Relationship between periodontal disease and stroke history in the geriatric population

서지정보

· 발행기관 : 대한치과의사협회
· 수록지 정보 : 대한치과의사협회지 / 44권 / 10호 / 658 ~ 670페이지
· 저자명 : 이효정

초록

The mean age of the population is growing
older；with this aging comes the economic
burden of caring for patients with age-related
diseases. One of the most debilitating diseases of
the elderly is cerebrovascular disease (CVD), or
stroke. The World Health Organization’s (1980)
definition of stroke is：“rapidly developing clinical
signs of focal (at times global) disturbance of
cerebral function, lasting more than 24 hours or
leading to death with no apparent cause other
than that of vascular origin”(1).
Another highly prevalent chronic disease of the
elderly is periodontal disease. Based on the Third
National Health and Nutrition Examination
Survey (NHANES III), 53% of US adults, aged
30 to 90 years old, had 3 millimeters (mm) or
more of attachment loss(2).
The connection between cardiovascular disease
and periodontal disease has been examined, but
results have been obscure(3). For more than 10
years, this relationship has been the focus of
many studies, with specific interest concentrating
on the ability of dental infections to cause
cardiovascular disease(4,5,6). In a meta-analysis of
nine such longitudinal studies, Janket et al.,
concluded that there was a small but significant
increase in the risk of cardiovascular disease
among persons who had periodontal disease at
baseline(7).While most of these studies suggest
that periodontal disease was more frequent in
coronary heart disease patients or ischemic stroke
subjects(8,9,10,11), this finding is not universal, since
other studies could not detect a statistically
significant association(12,13,14,15).
One of difficulty to find relationship between
two diseases is that both disease share common
important risk factors such as age and smoking,
which could lead over adjusting as confounders
in cross- sectional study(16,17).
Other studies have shown that subjects with
periodontal disease have elevated levels of
cardiovascular risk factors, such as C-reactive
protein, fibrinogen, and cholesterol(18,19,20). The
relationship of periodontal disease to
cardiovascular disease is further bolstered by
several recent trials that have reported a
decrease in systemic C-reactive protein (CRP)
after periodontal treatment(21,22,23).
Despite all of these studies, the association
between periodontal disease and stroke remains
unclear, and requires additional research until a
clear consensus is reached. Few studies have
been performed on large populations, with the
most notable studies utilizing data from the
NHANES I Follow-up Study(9,13,15,24). Since the
information collected was from 1970 and was
based on the Russell index with only visual
examination and no periodontal probing, it may
not accurately reflect the relationship of
cumulative periodontal disease to stroke. In
addition, no adjustment for C-reactive protein
was available from NHANES I data. Hence, it is
the aim of this study to use the more recent
NHANES III study population to examine the
association between cumulative periodontal
disease and stroke history in the elderly.

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