Inflammation buccale et accidents vasculaires cérébraux ischémiques non fatals

Abstract

Oral inflammation and occurrence of non-fatal ischemic strokes. Objective: Oral inflammation has been described as a presumed risk factor of stroke with ischemic origin. The objective of this study was to investigate the link between oral inflammation, occurrence of non-fatal ischemic strokes without motor or cognitive sequelae (NIH > 1 and Rankin > 1) and pro-atherosclerotic biomarkers. Materials and methods: A retrospective observational study of 48 cases of ischemic stroke and 47 control patients was conducted at the University Hospital of Dijon. A clinical dental examination and dental panoramic were performed one month after the ischemic stroke. Biological data collected on the day of the ischemic stroke (C-reactive protein or CRP, triglycerides, HDL, LDL, glucose) were analyzed. The vascular risk factors were identified. We estimated the odds ratios (ORs) after adjusting for age and sex. Edentulous patients with recurrent stroke, with a history of immunosuppression, cancer, an infectious or systemic inflammatory syndrome other than oral inflammation, were excluded. Results: Patients in both groups were comparable except for hypertension, which was more common in the 48 cases of ischemic stroke (50% vs. 17%, p = 0.014). In multivariate analysis, we found a higher risk of ischemic strokes in the case of severe periodontal disease compared to low periodontal disease (OR = 5.57; [95% CI: 1.6–18.5]). The DMFT index was significantly higher in ischemic stroke cases (OR = 4.37; [95% CI: 1.78–10.7]). Rates greater than 5mg/l CRP were also associated with the occurrence of ischemic strokes (OR = 5.6 [95% CI: 2– 15.7]). The analysis of the entire study population showed an increased CRP (p > 0.001)) and increased triglycerides (p = 0.001) while HDL levels decreased (p = 0.0056) in patients with severe periodontitis compared to patients with low or no periodontal disease. Conclusion: These results suggest the existence of a link between oral inflammation and the occurrence of ischemic stroke. A lipid and inflammatory profile favouring atheroma was found in patients with severe periodontal disease. The role of oral inflammation in the process of atherosclerosis is evoked. In patients with periodontal disease, the search for biomarkers favouring atherosclerosis could help contribute in the prevention of ischemic strokes. © SFCO, 2013.