, Ho Geol Woo and Tae‐Jin Song, contributed to conception and design of the study, data acquisition, analysis and interpretation of results, and drafted and critically revised the manuscript; Ji Sung Lee, contributed to design of the study, data acquisition and interpretation, and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work. Publisher Copyright: {\textcopyright} 2020 American Academy of Periodontology",

year = "2021",

month = jan,

doi = "10.1002/JPER.20-0053",

language = "English",

volume = "92",

pages = "87--94",

journal = "Journal of Periodontology",

issn = "0022-3492",

publisher = "John Wiley & Sons Inc.",

number = "1",

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T1 - Better oral hygiene is associated with lower risk of stroke

AU - Chang, Yoonkyung

AU - Woo, Ho Geol

AU - Lee, Ji Sung

AU - Song, Tae Jin

N1 - Funding Information: This project was supported by grant (2018R1D1A1B07040959) from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education. Drs. Chang, Woo, Lee and Song report no other conflicts of interest related to this study. The authors have no conflicts of interest to declare. Yoonkyung Chang,, Ho Geol Woo and Tae‐Jin Song, contributed to conception and design of the study, data acquisition, analysis and interpretation of results, and drafted and critically revised the manuscript; Ji Sung Lee, contributed to design of the study, data acquisition and interpretation, and critically revised the manuscript. All authors gave final approval and agreed to be accountable for all aspects of the work. Publisher Copyright: © 2020 American Academy of Periodontology

PY - 2021/1

Y1 - 2021/1

N2 - Background: Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. Methods: From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. Results: The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73–0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13–1.44). Conclusions: Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.

AB - Background: Periodontal disease or poor oral hygiene may lead to local infection, inflammation, and systemic inflammatory reactions, which are important mediators of development of stroke. We aimed to investigate the association of oral hygiene with risk of stroke in a nationwide population-based cohort. Methods: From Korean National Health Insurance System-Health Screening Cohort, 206,602 participants without missing data regarding demographic information, medical history, or blood/urine examination results were included. The presence of periodontal disease and indicators of oral hygiene, such as number of tooth brushings, dental visit history, dental scaling, and number of teeth loss and dental caries were evaluated. Occurrence of stroke including cerebral infarction, cerebral hemorrhage, and subarachnoid hemorrhage was defined as newly registration of International Classification of Diseases-10 codes from I60 to I64 accompanying brain CT and/or MR examination at that time of diagnosis. Results: The 7337 (3.6%) cases of stroke including 5795 (79.0%) cases of cerebral infarction, 1568 (21.4%) cases of cerebral hemorrhage, and 621 (8.5%) cases of subarachnoid hemorrhage occurred during a median 10.4 years follow-up. In multivariable analysis, frequent tooth brushing (≥3 times per day) was negatively associated with risk of stroke occurrence (hazard ratio [HR]: 0.78, 95% confidence interval [CI]: 0.73–0.84). Number of dental caries (≥4) was positively related to stroke occurrence (HR: 1.28, 95% CI: 1.13–1.44). Conclusions: Regular oral hygiene behavior was negatively, and infrequent oral hygiene care was positively associated with risk of occurrence for stroke, respectively. Brushing one's teeth three or more times daily may be associated with lower risk of stroke.

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Better oral hygiene is associated with lower risk of stroke

Abstract

Bibliographical note

Keywords

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