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Tooth loss is associated with atherosclerosis and a poorer functional outcome among stroke patients

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Abstract

Objectives

The purpose of the study was twofold: (1) to test the hypothesis that tooth loss is independently associated with carotid atherosclerotic burden (CAB) among individuals with ischemic stroke (IS) or transient ischemic attack (TIA) and (2) to test the association between tooth loss and disability following the occurrence of cerebral ischemia.

Materials and methods

This observational study included 418 patients with IS or TIA. Tooth loss and the CAB were measured through a head and neck multidetector computed tomography angiography. CAB was analyzed in both common, internal, and external carotid arteries and classified in five levels of vascular occlusion. The modified Rankin Scale (mRS) was used to evaluate the functional outcome at patient discharge. Health records provided information on sociodemographic and medical covariates. The association between CAB and tooth loss, as well as between tooth loss and subtypes of cerebral ischemia were estimated through Poisson regression. Cox regression was carried out to evaluate the association between tooth loss and the mRS, with α = 5%.

Results

Mean age was 65.6 ± 13.8 years, with 52.4% males. Multivariate analyses revealed that severe tooth loss (> 23 missing teeth) was independently associated with CAB ≥ 50% (PR = 2.86, 95% CI = 1.19–6.89) and mRS scores (> 2) (HR = 1.97, 95% CI = 1.10–3.75).

Conclusion

Tooth loss was independently associated with CAB and predicted a poorer functional outcome among IS and TIA patients.

Clinical relevance

Clinical assessment of tooth loss may provide important information on risk for CAB and poorer functional outcome among stroke patients.

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Funding

This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil-Finance Code 001.

Author information

Authors and Affiliations

  1. Graduate Program in Dentistry, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul, 6681 Av. Ipiranga, prédio 6, 90619900, Porto Alegre, RS, Brazil

    Thayana S. Leao & Maximiliano S. Gomes

  2. Department of Advanced Oral Sciences and Therapeutics, University of Maryland School of Dentistry, Baltimore, MD, USA

    Thayana S. Leao & Mark A. Reynolds

  3. Neurology Department of Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil

    Gustavo Tomasi, Lucas Conzatti & Luiz P. Marrone

  4. Department of Preventive Dental Sciences, College of Dentistry, Iman Abdulrahman bin Faisal University, Dammam, Saudi Arabia

    Maria S. Ibrahim

  5. Postgraduate Program in Promotion Health (PPGProSaude), Lutheran University of Brazil (ULBRA), Canoas, Rio Grande do Sul, Brazil

    Luiz P. Marrone

  6. Medical and Dental Center of the Military Police of Rio Grande do Sul, Porto Alegre, Brazil

    Maximiliano S. Gomes

Authors
  1. Thayana S. Leao
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  2. Gustavo Tomasi
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  3. Maria S. Ibrahim
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  5. Luiz P. Marrone
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  6. Mark A. Reynolds
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  7. Maximiliano S. Gomes
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Contributions

Leão TS contributed to the study concept and design, acquisition of data, statistical analysis, analysis and interpretation of data, drafting of the manuscript, and approval of the final version of the manuscript. Tomasi G contributed to acquisition of data, analysis and interpretation of data, and approval of the final version of the manuscript. Ibrahim MS contributed to statistical analysis, analysis and interpretation of data, and approval of the final version of the manuscript. Conzatti L contributed to acquisition of data, statistical analysis, and approval of the final version of the manuscript. Marrone LP contributed to the study concept and design, analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript. Reynolds MA contributed to analysis and interpretation of data, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript. Gomes MS contributed to the study concept and design, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, and approval of the final version of the manuscript. All authors gave their final approval and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Thayana S. Leao or Maximiliano S. Gomes.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Leao, T.S., Tomasi, G., Ibrahim, M.S. et al. Tooth loss is associated with atherosclerosis and a poorer functional outcome among stroke patients. Clin Oral Invest 24, 4541–4548 (2020). https://doi.org/10.1007/s00784-020-03319-z

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  • DOI: https://doi.org/10.1007/s00784-020-03319-z

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