The association between cumulative periodontal disease and stroke history in older adults

Hyo Jung Lee, Raul I. Garcia, Sok Ja Janket, Judith A. Jones, Ana Karina Mascarenhas, Thayer E. Scott, Martha E. Nunn

Research output: Contribution to journalArticle

37 Citations (Scopus)

Abstract

Background: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS 1, based on the median percentage of sites with ≥2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with ≥3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. Results: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. Conclusions: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.

Original languageEnglish
Pages (from-to)1744-1754
Number of pages11
JournalJournal of Periodontology
Volume77
Issue number10
DOIs
StatePublished - Oct 2006
Externally publishedYes

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Periodontal Diseases
Health Status
Stroke
Logistic Models
Periodontal Attachment Loss
Nutrition Surveys
Social Adjustment
Tobacco Use
Tooth
Regression Analysis
Health Status Indicators
Periodontal Index
Tooth Loss
Cross-Sectional Studies
History

All Science Journal Classification (ASJC) codes

  • Dentistry(all)

Cite this

Lee, H. J., Garcia, R. I., Janket, S. J., Jones, J. A., Mascarenhas, A. K., Scott, T. E., & Nunn, M. E. (2006). The association between cumulative periodontal disease and stroke history in older adults. Journal of Periodontology, 77(10), 1744-1754. https://doi.org/10.1902/jop.2006.050339

The association between cumulative periodontal disease and stroke history in older adults. / Lee, Hyo Jung; Garcia, Raul I.; Janket, Sok Ja; Jones, Judith A.; Mascarenhas, Ana Karina; Scott, Thayer E.; Nunn, Martha E.

In: Journal of Periodontology, Vol. 77, No. 10, 10.2006, p. 1744-1754.

Research output: Contribution to journalArticle

Lee, HJ, Garcia, RI, Janket, SJ, Jones, JA, Mascarenhas, AK, Scott, TE & Nunn, ME 2006, 'The association between cumulative periodontal disease and stroke history in older adults', Journal of Periodontology, vol. 77, no. 10, pp. 1744-1754. https://doi.org/10.1902/jop.2006.050339
Lee HJ, Garcia RI, Janket SJ, Jones JA, Mascarenhas AK, Scott TE et al. The association between cumulative periodontal disease and stroke history in older adults. Journal of Periodontology. 2006 Oct;77(10):1744-1754. https://doi.org/10.1902/jop.2006.050339
Lee, Hyo Jung ; Garcia, Raul I. ; Janket, Sok Ja ; Jones, Judith A. ; Mascarenhas, Ana Karina ; Scott, Thayer E. ; Nunn, Martha E. / The association between cumulative periodontal disease and stroke history in older adults. In: Journal of Periodontology. 2006 ; Vol. 77, No. 10. pp. 1744-1754.
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abstract = "Background: Since the late 1980s, several studies have been conducted to investigate the relationship between periodontal disease and ischemic stroke. The purpose of this study is to investigate the relationship of periodontal disease to the self-reported history of stroke in the elderly (60 years of age and older) by examining the data of the Third National Health and Nutrition Examination Survey (NHANES III). Methods: Data from NHANES III, a large population-based cross-sectional survey of the United States, were used for this study. Because 1,563 of the 5,123 subjects in the study were edentulous, and periodontal disease is a major cause of tooth loss, it was necessary to account for edentulousness in the statistical analysis to avoid bias. Hence, a new index called the periodontal health status (PHS) index was developed to address this problem. Two measures of PHS were developed: PHS 1, based on the median percentage of sites with ≥2 mm clinical attachment loss (CAL), and PHS II, based on the median percentage of sites with ≥3 mm CAL. Multiple logistic regression analysis was used to test for the association of PHS with stroke history. Two types of a multiple logistic regression model were fit: 1) logistic regression modeling with adjustment for age and tobacco use only; and 2) logistic regression modeling with adjustment of all statistically significant confounders. Results: Based on multiple logistic regression analysis of PHS with adjustment for age and tobacco use only, completely edentulous elderly adults (PHS Class 5) and partially edentulous (teeth in one arch) elderly adults with appreciable clinical attachment loss (PHS Class 4) were significantly more likely to have a history of stroke compared to dentate adults (teeth in both arches) without appreciable clinical attachment loss (PHS Class 1). When multiple logistic regression models were fit with adjustment of all significant confounders, no statistically significant association was found between PHS and stroke. Conclusions: Based on the results of this study, there is evidence of an association between cumulative periodontal disease, based on PHS, and a history of stroke. However, it is unclear whether cumulative periodontal disease is an independent risk factor for stroke or a risk marker for the disease.",
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AU - Scott, Thayer E.

AU - Nunn, Martha E.

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