Abstract TP16: Dental Caries Associated With Cerebral Small Vessel Disease

Abstract

Background: Dental caries is a chronic oral infection distinct from periodontal disease in that it is associated with both ischemic stroke and intracerebral hemorrhage (ICH). Few studies have investigated the relationship between dental caries and cerebral small vessel disease (CSVD). White matter hyperintensities (WMH) and cerebral microbleeds (CMB) are manifestations of CSVD. Methods: Using the Atherosclerosis Risk in Communities (ARIC) database, we extracted data from 1112 participants assessed for dental caries and vascular risk factors. Of those, 203 (18.3%) had caries and 909 (81.7%) did not. Brain imaging was performed on 3T scanners. WMH was imaged by T2 fluid-attenuated inversion recovery, with volumes derived by a semiautomated algorithm. Multinomial logistic regression to test the association between caries and WMH volume categorized into quartiles. Quartiles (Q) were defined as Q1: <6.4 cm 3 , Q2: 6.4 - <11.6 cm 3 , Q3: 11.6 - <21.4 cm 3 , Q4: ≥21.4 cm 3 . CMBs were graded using a T2* gradient echo. We used binary logistic regression to test the association between caries and CMB dichotomized as >5 or ≤5. Results: Participants with caries were more likely to be African American than white (54% vs. 46%, p<.001), more likely to have hypertension (41% vs. 26%, p<.001) and diabetes (15% vs. 9%, p=.005). There were no differences detected in age (61 + 5 with caries vs. 62 + 5 without caries, p=0.08), gender (54% female vs. 46% male, p=0.66), and smoking history (48% vs. 52%, p=0.71). Dental caries were associated with WMH volume quartiles: Q1 (reference), Q2 OR 1.43 (95% 0.95 to 2.16), Q3 OR 1.78 (1.16 to 2.72), Q4 OR 1.80 (1.17 to 2.77). These associations remained after adjusting for age, gender, race, hypertension, diabetes, and smoking: Q1 (reference), Q2 Adj. OR 1.52 (95% 0.96 to 2.41), Q3 Adj. OR 1.76 (1.11 to 2.78), Q4 Adj. OR 1.63 (1.03 to 2.60). Caries were also associated with CMB>5 (Crude OR 2.78, 95% CI 1.12-6.44), the association strengthened after adjustment (Adj. OR 3.15, 95% CI 1.33-7.47). Conclusion: We report significant independent associations of caries with higher WMH quartiles and CMB>5. This suggests that ischemic stroke and ICH risk in participants with caries may be mediated by CSVD.