Dataset Information

Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

ABSTRACT: BACKGROUND AND PURPOSE:Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk. METHODS:In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC underwent fullmouth periodontal measurements collected at 6 sites per tooth and classified into 7 periodontal profile classes (PPCs). RESULTS:In the ARIC study 10?362 stroke-free participants, 584 participants had incident ischemic strokes over a 15-year period. In the dental ARIC study, 6736 dentate subjects were assessed for periodontal disease status using PPC with a total of 299 incident ischemic strokes over the 15-year period. The 7 levels of PPC showed a trend toward an increased stroke risk (?2 trend P<0.0001); the incidence rate for ischemic stroke/1000-person years was 1.29 for PPC-A (health), 2.82 for PPC-B, 4.80 for PPC-C, 3.81 for PPC-D, 3.50 for PPC-E, 4.78 for PPC-F, and 5.03 for PPC-G (severe periodontal disease). Periodontal disease was significantly associated with cardioembolic (hazard ratio, 2.6; 95% confidence interval, 1.2-5.6) and thrombotic (hazard ratio, 2.2; 95% confidence interval, 1.3-3.8) stroke subtypes. Regular dental care utilization was associated with lower adjusted stroke risk (hazard ratio, 0.77; 95% confidence interval, 0.63-0.94). CONCLUSIONS:We confirm an independent association between periodontal disease and incident stroke risk, particularly cardioembolic and thrombotic stroke subtype. Further, we report that regular dental care utilization may lower this risk for stroke.

SUBMITTER: Sen S

PROVIDER: S-EPMC5780242 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

Sen Souvik S Giamberardino Lauren D LD Moss Kevin K Morelli Thiago T Rosamond Wayne D WD Gottesman Rebecca F RF Beck James J Offenbacher Steven S

Stroke 20180115 2

<h4>Background and purpose</h4>Periodontal disease is independently associated with cardiovascular disease. Identification of periodontal disease as a risk factor for incident ischemic stroke raises the possibility that regular dental care utilization may reduce the stroke risk.<h4>Methods</h4>In the ARIC (Atherosclerosis Risk in Communities) study, pattern of dental visits were classified as regular or episodic dental care users. In the ancillary dental ARIC study, selected subjects from ARIC u ...[more]

PMID: 29335336

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Project description:BackgroundThe cost of care is often reported as a primary reason why patients fail to seek dental treatment; however, this may not the only component.Aims/objectivesTo examine an underserved population's perspective on the importance of dental care and barriers they face to seek treatment. The effectiveness of compliance incentives, such as gift cards, was also examined.MethodsWe conducted a survey study to gain insight of an underserved population's perspective of barriers to care and correlated the reported barriers with the true reasons of missed appointments in our study cohort. Appointment compliance was also examined before and after implementation of gift card incentives, appoitment reminder letters and additional staff.ResultsMost patients felt dental care was important/very important to them. However, no correlations were found between survey responses and true reasons for missing appointments. Eighty-seven percent of patients report having some form of financial difficulty and compliance statistically improved after implementation of financial compensation in this population (69% completed appointments before gift card implementation versus 75% after gift card implementation, p=0.01), but not after the implementation of additional appointment reminders and contact staff.DiscussionAlthough the majority of patients reported dental care was important to them, there was an average of 31% missed appointments for patients who completed the survey and no correlations were found between the information patients reported and true reasons for non-compliance. Interestingly, even though care was free of charge, most patients reported to be in some form of financial difficulty and compliance was slightly improved through the implementation of financial compensation. Other potential barriers that need to be further examined include economic barriers, transportation, insurance utilization, and patient anxiety towards dental care.ConclusionA survey is a resource to identify reasons why patients abstain from seeking care but may be not the best one as reasons reported do not correlate with true reasons of appointment failure. Financial compensation was shown to improve compliance with appointments. Further information gathering is necessary to gain insight into true barriers to dental care within an underserved population.

Dataset Information

Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

Publications

Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke.

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