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                                                        DR. DAN PETERSON

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Risk toward stroke is affected by dental health

Stroke is characterized by bleeding in the brain. 

Periodontal disease has been shown to increases
 stroke risk 15 percent to 18 percent in whites.

Dental Care for Stroke Survivor Dental X-rays May Reveal Strokes in Women
Stroke News Updates Gum Diease May Raise Stroke Risk
Tooth loss, Gum Disease May 
Up Men's Stroke Risk

Brush Away Strokes

Dental Cared for Stroke Survivor

     Often dental health is an important part of general health and is often over looked during the rehabilitation process for a stroke.

    A consistent, preventive dental program is essential for stoke survivors.  The loss of senses, weakness of facial muscles, and side effects of medications can put you at high risk for dental problems.

     To help you maintain good dental health within the limits of the stroke try these tips:

bulletUse a wide elastic band to attach the toothbrush to your hand
bulletEnlarge the brush handle with a sponge, rubber ball or bicycle handle grip
bulletLengthen the handle with a piece of wood or plastic, such as a ruler or tongue depressor.
bulletTie dental floss into a loop for easier handling.
bulletUse an electric toothbrush or commercial flosser

     When scheduling appointments:

bulletMake sure the office is physically accessible to wheelchairs .
bulletTell receptionist when making your appointment of any special needs you have to allow enough appointment time to meet these needs.
bulletInform staff of swallowing
bulletAsk to have the medical/dental history form send to you BEFORE the appointment so you take take your time completing the form..
bulletIf you have a memory problem ask staff to write down all instructions.
bulletIf possible bring a friend or family member with you.
bulletInform staff of any procedures or events that confuse or frustrate you and tell them how they can help you with your communication needs.
bulletStroke survivors who have dentures should not buy a new set right after a stroke.  Wait until your therapist and doctor are satisfied that your jaw joint is back to a normal position and that oral muscle strength is at a maximum.

Stroke Smart pg 10, April 2002.

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Now doctors say a  bystander can recognize a stroke by asking three  simplequestions:

1. *Ask the  individual to SMILE.

2. *Ask him or her to  RAISE BOTH ARMS.

3. *Ask the person to SPEAK A  SIMPLE SENTENCE (Coherently)  (i.e. . . It is
sunny out today) If he or she  has trouble with any of these tasks,  call
9-1-1 immediately and  describe the symptoms to the dispatcher.

After discovering that a group of non-medical volunteers  could  identify facial weakness, arm weakness and speech problems,  researchers  urged the general public to learn the three questions. They  presented their  conclusions at the American Stroke Association's annual  meeting last February.  Widespread use of this test could result in prompt  diagnosis and treatment of the  stroke and prevent brain  damage.

Stroke News Updates

TIA is defined as a stroke in which the neurological symptoms resolve within 24-hours. TIA, transient ischemic attack, is sometimes called a 'mini-stroke'. A significant percentage of patients with TIAs go on to have a full-blown CVA within a year.These patients are frequently placed on anticoagulants in an effort  to minimize the risk of more events.

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Radiographic Measures of Chronic Periodontitis and Carotid Artery Plaque

 Chronic periodontitis (CP) is associated with stroke and subclinical atherosclerosis, but clinical measurement of CP can be time consuming and invasive. The purpose of this study was to determine whether radiographically assessed CP is associated with nonstenotic carotid artery plaque as an ultrasound measure of subclinical atherosclerosis. Panoramic oral radiographs were obtained from 203 stroke- free subjects ages 54 to 94 during the baseline examination

Severe periodontal bone loss is associated independently with carotid atherosclerosis. Panoramic oral radiographs may thus provide an efficient means to assess CP in studies of atherosclerosis risk.

Steven P. Engebretson, et al.,Radiographic Measures of ChronicPeriodontitis and Carotid Artery Plaque Stroke. 2005;36:561

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Dentures and eating after 3 strokes within a year
  You may never forget how, but you may lose the agility required to "bite" with your dentures. In this case there is tremendous value of using a food processor. A reasonable diet can be crafted with soups, stews, composed ground meat entrees, fruit salsa, along with eggs, yogurt, protein supplemented hot cereal etc.  Unfortunately many will depend on pudding cups, ice cream, & jello and generally spiral into very poor health.  With time, he may eventually regain the muscletone needed.

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The association of gingivitis and periodontitis with ischemic stroke 

The aim of this study was to assess the associations of different periodontal conditions with cerebral ischemia.  Patients were examined on average 3 days after ischemia. The individual mean clinical attachment loss measured at four sites per tooth was used as indicator variable for periodontitis. Patients had higher clinical attachment loss than the general population . After adjustment a mean clinical attachment loss >6 mm had a 7.4 times greater,  a gingival index >1.2 = a 18.3 times greater and a radiographic bone loss a 3.6 times higher risk of cerebral ischemia(stroke) than subjects without periodontitis or gingivitis. Periodontitis is an independent risk factor for stroke and acute exacerbation of inflammatory processes in the periodontium might be a trigger for the event of stroke.
 [Dörfer CE et al.,. The association of gingivitis and periodontitis with is= chemic stroke J Clin Periodontol 2004;31(5):396 - 401.]

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Tooth Loss, Stroke Linked

Tooth loss and periodontal disease may increase the risk of stroke. In a study men who had fewer than 25 teeth when they entered the study had a 57% higher risk of stroke than those with 25 or more teeth.  The link between stroke and gum disease shows that oral health is closely related to overall health states the American Heart Association.  AGD Impact pg 18, 2/04

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Tooth loss, Gum Disease May Up Men's Stroke Risk

Tooth loss and gum disease may increase a person's risk for having a stroke, new study findings suggest. Lead author Dr. Kaumudi J. Joshipura of Harvard School of Dental Medicine.  Periodontal disease, which includes gingivitis and periodontitis, involves a chronic bacterial infection that can lead to tooth loss. Scientists have speculated that over time, these oral bacteria may slip into the bloodstream and trigger inflammation in the blood vessels that feed the heart and brain. Studies on the topic have suggested a history of gum disease increases the risk of heart attack or stroke. In the current study, Joshipura and her team followed the heart and dental health of 41,380 men between the ages of 40 and 75 who had no sign of heart disease or diabetes at the start of the study. After 12 years, a total of 349 men had an ischemic stroke. This is the most common type of stroke, and occurs when a clot or blocked artery cuts off blood flow to the brain. Men who had 24 teeth or less at the start of the study had a 57 percent increase in their risk for having an ischemic stroke compared to men who had 25 teeth or more. Tooth loss in most cases was due to gum disease or cavities

 Stroke 2003;34., By Keith Mulvihill New York (Reuters Health)

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Dental X-Rays May Reveal Stroke Risk in Women

A trip to the dentist for a woman 55 or older may yield evidence about stroke risk.

Panoramic dental x-rays can reveal calcifications in the carotid arteries, which increase a person's risk of stroke.

In the study by Drs.  Friedlander and Altman, panoramic dental x-rays of 52 postmenopausal women aged 55 to 90 with no prior history of heart attack or stroke were studied. Sixteen (31%) of the women showed evidence of calcification in their carotid arteries.

Women older than 55 who receive panoramic dental x-rays should ask doctors to examine the x-rays for calcification in the carotid arteries that would be consistent with blockage of blood flow to the brain.

I was found that 94% of the women in this study were diagnosed with high blood pressure, 50% were characterized as overweight or obese, 38% were heavy smokers, and nearly 70% of the women had high levels of blood fats including cholesterol.

More than 60% of the deaths in the United States attributed to stroke occur in postmenopausal women.

As a woman's estrogen levels decrease after menopause, her blood levels of cholesterol increase, which makes her more vulnerable for build-up of arterial plaque.

These plaque deposits, which collect in the inner lining of the artery, contain fatty substances such as cholesterol, cellular waste products, calcium and other substances. Plaques may grow large enough to reduce blood flow through an artery. They can also become fragile and rupture. Plaques that rupture form blood clots that can block blood flow or break off and travel to another part of the body. If a clot blocks a blood vessel that feeds the brain, a stroke can result.

SOURCE: Journal of the American Dental Association 2001;132:1130-1136.

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Gum disease raises stroke risk

NEW YORK (Reuters Health) - Gum disease, apart from being unsightly and uncomfortable, might significantly increase a person's risk of stroke, according to results of a national study.

Dr. Tiejian Wu from the State University of New York at Buffalo and colleagues examined the link between gum disease, or periodontitis, and risk of having a stroke in nearly 10,000 adults who participated in a large health survey between the early 1970s and 1992.

"We found that periodontitis was associated with an increased risk of stroke in a 21-year follow-up of US adults," Wu told Reuters Health in an interview.

Gum disease begins insidiously with gingivitis, characterized by swollen gums that easily bleed. Without treatment, the condition progresses to periodontitis, the inflammation of the tissues supporting the teeth. Eventually, bone and tissue loss can result.

What sets the process in motion is the presence of bacteria. It is these bacteria, according to Wu, that get into the bloodstream and can stimulate clotting. And other effects associated with the bacteria can damage the lining of blood vessels. All these events can increase the risk of stroke.

Stroke is characterized by either bleeding in the brain because of a ruptured vessel or impaired blood flow to a part of the brain when a vessel is blocked by a clot.

The investigators were not able to define exactly which bacteria are to blame for the destructive effects of the condition, because this information could not be determined based on the data collected as part of the original survey. But they expect that future research will serve "to confirm the possible role of specific harmful microorganisms."

So while Wu cautioned that "the cause-effect relation is not conclusive at this point," he said that these findings indicate "people may need to pay more attention to their oral health, as it may influence their systemic health."

Health Center Dental News, October, 2000

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Brush Away Strokes

September 14, 2007

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