Dental Caries a Risk Factor for Intracerebral Hemorrhage.

INTRODUCTION: Streptococcus mutans is a known cause of dental caries that contains a collagen-binding protein, Cnm, and exhibits inhibition of platelet aggregation and matrix metalloproteinase-9 activation. This strain has been linked to aggravation of experimental intracerebral hemorrhage (ICH) and may be a risk factor for ICH.The purpose of this study was to test the association between dental caries and incident ICH.

METHODS: Presence of dental caries and periodontal disease was assessed in subjects from the Dental Atherosclerosis Risk in Communities Study (DARIC) without prior stroke or ICH. This cohort was followed for incident ICH over a period of 10 years. Cox regression was used to compute crude and adjusted hazards ratio from the dental assessment.

RESULTS: Among 6,315 subjects, dental surface caries and/or root caries were recorded in 1338 (27%) subjects. Of those 7 (0.5%) had incident ICH over a period of 10 years following the visit 4 assessment. Of the remaining 4977 subjects, 10 (0.2%) had incident ICH. Those with dental caries versus those without dental caries were younger (mean age 60±6 vs. 59±6, p<0.001), had a greater proportion of males (51% vs. 44%, p<0.001), African Americans (44% vs 10%, p<0.001) and were hypertensive (42% vs. 31%, p<0.001). The association between caries and ICH was significant (crude HR 2.69, 95% CI 1.02-7.06) and strengthened after adjustment for age, gender, race, education level, hypertension and periodontal disease (adj. HR 3.88, 95% CI 1.34-11.24).

DISCUSSION/CONCLUSION: Dental caries is a potential risk for incident ICH after caries detection. Future studies are needed to determine if treatment of dental caries can reduce the risk of ICH.