Periodontal health interventions may be associated with a lower risk of first-ever ischemic stroke, according to a systematic review and meta-analysis.
In the analysis, investigators included seven cohort studies published between 2012 and 2025 comprising nearly 1.9 million patients from the Medline, Embase, Scopus, Lilacs, Web of Science, and Cochrane Central Register of Controlled Trials databases and population-based cohorts, with follow-up ranging from 3 to 15 years. The studies compared patients receiving periodontal interventions—including dental visits; toothbrushing; tooth scaling; and more intensive treatments such as root planing, periodontal flap surgery, and tooth extraction—with those receiving no or alternative care. The primary outcome was incident ischemic stroke.
The investigators found that periodontal interventions were associated with a lower likelihood of ischemic stroke. Tooth scaling showed the greatest protective effect, consistently reducing the risk of ischemic stroke.
Investigators showed similar trends for routine oral health behaviors. Regular dental care vs episodic or no care was associated with reduced stroke risk, and higher toothbrushing frequency showed a graded association, with lower risk at two or more daily brushings.
The findings for more intensive periodontal treatments were mixed. Patients who received periodontal treatment were less likely to experience ischemic stroke compared with those who didn't receive treatment. For instance, when examined separately, scaling, root planing, and periodontal surgery showed no statistically significant differences compared with tooth scaling, whereas tooth extraction was associated with increased risk in one study. A quantitative analysis demonstrated that these interventions weren't associated with a significant reduction in ischemic stroke risk.
Subgroup analyses suggested variability by age and population. The association between periodontal interventions and stroke risk wasn't observed in patients older than 65 years. Meanwhile intensive periodontal interventions decreased the risk of ischemic stroke in patients aged 45 to 64 years but increased the risk in those aged 20 to 44 years. Studies limited to patients with periodontal disease showed more consistent associations compared with those including general populations. The results also differed across high-risk groups, with benefit observed in patients undergoing hemodialysis but not in those with prior myocardial infarction.
The investigators noted substantial heterogeneity across the studies, including differences in intervention definitions, populations, and follow-up. All of the included studies were observational, limiting causal inference. Adjustment for key confounders such as smoking was inconsistent, and most data came from Asian populations, which may have limited generalizability.
“Periodontal health interventions—especially tooth scaling—appear to be associated with a lower risk of ischemic stroke,” wrote lead study author Jorge Moldes, of the Family and Community Medicine Department at the Bueu Health Centre at the Pontevedra University Clinical Hospital in Spain, and colleagues.
The study was supported by regional research funding. The study authors reported no conflicts of interest.