Periodontitis in Ischemic Stroke Patients: Case Definition Challenges of the New Classification Scheme (2018)

Cristina Andrada Costea,Andrada Soancă,Adriana Elena Bulboacă,Alexandra Roman,Ștefan Ioan Stratul,Ruxandra Christodorescu,Darian Rusu,Iulia Cristina Micu,Dora Maria Popescu,Aurel Popa-Wagner

doi:10.3390/jcm11030520

Abstract

The identification of the associative relationships between ischemic stroke (IS) and risk factors such as advanced age and periodontitis is essential to design real screening protocols and to address them using primary and secondary preventive policies. This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of IS patients. Secondarily, we report the periodontal status of IS patients and the associative relationship with respect to some risk factors. Patients with their first IS were assessed based on demographic data, medical, oral risk factors and periodontal parameters. The two case definitions were applied to identify the periodontitis burden. The agreement between the two case definition systems, as well as the misclassification ratio, were calculated. A total of 141 patients were included. According to the 2012 CDC/AAP and the 2018 EFP/AAP case definitions, a frequency of periodontitis of 98.5% and 97.8% based on two modalities of inclusion of cases in the severity groups, sensitivity values of 98.54% or 100%, and specificity values of 25% or 14.7% were calculated. Thus, the new case definition system has a higher capacity to detect periodontitis, especially the well-established forms.

Highlights

Stroke is the second most common cause of mortality worldwide [1], and it is the third leading cause of permanent acquired disability [2]
This study primarily aimed to evaluate the diagnostic performance of the 2018 European Federation of Periodontology/American Academy of Periodontology (EFP/AAP) case definition in detecting periodontitis against the 2012 Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) case definition in a group of ischemic stroke (IS) patients
For both 2012 CDC/AAP and 2018 EFP/AAP case definition systems, low-density lipoprotein cholesterol values were significantly higher in the “other” category in comparison with the “severe” category (p = 0 and p = 0.03, respectively)

Summary

Introduction

Stroke is the second most common cause of mortality worldwide [1], and it is the third leading cause of permanent acquired disability [2]. The Global Burden Disease Study 2013 findings indicated that two thirds of all strokes occurred among persons less than 70 years of age [3]. A significantly increasing trend was found for the evolution of the burden of stroke between 1990 and 2010, in terms of an increased absolute number of incidental strokes, deaths, and disability-adjusted life years loss [4]. It seems that primary stroke prevention is not effective enough, it has long been considered feasible in practice [5].

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Conclusion