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Gum disease and cavities linked to increased stroke risk
American Academy of Neurology
Highlights:
- A new study finds that having both gum disease and cavities is linked to an 86% increased risk of stroke compared to having a healthy mouth.
- Poor oral health was tied to a 36% higher risk of heart attacks and other cardiovascular events.
- People with regular dental visits were 81% less likely to have both gum disease and cavities.
- Researchers say improving oral health could be an important — and often overlooked — way to help reduce stroke risk.
MINNEAPOLIS – People with both cavities and gum disease may face a higher risk of ischemic stroke, according to a study published on October 22, 2025, in Neurology® Open Access, an official journal of the American Academy of Neurology. The study does not prove that poor oral health causes strokes; it only shows an association.
Ischemic strokes are the most common type of stroke and occur when a clot or blockage reduces blood flow to the brain, depriving it of oxygen and nutrients.
Cavities are holes in the tooth enamel caused by sugary or starchy foods or factors such as poor oral hygiene or genetics. Gum disease, usually caused by poor oral hygiene, is an inflammation or infection of the gums and jawbone. It can lead to tooth loss.
“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. “These findings suggest that improving oral health may be an important part of stroke prevention efforts.”
Researchers analyzed data from 5,986 adults with an average age of 63 who had no prior history of stroke at the start of the study. All participants completed dental exams that assessed whether participants had gum disease, cavities or both. Participants were then placed in three groups: having a healthy mouth, gum disease only or gum disease with cavities.
Researchers followed them for two decades, using phone visits and medical records to determine which people had a stroke.
Of 1,640 people with healthy mouths, 4% had a stroke, of 3,151 people with gum disease only, 7% had a stroke and of 1,195 people with gum disease and cavities, 10% had a stroke.
After adjusting for factors such as age, body mass index and smoking status, researchers found when compared to people with healthy mouths, those with both gum disease and cavities had an 86% higher risk of stroke. Those with gum disease alone had a 44% increased risk.
The study also looked more broadly and found that people with both gum disease and cavities had a 36% higher risk of experiencing a major cardiovascular event, such as a heart attack, fatal heart disease or stroke when compared to people with healthy mouths.
Participants who reported visiting the dentist regularly had 81% lower odds of having both gum disease and cavities and 29% lower odds of having gum disease alone.
“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,” said Sen. “People with signs of gum disease or cavities should seek treatment not just to preserve their teeth, but potentially to reduce stroke risk.”
A limitation of the study is that participants’ oral health was assessed only once at the start of the study, so changes in dental health over time weren’t captured. It’s also possible that other unmeasured health factors contributed to the findings.
Discover more about brain health at Brain & Life®, from the American Academy of Neurology. This resource offers a website, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life® on Facebook, X, and Instagram.
The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine.
Explore the latest in neurological disease and brain health, from the minds at the AAN at AAN.com or find us on Facebook, X, Instagram, LinkedIn, and YouTube.
Gum disease associated with changes in the brain
MINNEAPOLIS – Adults with gum disease may be more likely to have signs of damage to the brain’s white matter, called white matter hyperintensities, than people without gum disease, according to a new study published on October 22, 2025, in Neurology® Open Access, an official journal of the American Academy of Neurology.
White matter refers to nerve fibers that help different parts of the brain communicate. Damage to this tissue can affect memory, thinking, balance and coordination and has been linked to higher stroke risk.
White matter hyperintensities are bright spots that appear on brain scans that are thought to reflect damaged white matter tissue. While the study found an association, it does not prove that gum disease causes white matter damage.
“This study shows a link between gum disease and white matter hyperintensities suggesting oral health may play a role in brain health that we are only beginning to understand,” said study author Souvik Sen, MD, MS, MPH, of the University of South Carolina in Columbia. “While more research is needed to understand this relationship, these findings add to growing evidence that keeping your mouth healthy may support a healthier brain.”
The study included 1,143 adults with an average age of 77. Each person had a dental exam to check for gum disease. Of participants, 800 had gum disease and 343 did not.
Participants had brain scans to look for signs of cerebral small vessel disease, which is damage in the brain’s small blood vessels that can appear as white matter hyperintensities, cerebral microbleeds or lacunar infarcts. These brain changes become more common with age and are associated with increased risk of stroke, memory problems and mobility issues.
People with gum disease had more white matter hyperintensities, with an average volume of 2.83% of total brain volume compared to 2.52% for people without gum disease.
Researchers divided people into four groups based on white matter hyperintensity volume. Those in the highest group had a volume of more than 21.36 centimeters cubed (cm³) while those in the lowest group had a volume of less than 6.41 cm³.
Of people with gum disease, 28% were in the highest group compared to 19% of people without gum disease.
After adjusting for factors such as age, sex, race, high blood pressure, diabetes and smoking, people with gum disease had 56% higher odds of falling into the highest group of white matter hyperintensities than people without gum disease.
However, no links were found between gum disease and two other brain changes tied to small vessel disease, cerebral microbleeds and lacunar infarcts.
“Gum disease is preventable and treatable,” said Sen. “If future studies confirm this link, it could offer a new avenue for reducing cerebral small vessel disease by targeting oral inflammation. For now, it underscores how dental care may support long-term brain health.”A limitation of the study is that brain imaging and dental assessments were conducted only once, making it difficult to assess changes over time.
Discover more about brain health at Brain & Life® from the American Academy of Neurology. This resource offers a website, podcast, and books that connect patients, caregivers and anyone interested in brain health with the most trusted information, straight from the world’s leading experts in brain health. Follow Brain & Life® on Facebook, X, and Instagram.
The American Academy of Neurology is the leading voice in brain health. As the world’s largest association of neurologists and neuroscience professionals with more than 40,000 members, the AAN provides access to the latest news, science and research affecting neurology for patients, caregivers, physicians and professionals alike. The AAN’s mission is to enhance member career fulfillment and promote brain health for all. A neurologist is a doctor who specializes in the diagnosis, care and treatment of brain, spinal cord and nervous system diseases such as Alzheimer's disease, stroke, concussion, epilepsy, Parkinson's disease, multiple sclerosis, headache and migraine.
Explore the latest in neurological disease and brain health, from the minds at the AAN at AAN.com or find us on Facebook, X, Instagram, LinkedIn, and YouTube.
Less pain, same results? Researchers explore drill-free treatments for cavities in older adults
image:
Suchitra Nelson
view moreCredit: Case Western Reserve University
Less pain, same results? Researchers explore drill-free treatments for cavities in older adults
CLEVELAND—A trip to the dentist isn’t something people usually look forward to.
“Because of all the drilling and injections, it’s not fun,” acknowledged Suchitra Nelson, an associate dean and professor at the Case Western Reserve University School of Dental Medicine.
While discomfort can’t be entirely avoided in all dental procedures, Nelson is leading a new study to advance previous research that found two less-invasive options to treat and prevent cavities were equally effective.
The study focuses on older adults living in subsidized housing with limited access to dental care because of such barriers as dental insurance, transportation and their overall general health—especially mobility.
As with the previous study, the patients will be treated for cavities with two methods that don’t require a dental drill or anesthesia: Silver Diamine Fluoride (SDF) and Atraumatic Restorative Treatment (ART).
SDF, a liquid medication applied to cavities to stop them from progressing, is a quick and painless treatment that kills bacteria and strengthens the tooth’s surface, Nelson said. And ART involves removing decayed tissue with hand instruments and then applying a dental restorative material.
“Long-term evidence for these treatments is lacking,” Nelson said. “This long-term follow-up study can inform the best treatments for patients and providers to prevent and treat tooth decay.”
The study is being supported with a five-year, $5 million grant from the nonprofit Patient-Centered Outcomes Research Institute (PCORI).
Among older adults nationally, nearly 96% have had a cavity, and 33% of non-Hispanic Black, Hispanic and low-income older adults have teeth with decay that has gone untreated because of limited access to affordable dental care, according to according to the Centers for Disease Control’s National Center for Health Statistics.
Untreated tooth decay leads to painful toothaches, infection and tooth loss. But the related health concerns are much broader: Major dental issues can make heart and lung disease and diabetes worse.
In Nelson’s previous PCORI-funded study, 568 participants received either SDF or ART to prevent cavities. Participants received dental exams, treatments for cavities and completed surveys. The research found that the two treatments were equally effective in preventing cavities.
“We also found that dental hygienists can successfully deliver dental care at the housing facilities where older adults live,” Nelson said.
The new study will follow up with 480 of the patients living in 33 subsidized housing facilities in Northeast Ohio. The follow-up participants will be tracked for three visits over a year and receive the same treatments (SDF or ART) for any new cavities.
While the subject of the studies is older adults, Nelson said less invasive treatments could be used for patients of any age.
“Our stakeholder partners from local, state and national organizations have enthusiastically indicated that they would use the results of our work to make changes that improve access and clinical care, improve Medicaid policies for reimbursement and make the study’s results widely available,” she said.
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