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Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis

Authors Fagundes NCF, Almeida APCPSC, Vilhena KFB, Magno MB, Maia LC, Lima RR

Received 4 February 2019

Accepted for publication 1 August 2019

Published 6 November 2019 Volume 2019:15 Pages 519—532


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Magnus Bäck

Nathalia Carolina Fernandes Fagundes,1,2 Anna Paula Costa Ponte Sousa Carvalho Almeida,1 Kelly Fernanda Barbosa Vilhena,1 Marcela Baraúna Magno,3 Lucianne Cople Maia,3 Rafael Rodrigues Lima1

1Laboratory of Functional and Structural Biology, Institute of Biological Sciences, Universidade Federal do Pará, Belém-Pará, Brazil; 2School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada; 3Department of Pediatric Dentistry and Orthodontics, School of Dentistry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

Correspondence: Rafael Rodrigues Lima
Laboratory of Structural and Functional Biology, Institute of Biological Sciences, Federal University of Pará, Rua Augusto Corrêa nº 1, Guamá, Belém 66075-900, PA, Brazil

Abstract: This systematic review and meta-analysis investigate the association between periodontitis and stroke. This review followed the methods established by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Searches were conducted in five databases and two sources of grey literature. After the selection of the articles, a risk of bias evaluation was performed. Three meta-analyzes were performed: Assessing the overall association between stroke and periodontitis in case–control studies; Ischemic stroke and periodontitis in case–control studies; The association between stroke and periodontitis in cohort studies. Heterogeneity was assessed using the I2 index and the odds ratio was also calculated (p < 0.05). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to evaluate the level of evidence. 2193 potentially relevant studies were identified, with 10 studies included in qualitative and quantitative analysis. All the articles were considered with low risk of bias and a low level of certainty. The results demonstrated a positive association between both disorders and increased risk for stroke among cohort studies (RR 1.88 [1.55, 2.29], p<0.00001, I2=0%) and for ischemic stroke events in case–control studies (RR 2.72 [2.00, 3.71], p<0.00001, I2= 4%). Periodontitis may represent a risk factor for stroke, especially in ischemic events. However, new studies with a robust design are necessary for a reliable conclusion.

Keywords: central nervous system, cerebrovascular disorders, stroke, periodontitis, periodontal attachment loss

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