Periodontitis is associated with an increased risk of ischemic stroke, and the risk may be particularly high among young people with unexplained stroke etiology. Thus, we investigated in a case-control study whether periodontitis or recent invasive dental treatments are associated with young-onset cryptogenic ischemic stroke (CIS). We enrolled participants from a multicenter case-control SECRETO study including adults aged 18 to 49 y presenting with an imaging-positive first-ever CIS and stroke-free age- and sex-matched controls. Thorough clinical and radiographic oral examination was performed. Furthermore, we measured serum lipopolysaccharide (LPS) and lipotechoic acid (LTA) levels. Multivariate conditional regression models were adjusted for stroke risk factors, regular dentist visits, and patent foramen ovale (PFO) status. We enrolled 146 case-control pairs (median age 41.9 y; 58.2% males). Periodontitis was diagnosed in 27.5% of CIS patients and 20.1% of controls ( P < 0.001). In the fully adjusted models, CIS was associated with high periodontal inflammation burden (odds ratio [OR], 95% confidence interval) with an OR of 10.48 (3.18–34.5) and severe periodontitis with an OR of 7.48 (1.24–44.9). Stroke severity increased with the severity of periodontitis, having an OR of 6.43 (1.87–23.0) in stage III to IV, grade C. Invasive dental treatments performed within 3 mo prestroke were associated with CIS, with an OR of 2.54 (1.01–6.39). Association between CIS and invasive dental treatments was especially strong among those with PFO showing an OR of 6.26 (1.72–40.2). LPS/LTA did not differ between CIS patients and controls but displayed an increasing trend with periodontitis severity. Periodontitis and recent invasive dental procedures were associated with CIS after controlling for multiple confounders. However, the role of bacteremia as a mediator of this risk was not confirmed.

中文翻译：

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牙周炎、牙科手术和早发型隐源性中风

牙周炎与缺血性中风的风险增加有关，在中风病因不明的年轻人中，这种风险可能特别高。因此，我们在一项病例对照研究中调查了牙周炎或最近的侵入性牙科治疗是否与年轻发病的隐源性缺血性中风（CIS）有关。我们招募了一项多中心病例对照 SECRETO 研究的参与者，其中包括 18 至 49 岁的成年人，首次出现影像学阳性的 CIS 和无中风的年龄和性别匹配对照。进行了彻底的临床和放射学口腔检查。此外，我们还测量了血清脂多糖（LPS）和脂磷壁酸（LTA）水平。多变量条件回归模型根据中风危险因素、定期看牙医和卵圆孔未闭 (PFO) 状态进行调整。我们招募了 146 对病例对照组（中位年龄 41.9 岁；58.2% 为男性）。 27.5% 的 CIS 患者和 20.1% 的对照组被诊断出牙周炎 ( P < 0.001)。在完全调整的模型中，CIS 与高牙周炎症负担（比值比 [OR]，95% 置信区间）相关，OR 为 10.48 (3.18–34.5)，与严重牙周炎相关，OR 为 7.48 (1.24–44.9)。中风严重程度随着牙周炎的严重程度而增加，III 至 IV 期、C 级的 OR 为 6.43 (1.87–23.0)。中风前 3 个月内进行的侵入性牙科治疗与 CIS 相关，OR 为 2.54 (1.01–6.39) ）。 CIS 与侵入性牙科治疗之间的关联在 PFO 患者中尤其明显，OR 为 6.26 (1.72–40.2)。 LPS/LTA ​​在 CIS 患者和对照组之间没有差异，但随着牙周炎严重程度的增加而呈增加趋势。在控制了多个混杂因素后，牙周炎和最近的侵入性牙科手术与 CIS 相关。然而，菌血症作为这种风险介质的作用尚未得到证实。