Loesche W J, Schork A, Terpenning M S, Chen Y M, Kerr C, Dominguez B L
University of Michigan, School of Dentistry, Department of Biologic and Materials Science, Ann Arbor, MI, USA.
Ann Periodontol. 1998 Jul;3(1):161-74. doi: 10.1902/annals.1998.3.1.161.
We report here information obtained from a cross-sectional study of 401 veterans, who were at least 60 years of age, which showed that several dental/oral conditions can be significantly associated with the diagnosis of a cerebral vascular accident (CVA), when included in a multivariate logistic regression model with and without many of the known risk factors for a CVA. The dental findings relative to the prevalence of dental caries and periodontal disease were not distinctly different between the subjects with and without a CVA in the bivariate analysis. A higher stimulated salivary flow was negatively associated with a CVA in the multivariate models. The plaque index and oral hygiene habits relating to brushing, flossing, and frequency of having teeth cleaned by a dentist/hygienist were significantly associated with a CVA in the bivariate analysis. Among these oral hygiene parameters, *needing help in brushing one's teeth" and the reported annual visit to the dentist/hygienist for teeth cleaning remained significant in the multivariate models involving the dependent-living subjects. The need for help in brushing one's teeth could reflect the fact that many subjects had reduced manual dexterity as a result of the CVA and required this extra care. However, the finding that those dependent-living individuals who reported that they did not have their teeth cleaned at least once a year were 4.76 times more likely to have had a CVA, suggests that a pattern of oral neglect might be associated with developing a CVA. The implications of this in terms of an intervention strategy for CVA warrants further consideration. However, caution is recommended because the data were obtained from a convenience sampling of older veterans and may not be generalizable to other populations.
我们在此报告一项针对401名至少60岁退伍军人的横断面研究所得信息。该研究表明，在包含和不包含多种已知脑血管意外（CVA）风险因素的多变量逻辑回归模型中，几种牙齿/口腔状况与脑血管意外的诊断显著相关。在双变量分析中，患有和未患CVA的受试者在龋齿患病率和牙周病方面的牙科检查结果并无明显差异。在多变量模型中，较高的刺激唾液流量与CVA呈负相关。在双变量分析中，菌斑指数以及与刷牙、使用牙线和看牙医/保健员清洁牙齿频率相关的口腔卫生习惯与CVA显著相关。在这些口腔卫生参数中，“刷牙需要帮助”以及报告的每年看牙医/保健员清洁牙齿在涉及生活不能自理受试者的多变量模型中仍然具有显著意义。刷牙需要帮助可能反映出许多受试者由于CVA导致手部灵活性下降，需要这种额外护理。然而，那些报告每年至少没有清洁过一次牙齿的生活不能自理个体发生CVA的可能性高出4.76倍这一发现表明，口腔忽视模式可能与发生CVA有关。这对于CVA干预策略的意义值得进一步考虑。然而，建议谨慎看待，因为数据是从老年退伍军人的便利样本中获得的，可能无法推广到其他人群。
