Epidemiology and Health

Original Articles

Association between regular dental scaling and stroke risk in patients with periodontal diseases: evidence from a Korean nationwide database: Yu-Rin Kim, Minkook Son, Seon-Rye Kim; Epidemiol Health. 2025;47:e2025020. Published online April 19, 2025; DOI: https://doi.org/10.4178/epih.e2025020

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Abstract

OBJECTIVES
This study aimed to evaluate the association between the frequency of dental scaling and the risk of stroke among individuals with moderate-to-severe periodontal diseases and verify the effect of regular dental scaling on stroke risk in this population.

METHODS

In this retrospective study, 25,758 subjects with moderate-to-severe periodontal diseases were selected from the Korean National Health Insurance Service-National Health Screening Cohort database. Based on the frequency of dental scaling, the subjects were divided into three groups: regular, occasional, and infrequent. Restricted cubic splines were used to evaluate hazard ratios (HRs) with 95% confidence intervals (CIs) for stroke. Additionally, landmark analysis was conducted to strengthen the reliability of the results.

RESULTS

There were 293, 111, and 38 stroke cases in the infrequent, occasional, and regular group, respectively. The adjusted HR for stroke in the regular group, compared to that in the infrequent group, was 0.40 (95% CI, 0.29 to 0.57). In the landmark analysis with follow-up after 1 year and after 2 years, the adjusted HR in the regular group compared to that in the infrequent group was 0.41 (95% CI, 0.28 to 0.60) and 0.50 (95% CI, 0.33 to 0.76), respectively.

CONCLUSIONS

Regular dental scaling was significantly associated with a reduced risk of stroke in patients with moderate-to-severe periodontal diseases. These findings may suggest a potential preventive role of dental scaling beyond oral health. Further studies are needed to explore the underlying biological mechanisms linking periodontal care to stroke prevention and to explore causal relationships between dental scaling and stroke risk.

Summary

Korean summary
중등도 이상의 치주염을 가진 성인을 대상으로 분석한 결과, 정기적으로 치석 제거(스케일링)를 시행한 집단은 비정기적 또는 미시행 집단에 비해 뇌졸중 발생 위험이 통계적으로 유의하게 낮은 것으로 나타났다. 이러한 보호 효과는 특히 남성 및 65세 이상 고령층에서 더욱 뚜렷하게 관찰되었다. 본 결과는 정기적인 구강건강관리가 뇌혈관질환 예방에 있어 잠재적인 기여 요인임을 시사한다.

Key Message
Among adults with moderate to severe periodontitis, those who underwent regular dental scaling had a significantly lower risk of stroke compared to those without routine scaling. This protective effect was especially evident in males and individuals aged 65 and older. These results suggest that regular oral healthcare may serve as a potential contributing factor in the prevention of cerebrovascular diseases.

Citations

Citations to this article as recorded by

Periodontitis and risk of stroke: a systematic review and meta-analysis of observational studies
Xinyu Meng, Xiaohua Chen
Frontiers in Neurology.2025;[Epub] CrossRef

Importance of younger age group and high inflammatory status in the association between periodontal disease and diabetes mellitus: results from the Korea National Health and Nutrition Examination Survey 2012-2018: Hyunmin Lee, Myung-Hee Shin; Epidemiol Health. 2024;46:e2024088. Published online November 15, 2024; DOI: https://doi.org/10.4178/epih.e2024088

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Abstract Summary PDF

Abstract

OBJECTIVES
Although previous studies have demonstrated an association between periodontal disease (PD) and diabetes mellitus (DM), the influence of age and the mediating role of inflammation have seldom been explored. This study investigated this association while considering the modifying effects of age and inflammatory status.

METHODS

This study included 29,491 participants from the 2012-2018 Korea National Health and Nutrition Examination Survey. The community periodontal index (CPI) was assessed by trained dentists using the World Health Organization CPI probe. PD was defined as a CPI score of 3 or 4. Pre-existing and incident DM were identified based on serum glucose levels, a history of DM diagnosis, medication use, and insulin injections. Serum high-sensitivity C-reactive protein (hs-CRP) levels were utilized as an indicator of chronic inflammation.

RESULTS

PD and DM exhibited a significant association, which was more pronounced with incident DM than with pre-existing DM, particularly in individuals younger than 65 years. Among those aged 20-44 years, the odds ratio of incident DM for CPI=4 versus CPI=0 was 2.61 (95% confidence interval, 1.16 to 6.09). High hs-CRP levels (>3 mg/L) were also associated with DM, especially in individuals with PD. This association was stronger with incident DM than with pre-existing DM. A notable joint effect was observed in younger individuals and those with PD.

CONCLUSIONS

The association between PD and DM was more pronounced in younger age groups and those with higher levels of inflammation. Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Summary

Korean summary
- 치주 질환과 당뇨병 사이의 연관성은 젊은 연령과 염증 수치가 높게 나타난 대상에서 더 두드러지게 나타남 - 치주 질환과 높은 염증 수치를 동시에 가지고 있을 경우의 당뇨 오즈비는 각각의 오즈비 합보다 더 크게 나타나 시너지 효과를 보였음 - 젊은 치주 질환 환자에 대한 조기 개입은 당뇨병 예방에 중요하게 작용할 수 있음

Key Message
• The association between PD and DM was more pronounced in younger age groups and those with higher levels of in- flammation. • The odds of DM increased synergistically for those with both PD and high inflammatory status. • Therefore, early interventions for PD in younger patients may be crucial for preventing DM.

Citations

Citations to this article as recorded by

Synergic Elevation of Systemic Inflammation by the Coexistence of Periodontitis and Diabetes Mellitus: A Nationwide Analysis of Korean Adults
Hye-Sun Shin
Biomedicines.2025; 13(10): 2441. CrossRef
Resveratrol supplementation as a non-surgical treatment in periodontitis and related systemic conditions
Caterina Vinciguerra, Loredana Bellia, Graziamaria Corbi, Sandro Rengo, Alessandro Cannavo
Journal of Traditional and Complementary Medicine.2024;[Epub] CrossRef

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