It is well known among dental practitioners that oral health has a strong association with general health, but patients may be less familiar with this. As such there is a need for patient awareness to be improved, particularly on the impact that neglecting their oral hygiene can have on the rest of the body.
Among adults, strokes are one of the leading causes of disability and mortality in the UK. Over 100k people have a stroke each year. Of major concern to dental practitioners is the link between oral disease and strokes: patients with periodontitis are around twice as likely to have a stroke, whilst patients who have had strokes are at a greater risk of infection in the oral cavity due to inadequate hygiene. Practitioners can help with both circumstances.
Raising awareness
Strokes are not curable, but the wider public awareness of FAST (Face, Arms, Speech, Time) has improved the speed at which patients can be diagnosed and treated. Whilst FAST and innovations in emergency treatments have led to a decrease in fatalities, strokes remain the fourth single leading cause of death in the UK.
There are two types: haemorrhagic strokes and ischaemic strokes. The former are caused by blood vessels that burst in the brain and are associated with high mortality. Ischaemic strokes are caused by a blockage, such as a clot, which starves the brain of blood and oxygen. Eighty five per cent of strokes are ischaemic strokes.
Controlling the risks
There are many risk factors for strokes, such as age, diet, education, exercise, smoking, alcohol consumption, stress, diabetes, hypertension and cardiovascular disease. For patients who are more at risk of having a stroke, periodontitis is also a concern as it heightens the risk: there is a higher prevalence rate and a lower survival rate of strokes in patients with periodontal disease compared to those with gingivitis.
Periodontitis causes inflammation which affects the supporting structures of the teeth, including the gingivae, alveolar bone and periodontal ligament. Bleeding of the gingivae can be common, leading to the infectious bacteria responsible for the disease entering the bloodstream. The bacteria can also reach the circulatory system through eating, chewing and toothbrushing.
The presence of infectious bacteria in the bloodstream causes the body to react, leading to a rise in C-reactive proteins and IL-6 that inflame the blood vessels and reduce the blood flow to the brain. These inflammatory markers are indicators for an increased stroke risk and are also identified as biomarkers of periodontitis. A consistent and effective oral hygiene routine can prevent periodontitis, minimising the risk of inflammation in the bloodstream.
Post-stroke worries
In addition to being a risk factor for strokes, periodontitis prevalence can also increase for patients who have had a stroke. There are 1.3m stroke survivors in the UK, and many have poor oral hygiene. After a stroke, neurons begin to die within minutes when the oxygen supply is cut off, leading to brain damage and the subsequent impairment of certain bodily functions like movement, memory and speech.
Disability in the face, hands and arms can prevent stroke patients from effectively brushing their teeth. This can lead to oral health neglect, which is why support in their oral hygiene routine is needed to protect them from further complications. Moreover, inflammation may lead to stroke recurrence and less favourable outcomes; preventing gingival disease or periodontitis can help reduce this likelihood.
It is also likely that stroke survivors develop dysphagia; the reduced ability to swallow increases the risk of bacterial colonisation in the oral cavity, with saliva or bolus lingering in the oral cavity. Infection from these particles can lead to aspiration pneumonia, so maintaining a consistent oral hygiene routine can reduce the presence of harmful bacteria and prevent further health complications.
A suitable solution
An effective and reliable interdental brush can protect the teeth and gingivae from disease. The Flexi series of interdental brushes, from Tandex, includes 11 different sizes for optimal access. Able to clean the tooth surface and massage the gums, using Flexi is an effective way to reduce the risk of infection. With a flexible handle and a brush that can be shaped for user preference, this is an interdental brush for comfort. Use with Prevent Gel, from Tandex, for an antibacterial boost and a fluoride flourish.
Chronic exposure to common infections contributes to stroke risk. Preventing oral diseases among those vulnerable to strokes can better protect them, maintaining their quality of life.
References available on request.
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