Having this disease doubles the risk of Alzheimer's and triples that of stroke

Having iron health implies having many factors under control that are not always easy to control. In fact, behind the appearance of some diseases as common as dementia, Alzheimer's or stroke, a lesser-known pathology may lurk, but with a fundamental importance that hides in our mouths.. Periodontitis not only increases the risk of ischemic stroke and Alzheimer's dementia, but different oral health interventions are also considered to reduce the risk of these neurological disorders. This is clear from a rigorous and exhaustive consensus report carried out by the joint working group of the Spanish Society of Periodontics and Osseointegration (SEPA) and the Spanish Society of Neurology (SEN) that has been released today.

In recent years, new studies have accumulated that point to a suggestive link between periodontitis and some neurological diseases.. As Dr. Miguel Carasol, coordinator of the SEPA working groups, points out, “hence 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, ultimately, for the general population”. As the vice-president of SEPA, Dr. Paula Matesanz, states, “the result of the report shows that periodontitis increases the risk of suffering from ischemic stroke and Alzheimer's-type dementia”. In addition, 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”.

Of all the neurological diseases, this report has analyzed the two for which there is the greatest scientific evidence of their relationship with periodontitis: cerebrovascular disease and dementia.. As revealed by Dr. José Vivancos, a neurologist and member of the SEPA-SEN working group, “the main difficulty in preparing the report has been to synthesize all the available literature on the subject, as well as to include, to the extent possible, studies with a good methodological quality”. Thus, the report reports the evidence from three clearly defined points: the epidemiological association between periodontitis and these two neurological diseases, the biological mechanisms that can explain these associations, and intervention studies on the effect of periodontal treatment as a primary or secondary preventive measure. of stroke and dementia.

epidemiological association

Neurological diseases, among which cerebrovascular diseases and dementia stand out due to their frequency and morbidity and mortality, constitute a serious public health problem, with the enormous disability problems that they entail being very relevant.. In recent years, given the known risk factors in the onset and progression of these diseases, it has been assessed that periodontitis may somehow influence the etiopathogenesis of these neurological conditions.

Based on the epidemiological data extracted 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 periodontally healthy people.” ”, 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 at Hospital Universitario La Paz (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.

Inflammation, presumed “culprit”

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 may increase the risk of cerebral embolism/thrombosis..

In the case of Alzheimer's disease, according to the periodontist Leira, “multiple animal studies have shown that bacteremia and endotoxemia that occur in periodontitis, together with a state of low-grade chronic inflammation, contribute 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.. Therefore, as explained in this report, there are different pathophysiological mechanisms studied in experimental models that support the biological plausibility of the epidemiological association.

The “neurological” benefits of periodontal treatment

Currently, there are no randomized clinical trials that study the impact of periodontal treatment in reducing the risk of stroke and dementia, and there are no intervention studies on secondary prevention of these pathologies.. However, as clarified in the SEPA-SEN report, various observational studies have been published suggesting that different oral health interventions can reduce the risk of 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”, says Anne Frank. In his 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,…)”.

Láinez, president of the SEN, emphasizes this last aspect, who 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.”

And it is that neurologists can play a key role when it comes to screening patients with signs of periodontal disease, and thus be able to refer them to the dentist for diagnosis and, if necessary, receive correct dental treatment.

For her part, as the vice-president of SEPA points out, “dentists need to know that periodontitis is related to an increased risk of stroke and Alzheimer's disease”. For this reason, Dr. Leira clarifies that “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”.