The Association Between Periodontal Disease, Cerebrovascular Events, and Neurodegenerative Diseases

Abstract

Periodontitis is a chronic inflammatory disease characterized by the destruction of the supporting tissues of the teeth. Key features include clinical attachment loss, periodontal pocket formation, bleeding on probing, and bone loss detectable via radiographs. Stroke is a vascular condition that causes damage to the central nervous system, while Alzheimer’s disease is a neurodegenerative disorder marked by the accumulation of amyloid-beta plaques and neurofibrillary tangles in brain regions responsible for learning and memory, ultimately leading to dementia. Parkinson’s disease is a progressive neurodegenerative disorder characterized by motor symptoms such as tremors, muscle stiffness, bradykinesia, and involuntary movements. Periodontal inflammation induces the host immune response, leading to the release of pro-inflammatory cytokines and an increase in systemic inflammatory markers. These cytokines, along with periodontopathogens, can cross the blood–brain barrier and trigger neuroinflammation. Chronic neuroinflammation activates microglia, resulting in central nervous system damage and contributing to neurodegeneration. Periodontitis has thus been associated with the onset and progression of stroke, Alzheimer’s disease, and Parkinson’s disease. This review aims to evaluate the relationship between periodontal disease and cerebrovascular as well as neurodegenerative disorders. A bidirectional relationship between periodontitis and these conditions has been observed. In patients with stroke, Alzheimer's disease, and Parkinson's disease, declines in physical and cognitive functions often complicates the ability to maintain proper oral hygiene, thereby increasing the risk of periodontal disease and tooth loss. Evidence suggests that periodontal treatment may improve clinical outcomes in these populations. Regular attendance at dental maintenance therapy sessions and maintaining good oral hygiene are therefore critically important for reducing systemic inflammation and preserving periodontal health.