Oral health is a major driver of ischemic stroke risk

People with gum disease plus cavities have a significantly increased risk of suffering an ischemic stroke compared to those with a healthy mouth, researchers report.

The findings were published on October 22, 2025, in Neurology^® Open Access, an official journal of the American Academy of Neurology.

“We found that people with both cavities and gum disease had almost twice the risk of stroke when compared to people with good oral health, even after controlling for cardiovascular risk factors,” said study author Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia.

“This study reinforces the idea that taking care of your teeth and gums isn’t just about your smile; it could help protect your brain,” added Sen. “People with signs of gum disease or cavities should seek treatment not just to preserve their teeth, but potentially to reduce stroke risk.”

In this retrospective study, the investigators analyzed data from the Atherosclerosis Risk in Communities study.

Subjects in that earlier study completed dental assessments during Visit 4 (1996–1998). Oral health status was categorized as: good oral health, gum disease only, or gum disease with cavities.

The Atherosclerosis Risk in Communities study lasted for two decades The researchers identified ischemic stroke, myocardial infarction and fatal congenital heart disease among the subjects through 2019.

Among 5,986 subjects (mean age 63 and 52% female), 1,640 had good oral health, 3,151 had gum disease only, and 1,195 had gum disease plus cavities. Respectively, the incidence of ischemic stroke was 4.1%, 6.9%, and 10.0% across the three groups.

After adjusting for age, body mass index and smoking status, the investigators found that, compared to subjects with good oral health, those with both gum disease and cavities had an 86% higher risk of stroke. Those with gum disease only had a 44% higher risk of stroke.

The investigators also reported that subjects with both gum disease and cavities had a 36% higher risk of experiencing a major cardiovascular event when compared to those with healthy mouths.

The authors said, “Even after accounting for a wide range of demographic and clinical covariates, the presence of both PD [periodontal/gum disease] and caries [cavities] remained an independent predictor of adverse vascular outcomes. This supports the growing body of evidence linking oral-systemic inflammation to atherosclerotic disease and cerebrovascular pathology.”