Periodontitis is an inflammatory oral disease that can have serious consequences for the whole organism because those affected have a 1.7 times greater risk of developing Alzheimer’s and 2.8 times more risk of suffering an ischemic stroke, according to the report ‘Periodontitis and Neurological Diseases ‘ of the Spanish Society of Periodontics and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN). The good news is that another of his conclusions is that various interventions to care for oral health can reduce the risk of suffering from these neurological problems.
In the report – which was presented at a press conference on May 11 – two of the neurological diseases for which there is the greatest scientific evidence of their relationship with periodontitis have been analyzed: cerebrovascular disease and dementia. Dr. Paula Matesanz, vice-president of SEPA, has pointed out that “the results of the report show that periodontitis increases the risk of suffering from ischemic stroke and Alzheimer’s-type dementia”. According to Dr. José Miguel Láinez, president of the Spanish Society of Neurology (SEN), “risk markers such as periodontitis are of great help in trying to avoid, reduce or minimize the impact of these neurological disorders.”
Studies carried out in recent years point to a potential link between periodontitis and some neurological diseases. “From this arises the need to review the scientific evidence of this relationship, as well as the interest in drawing some conclusions and advice on how to act with patients with periodontitis and neurological diseases, which are useful for both the dentist and the neurologist and In short, for the general population”, declared Dr. Miguel Carasol, coordinator of the SEPA working groups.
Inflammation: risk factor for neurological diseases
Based on epidemiological data from studies evaluated in this report, “it is estimated that people with periodontitis have a 1.7 times greater risk of suffering from Alzheimer’s dementia and a 2.8 times greater risk of suffering an ischemic stroke than people with periodontitis healthy”, highlights Dr. Yago Leira, periodontist and coordinator of the SEPA-SEN working group, who recalls that “periodontal disease is very frequent among the adult population (it is estimated that 8 out of 10 Spaniards have some degree or type of periodontal disease)”; In addition, as Dr. Ana Frank, head of the Neurology Service of the La Paz University Hospital (Madrid) and member of the SEPA-SEN group, points out, “this gum disease is especially common among the elderly population, although it generally goes unnoticed and/or or not enough attention is paid to it.
“It is estimated that people with periodontitis have a 1.7 times greater risk of suffering from Alzheimer’s dementia and a 2.8 times greater risk of suffering an ischemic stroke than periodontally healthy people”
Now, as Dr. Frank advises, “it would be very important to have epidemiological studies that confirm this relationship and, above all, studies that help us to know in detail the mechanisms involved.” In this sense, the suspicions revolve, fundamentally, on the inflammatory hypothesis; Specifically, as this expert explains, “it is speculated that this link may be due to the inflammatory effect produced by periodontitis, a chronic, low-grade but persistent inflammation in the body that triggers an inflammatory cascade, which ends up not only causing negative consequences at a neurological level but also in other target organs, which would also explain its incidence in cardiovascular health or diabetes”.
Specifically, in ischemic cerebrovascular disease, there is experimental evidence on how the chronic immunoinflammatory response of periodontitis triggers a prothrombotic state of hypercoagulability and vascular endothelial dysfunction that can increase the risk of cerebral embolism/thrombosis.
In the case of Alzheimer’s disease, according to the periodontist Yago Leira, “a multitude of animal studies have shown that the bacteremia and endotoxemia that occur in periodontitis, together with a state of chronic low-grade inflammation, contribute significantly to significantly to the development of neurodegenerative processes involved in cognitive dysfunction, such as neuroinflammation and neuronal death, the formation of senile plaques due to deposits of amyloid beta peptides, as well as the appearance of neurofibrillary tangles due to hyperphosphorylation of the Tau protein”.
Periodontal treatment to prevent neurological disorders
There are no clinical trials that have evaluated the effects of periodontal treatment in reducing the risk of stroke and dementia, but as indicated in the SEPA-SEN report, various observational studies have been published that suggest that different oral health interventions can reduce the risk of suffer stroke or dementia.
In any case, and the results of all these studies are still pending, “there is no doubt that, as this SEPA-SEN Report teaches us, we can and must do something now,” says Anne Frank. In her opinion, “in the light of this work, two very concrete and practical actions can now be carried out: 1) dental clinics in Spain should be aware of and disseminate this report; 2) through the Spanish Society of Neurology, we are going to insist to all neurologists on the importance of periodontal health in their patients and, furthermore, we are going to recommend that in all their patient reports (regardless of the neurological disease who suffers) state specific preventive advice on oral health (insisting on daily tooth brushing, regular visits to the dentist,…)”.
On this last aspect, Dr. José Miguel Láinez, president of the SEN, insists that “neurologists must be aware that the presence of a periodontal disease, such as periodontitis, can increase the incidence and be an important risk factor for some types of dementia or stroke. And, for this reason, he adds, “we must recommend to our patients that they take extreme care and review their oral health, including these indications within the general health advice that we offer them.”
For her part, as the vice-president of SEPA points out, “dentists need to know that periodontitis is related to a greater risk of stroke and Alzheimer’s disease.” Therefore, clarifies Dr. Yago Leira, “it is of vital importance that in dental offices we are able to screen patients with possible vascular risk factors that are related to neurological diseases such as hypertension or diabetes.” On the other hand, according to the coordinator of the SEPA-SEN working group, “in our clinics we care for thousands of patients who suffer from a neurological disease and we will have to be in contact with our neurologist colleagues to be able to offer these patients the best possible treatment.” , with an adequate handling adapted to each case”.
To achieve the success of these measures, it is necessary to disseminate among the general population the information that relates periodontal health and neurological health. “Carrying out information and awareness campaigns would be a first step so that the message derived from this report can reach society, and thus the possible neurological risk associated with diseased gums is known,” says Dr. Leira. , who is committed to “promoting among the general population the message that oral health goes hand in hand with general health: the mouth is part of the human body!”.
Source: Spanish Society of Periodontics and Osseointegration (SEPA) and Spanish Society of Neurology (SEN)
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