Dental Disease And Risk Of Stroke

It is a myth that stroke occurs only in elderly adults. In actuality, stroke strikes all age groups, from fetuses still in the womb to centenarians. It is true, however, that older people have a higher risk for stroke than the general population and that the risk for stroke increases with age. For every decade after the age of 55, the risk of stroke doubles, and two-thirds of all strokes occur in people over 65 years old. People over 65 also have a seven-fold greater risk of dying from stroke than the general population. And the incidence of stroke is increasing proportionately with the increase in the elderly population. When the baby boomers move into the over-65 age group, stroke and other diseases will take on even greater significance in the health care field.

Gender also plays a role in risk for stroke. Men have a higher risk for stroke, but more women die from stroke. The stroke risk for men is 1.25 times that for women. But men do not live as long as women, so men are usually younger when they have their strokes and therefore have a higher rate of survival than women. In other words, even though women have fewer strokes than men, women are generally older when they have their strokes and are more likely to die from them.

Stroke seems to run in some families. Several factors might contribute to familial stroke risk. Members of a family might have a genetic tendency for stroke risk factors, such as an inherited predisposition for hypertension or diabetes. The influence of a common lifestyle among family members could also contribute to familial stroke.

The most important risk factors for stroke are hypertension, heart disease, diabetes, and cigarette smoking. Others include heavy alcohol consumption, high blood cholesterol levels, illicit drug use, and genetic or congenital conditions, particularly vascular abnormalities. People with more than one risk factor have what is called “amplification of risk.” This means that the multiple risk factors compound their destructive effects and create an overall risk greater than the simple cumulative effect of the individual risk factors.

Researchers recently demonstrated an association between gum disease and the increased risk of stroke due to potential blockages of the main blood vessels leading to the brain (carotid artery). These blockages, or atheromas, contain calcium and can be detected on dental panoramic radiographs. Given this provocative finding, a UCLA study was conducted to determine if dental disease depicted on a panoramic radiograph is more prevalent among people with atheromas seen on their dental radiograph than among people without atheromas but matched for stroke risk factors (body mass, smoking history, need for medications to control hypertension, hypercholesterolemia, and diabetes). The group with carotid atheromas seen on dental panoramic radiographs was found to have more dental disease, as determined by the number of teeth with decay, missing teeth, and the amount of bone loss around teeth, than the group without any radiographically detectable atheromas. The results of this study indicate that dental disease may play a role in the formation of carotid atheromas in patients already at risk for stroke.

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