ESOC 2025 | The ARIC study: dental flossing is linked to lower stroke risk

So, ARIC is a multiple kind of, it’s a big large cohort study run out of community-based, community and population-based out of four counties in the United States. It originally started in 1987 when 15,000 odd subjects were recruited. And then in the visit, so they have had multiple visits practically approximately every three years. In visit four is when they had dental assessment, dental questionnaire, as well as measurement of inflammatory markers. And since then, they have had follow-up and adjudication of outcomes such as stroke and cardiovascular event up to 2021. And so there’s follow-up data from there. In this study, so a brief background is there is a study originally out of Kuopio in Finland which showed that flossing is tied to lowering of cardiovascular event. Subsequently, it’s also been published out of a ENHANCE study about cardiovascular outcome. However, none of the studies looked at specifically stroke. So in the ARIC study, we were able to investigate the impact of oral care on the stroke risk and primary stroke risk. And then we were able to tie that with inflammation as well as oral infection. Oral infection included measurement of gum disease or periodontal disease and tooth decay or dental care risk. So what we found in the study was that both, or all kinds of oral care including regular brushing, dental flossing, and regular dental visit lowered the risk of ischemic stroke, primary ischemic stroke. And among them, the biggest impact was noted with dental flossing and regular dental visit and when we adjusted for all risk factors and the other forms of oral care it was dental flossing which had a 20 percent risk reduction in incidence of ischemic stroke. All three measures lowered evidence of gum disease as well as tooth decay. And all three measures, so if you look at inflammation, there is inflammation which can be measured by the tooth, there’s infection and inflammation that causes local inflammation and that causes what we call pro-inflammatory markers, such as interleukin-6 and interleukin-1 beta. Subsequently from the liver, once the interleukin-6 and interleukin-1 beta trigger production of CRP, and that is tied to vascular disease. What we found in the ARIC study was that all three measures lowered interleukin-6, which is a pro-inflammatory marker, and only regular dental visits, which involves once a year or more of dental visits and dental cleaning, was the only one which lowered CRP. So suggesting that essentially dental flossing, so essentially the conclusion of the study is that dental flossing independently lowers stroke risk. All strategies improve oral health and reduce interleukin-6. Only regular dental use lowers the risk of C-reactive protein. So the public health message from this is promoting oral healthcare habits may reduce stroke risk.

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