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Ischemic stroke
Original research
Oral health and functional outcomes following mechanical thrombectomy for ischemic stroke
  1. Michael J Feldman1,
  2. Stefan W Koester2,
  3. Ryan S Chaliff3,
  4. Aaron Yengo-Kahn1,
  5. Gunther Wong2,
  6. Steven Roth1,
  7. Michael Longo1,
  8. Matthew R Fusco4,
  9. Michael T Froehler4,
  10. Rohan Chitale4
  1. 1 Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  2. 2 Vanderbilt University School of Medicine, Nashville, Tennessee, USA
  3. 3 Department of Oral and Maxillofacial Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  4. 4 Vanderbilt Cerebrovascular Program, Vanderbilt University Medical Center, Nashville, Tennessee, USA
  1. Correspondence to Mr Stefan W Koester, Vanderbilt University School of Medicine, Nashville, TN 85013, USA; stefanwkoester{at}gmail.com

Abstract

Background An association between poor dentition and the risk of ischemic stroke has previously been reported in the literature. In this study we assessed oral hygiene (OH), including tooth loss and the presence of dental disease, to determine if an association exists with functional outcomes following mechanical thrombectomy (MT) for large-vessel ischemic stroke.

Methods A retrospective review was conducted of consecutive adult patients at a single comprehensive stroke center who underwent MT from 2012 to 2018. Inclusion criteria included availability of CT imaging to radiographically assess OH. A multivariate analysis was performed, with the primary outcome being 90-day post-thrombectomy modified Rankin Scale (mRS) score >2.

Results A total of 276 patients met the inclusion criteria. The average number of missing teeth was significantly higher in patients with a poor functional outcome (mean (SD) 10 (11) vs 4 (6), p<0.001). The presence of dental disease was associated with poor functional outcome, including cavities (21 (27%) vs 13 (8%), p<0.001), periapical infection (18 (23%) vs 11 (6.7%), p<0.001), and bone loss (27 (35%) vs 11 (6.7%), p<0.001). Unadjusted, missing teeth was a univariate predictor of poor outcome (OR 1.09 (95% CI 1.06 to 1.13), p<0.001). After adjustment for recanalization scores and use of tissue plasminogen activator (tPA), missing teeth remained a predictor of poor outcome (OR 1.07 (95% CI 1.03 to 1.11), p<0.001).

Conclusion Missing teeth and the presence of dental disease are inversely correlated with functional independence following MT, independent of thrombectomy success or tPA status.

  • Stroke
  • Thrombectomy
  • Oral cavity

Data availability statement

Data may be obtained from a third party and are not publicly available. Not publicly available.

https://doi.org/10.1136/jnis-2022-019392

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Not publicly available.

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    Footnotes

    • MJF and SWK are joint first authors.

    • Twitter @KahnYengo

    • MJF and SWK contributed equally.

    • Contributors Conception and design: MJF, RSC, RC. Acquisition of data: MJF, RSC, SWK. Analysis and interpretation of data: SWK, MJF. Drafting the article: MJF, SWK, RSC, AYK, GW, SR, ML. Critically revising the article: MJF, SWK, RSC, AYK, GW, SR, ML, MRF, MTF, RC. Reviewed final version of the manuscript and approved it for submission: MJF, SWK, RSC, AYK, GW, SR, ML, MRF, MTF, RC. Statistical analysis: SWK, MJF. Administrative/technical/material support: RC. Study supervision: MTF, RC. Guarantor: MJF, RC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.