Oral Health, Periodontal Disease, Oral Microbiome and Stroke Risk: Mechanisms and Translational Potential

The occurrence of periodontal disease and oral dysbiosis has become relevant as contributing to stroke risk. The systematic review involves the analysis of recent (within the last ۱۰ years) articles that have investigated the relationship between oral health (particularly periodontitis) and stroke with a focus on underlying mechanisms and translational consequences. We identified epidemiological, clinical, and mechanistic studies in PubMed and other connected databases that could connect periodontal disease, the oral microbiome, and stroke. It is always evidenced that periodontitis is positively related to the occurrence of stroke, especially ischemic stroke. The new oral microbiome studies indicate unique microbial phenotypes (e.g., overgrowth of some Gram-negative species) in stroke patients. Mechanistically, systemic inflammation (high CRP, IL-۶) and endothelial dysfunction are mediated by chronic periodontal infection, and atherosclerosis is directly accelerated by periodontal pathogens (e.g., Porphyromonas gingivalis). Experimental periodontitis promotes cerebral ischemic injury through NLRP۳ inflammasome-mediated neuroinflammation, which is confirmed by animal models. Periodontal treatment and excellent oral health decrease systemic inflammatory levels and cardiovascular danger scores. These results indicate an oral-brain connection between oral and cerebral health. The translational potentials involve application of oral biomarkers (microbial or inflammatory) to determine high-risk individuals and incorporate periodontal care in stroke prevention. More clinical trials are encouraged to confirm that oral health can be improved to decrease the incidence of stroke.

Keywords:

Oral health , Periodontal disease , Oral microbiome , Stroke , Atherosclerosis