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International Poster Journal of Dentistry and Oral Medicine



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Int Poster J Dent Oral Med 7 (2005), No. 2     15. June 2005

Int Poster J Dent Oral Med 2005, Vol 7 No 02, Poster 274

Association between oral self care and ischemic stroke

Language: English

Dr. Daniela Jörß, Clinic for Conservative Dentistry, University of Heidelberg, Germany
Prof. Dr. Armin J. Grau, Clinic for Neurology, University of Heidelberg, Germany
Dr. Christof Lichy, Clinic for Neurology, University of Heidelberg, Germany
Prof. Dr. Heiko Becher, Department of Epidemiology, German Cancer Research Center, Heidelberg, Germany
Priv.-Doz. Dr. Christof E. Dörfer, Clinic for Conservative Dentistry, University of Heidelberg, Germany

ICC Berlin, Germany


To evaluate the association between the oral self care behaviour and acute cerebral ischemia.

Material and Methods

303 consecutive patients with acute ischemic stroke (T) and 300 representative population controls (C) matched for age, gender, ethnicity and area of residence underwent a clinical and radiographic dental examination. A questionnaire was used by trained interviewers in a face-to-face interview to investigate all known and/or suspected risk factors for stroke and periodontitis as well as their oral self care behaviour (Tab. 2).

Statistical analysis

Logistic regression analysis was used to analyse the association of factors with cerebral ischemia. All factors of interest were first analysed in a univariate model with adjustment for age, gender and number of teeth in dental parameters. In the multivariate model, the mean clinical attachment loss, the mean plaque index and the number of lost teeth were included plus all other factors, which were significant in the univariate analysis (p < 0.05). Odds ratios and 95 % - confidence intervals are given for all factors. The software package SAS (SAS Inc., Heidelberg) was used for the analyses.

Inclusion Criteria

- native german speaker
- aged between 18 and 75 years
- resident of the greater Heidelberg area
- written informed consent
- willing to undergo an extensive dental examination and to follow an interview

Exclusion criteria

- pregnancy
- inability to give informed consent or to cooperate in the dental examination within 1 week after ischemia or admission
- any known condition in which a prophylactic antibiotic treatment before dental examination is required
- bleeding disorder
- professionals exposed to x-radiation

Tab. 1: Demographic variables

Tab. 2: Parameters of the interview and the clinical and radiographic status

Tab. 3: Logistic regression analysis for Gingivitis- and Plaque Index (simple model controlled for age, gender and number of lost teeth)

Tab. 4: Variables of oral self care


There was no statistically significant difference between the groups in terms of the use of toothbrushes and toothpastes, flosses and interdental brushes or irrigators. In a multivariate modell with "Preceeding Stroke" (OR 10,38; 95%-CI 4,39-24,54; p< 0,001), "Preceding Cardiovascular Disease" (OR 2,44; 95%-CI 1,13-5,29; p=0,023), "Hypertension"(OR 1,87; 95%-CI 1,19 - 2,95; p=0,007), "Diabetes mellitus" (OR 3,45; 95%-CI 1,64-7,25; p=0,001), "Total Alcohol Uptake" (n.s.), "Smoking" (OR 1,24; 95%-CI 1,04-1,47; p=0,009) and "Socioeconomic Status" (n.s.), the use of mouth rinses (OR 2,46; 95%-CI 1,38 - 4,37; p=0,002) and of toothpicks (OR 1,87; 95%-CI 1,07-3,27; p=0,028) remained a significant risk indicator.

Fig. 4: Multivariate analysis of statistically significant variables. Odds ratios (95% CI) are given. The model was also adjusted for age, gender and other oral hygiene aids.


The associations identified in this study were found to be independent from other risk factors for stroke in an extensive multivariate model. However, oral health care is most likely an indicator of health awareness instead of a causal factor.

This Poster was submitted by Dr. Daniela Jörß.

Correspondence address:
Dr. Daniela Jörß
Clinic for Conservative Dentistry
University of Heidelberg
Im Neuenheimer Feld 400
69120 Heidelberg