TY - JOUR T1 - The Association Between Periodontal Disease, Cerebrovascular Events, and Neurodegenerative Diseases TT - Periodontal Hastalıklarla Serebrovasküler Olaylar ve Nörodejeneratif Hastalıklar Arasındaki İlişki AU - Çiçek, Yasemin AU - İşler, Sıla Çağrı PY - 2025 DA - August Y2 - 2025 JF - Unika Sağlık Bilimleri Dergisi JO - Unika. Sag. Bil. Derg. PB - Karabük Üniversitesi WT - DergiPark SN - 2757-6817 SP - 213 EP - 229 VL - 5 IS - 2 LA - en AB - Periodontitis is a chronic inflammatory disease characterized by the destruction of the supporting tissues of the teeth. Key features include clinical attachment loss, periodontal pocket formation, bleeding on probing, and bone loss detectable via radiographs. Stroke is a vascular condition that causes damage to the central nervous system, while Alzheimer’s disease is a neurodegenerative disorder marked by the accumulation of amyloid-beta plaques and neurofibrillary tangles in brain regions responsible for learning and memory, ultimately leading to dementia. Parkinson’s disease is a progressive neurodegenerative disorder characterized by motor symptoms such as tremors, muscle stiffness, bradykinesia, and involuntary movements. Periodontal inflammation induces the host immune response, leading to the release of pro-inflammatory cytokines and an increase in systemic inflammatory markers. These cytokines, along with periodontopathogens, can cross the blood–brain barrier and trigger neuroinflammation. Chronic neuroinflammation activates microglia, resulting in central nervous system damage and contributing to neurodegeneration. Periodontitis has thus been associated with the onset and progression of stroke, Alzheimer’s disease, and Parkinson’s disease. This review aims to evaluate the relationship between periodontal disease and cerebrovascular as well as neurodegenerative disorders. A bidirectional relationship between periodontitis and these conditions has been observed. In patients with stroke, Alzheimer's disease, and Parkinson's disease, declines in physical and cognitive functions often complicates the ability to maintain proper oral hygiene, thereby increasing the risk of periodontal disease and tooth loss. Evidence suggests that periodontal treatment may improve clinical outcomes in these populations. Regular attendance at dental maintenance therapy sessions and maintaining good oral hygiene are therefore critically important for reducing systemic inflammation and preserving periodontal health. KW - Periodontitis KW - Cerebrovascular events KW - Alzheimer’s disease KW - Parkinson’s disease N2 - Periodontitis, dişleri destekleyen dokuların yıkımıyla karakterize olan kronik bir inflamatuar hastalıktır. Periodontitisin temel özellikleri arasında klinik ataşman kaybı, periodontal cep oluşumu, sondlamada kanama ve radyografik olarak tespit edilebilen kemik kaybı yer alır. İnme, merkezi sinir sisteminde hasara yol açan vasküler bir durumdur. Alzheimer hastalığı ise öğrenme ve bellekten sorumlu beyin bölgelerinde amiloid-beta plaklarının ve nörofibriler yumakların birikimi ile karakterize edilen ve demansa yol açan nörodejeneratif bir hastalıktır. Parkinson hastalığı ise titreme, kas sertliği, bradikinezi ve istemsiz hareketler gibi motor semptomlarla karakterize, ilerleyici bir nörodejeneratif bozukluktur. Periodontal inflamasyon, bağışıklık sistemini tetikleyerek pro-inflamatuar sitokinlerin salınımına ve sistemik inflamatuar belirteçlerin artışına yol açar. Bu sitokinler ve periodontopatojenler, kan-beyin bariyerini geçerek nöroinflamasyonu başlatabilir. Kronik nöroinflamasyon, mikroglia aktivasyonunu tetikleyerek merkezi sinir sisteminde hasara ve nörodejenerasyona neden olur. Bu bağlamda, periodontitis; inme, Alzheimer hastalığı ve Parkinson hastalığının başlangıcı ve ilerlemesi ile ilişkilendirilmiştir. Bu derleme, periodontal hastalık ile serebrovasküler olaylar ve nörodejeneratif hastalıklar arasındaki bağlantıyı değerlendirmeyi amaçlamaktadır. Periodontitis ile bu hastalıklar arasında çift yönlü bir ilişki olduğu gözlemlenmiştir. İnme, Alzheimer hastalığı ve Parkinson hastalığı olan bireylerde fiziksel ve bilişsel işlevlerdeki azalma, ağız hijyenini sağlamayı zorlaştırmakta, periodontal hastalık riskini ve diş kaybını artırmaktadır. Kanıtlar, periodontal tedavinin bu hastalıkların klinik seyrini iyileştirebileceğini göstermektedir. Bu nedenle, düzenli dental idame tedavilerine katılım ve optimal plak kontrolü, sistemik inflamasyonu azaltmak ve periodontal sağlığı korumak için kritik öneme sahiptir. CR - Adams, H. P., Jr., Bendixen, B. H., Kappelle, L. J., Biller, J., Love, B. B., Gordon, D. L., & Marsh, E. E., 3rd. (1993). Classification of subtype of acute ischemic stroke. Definitions for use in a multicenter clinical trial. TOAST. Trial of Org 10172 in Acute Stroke Treatment. Stroke, 24(1), 35-41. https://doi.org/10.1161/01.str.24.1.35 CR - Aoki, S., Hosomi, N., Nishi, H., Nakamori, M., Nezu, T., Shiga, Y., . . . Maruyama, H. (2020). Serum IgG titers to periodontal pathogens predict 3-month outcome in ischemic stroke patients. PLoS One, 15(8), e0237185. https://doi.org/10.1371/journal.pone.0237185 CR - Arrive, E., Letenneur, L., Matharan, F., Laporte, C., Helmer, C., Barberger-Gateau, P., . . . Dartigues, J. F. (2012). Oral health condition of French elderly and risk of dementia: a longitudinal cohort study. Community Dent Oral Epidemiol, 40(3), 230-238. https://doi.org/10.1111/j.1600-0528.2011.00650.x CR - Ascherio, A., & Schwarzschild, M. A. (2016). The epidemiology of Parkinson's disease: risk factors and prevention. Lancet Neurol, 15(12), 1257-1272. https://doi.org/10.1016/S1474-4422(16)30230-7 CR - Botelho, J., Lyra, P., Proenca, L., Godinho, C., Mendes, J. J., & Machado, V. (2020). Relationship between Blood and Standard Biochemistry Levels with Periodontitis in Parkinson's Disease Patients: Data from the NHANES 2011-2012. J Pers Med, 10(3). https://doi.org/10.3390/jpm10030069 CR - Botelho, J., Machado, V., Mendes, J. J., & Mascarenhas, P. (2021). Causal Association between Periodontitis and Parkinson's Disease: A Bidirectional Mendelian Randomization Study. Genes (Basel), 12(5). https://doi.org/10.3390/genes12050772 CR - Caton, J. G., Armitage, G., Berglundh, T., Chapple, I. L. C., Jepsen, S., Kornman, K. S., . . . Tonetti, M. S. (2018). A new classification scheme for periodontal and peri-implant diseases and conditions - Introduction and key changes from the 1999 classification. J Clin Periodontol, 45 Suppl 20, S1-S8. https://doi.org/10.1111/jcpe.12935 CR - Chen, C., Zhu, J., Deng, X., Yang, Z., Lin, W., Ma, Y., . . . Zhu, F. (2021). Severe periodontitis is associated with the serum levels of hypersensitive C reactive protein and lipoprotein-associated phospholipase A2 in the patients of acute ischemic stroke. J Clin Neurosci, 88, 232-236. https://doi.org/10.1016/j.jocn.2021.04.007 CR - Chen, C. K., Huang, J. Y., Wu, Y. T., & Chang, Y. C. (2018). Dental Scaling Decreases the Risk of Parkinson's Disease: A Nationwide Population-Based Nested Case-Control Study. Int J Environ Res Public Health, 15(8). https://doi.org/10.3390/ijerph15081587 CR - Chen, C. K., Wu, Y. T., & Chang, Y. C. (2017a). Association between chronic periodontitis and the risk of Alzheimer's disease: a retrospective, population-based, matched-cohort study. Alzheimers Res Ther, 9(1), 56. https://doi.org/10.1186/s13195-017-0282-6 CR - Chen, C. K., Wu, Y. T., & Chang, Y. C. (2017b). Periodontal inflammatory disease is associated with the risk of Parkinson's disease: a population-based retrospective matched-cohort study. PeerJ, 5, e3647. https://doi.org/10.7717/peerj.3647 CR - Chen, D. Y., Lin, C. H., Chen, Y. M., & Chen, H. H. (2016). Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study. PLoS One, 11(10), e0165601. https://doi.org/10.1371/journal.pone.0165601 CR - Chen, Y., Jin, Y., Li, K., Qiu, H., Jiang, Z., Zhu, J., . . . Yang, D. (2023). Is There an Association Between Parkinson's Disease and Periodontitis? A Systematic Review and Meta-Analysis. J Parkinsons Dis, 13(7), 1107-1125. doi:10.3233/JPD-230059 CR - Choi, S., Kim, K., Chang, J., Kim, S. M., Kim, S. J., Cho, H. J., & Park, S. M. (2019). Association of Chronic Periodontitis on Alzheimer's Disease or Vascular Dementia. J Am Geriatr Soc, 67(6), 1234-1239. https://doi.org/10.1111/jgs.15828 CR - Colaianni, V., Mazzei, R., & Cavallaro, S. (2016). Copy number variations and stroke. Neurol Sci, 37(12), 1895-1904. https://doi.org/10.1007/s10072-016-2658-y CR - D'Aiuto, F., Parkar, M., Nibali, L., Suvan, J., Lessem, J., & Tonetti, M. S. (2006). Periodontal infections cause changes in traditional and novel cardiovascular risk factors: results from a randomized controlled clinical trial. Am Heart J, 151(5), 977-984. https://doi.org/10.1016/j.ahj.2005.06.018 CR - Diaz-Zuniga, J., Munoz, Y., Melgar-Rodriguez, S., More, J., Bruna, B., Lobos, P., . . . Paula-Lima, A. (2019). Serotype b of Aggregatibacter actinomycetemcomitans triggers pro-inflammatory responses and amyloid beta secretion in hippocampal cells: a novel link between periodontitis and Alzheimer s disease? J Oral Microbiol, 11(1), 1586423. https://doi.org/10.1080/20002297.2019.1586423 CR - Fagundes, N. C. F., Almeida, A., Vilhena, K. F. B., Magno, M. B., Maia, L. C., & Lima, R. R. (2019). Periodontitis As A Risk Factor For Stroke: A Systematic Review And Meta-Analysis. Vasc Health Risk Manag, 15, 519-532. https://doi.org/10.2147/VHRM.S204097 CR - Freiherr Von Seckendorff, A., Nomenjanahary, M. S., Labreuche, J., Ollivier, V., Di Meglio, L., Dupont, S., . . . compo, C. s. g. (2024). Periodontitis in ischemic stroke: impact of Porphyromonas gingivalis on thrombus composition and ischemic stroke outcomes. Res Pract Thromb Haemost, 8(1), 102313. https://doi.org/10.1016/j.rpth.2023.102313 CR - Gani, D. K., Mallineni, S. K., Ambalavanan, Ramakrishnan, Deepalakshmi, & Emmadi, P. (2012). Estimation of the levels of C-reactive protein, interleukin-6, total leukocyte count, and differential count in peripheral blood smear of patients with chronic periodontitis in a South Indian population. West Indian Med J, 61(8), 826-831. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23757905 CR - Gao, S. S., Chu, C. H., & Young, F. Y. F. (2020). Oral Health and Care for Elderly People with Alzheimer's Disease. Int J Environ Res Public Health, 17(16). https://doi.org/10.3390/ijerph17165713 CR - Gelders, G., Baekelandt, V., & Van der Perren, A. (2018). Linking Neuroinflammation and Neurodegeneration in Parkinson's Disease. J Immunol Res, 2018, 4784268. https://doi.org/10.1155/2018/4784268 CR - Grysiewicz, R. A., Thomas, K., & Pandey, D. K. (2008). Epidemiology of ischemic and hemorrhagic stroke: incidence, prevalence, mortality, and risk factors. Neurol Clin, 26(4), 871-895, vii. https://doi.org/10.1016/j.ncl.2008.07.003 CR - Hajishengallis, G., & Lamont, R. J. (2021). Polymicrobial communities in periodontal disease: Their quasi-organismal nature and dialogue with the host. Periodontol 2000, 86(1), 210-230. https://doi.org/10.1111/prd.12371 CR - Hanaoka, A., & Kashihara, K. (2009). Increased frequencies of caries, periodontal disease and tooth loss in patients with Parkinson's disease. J Clin Neurosci, 16(10), 1279-1282. https://doi.org/10.1016/j.jocn.2008.12.027 CR - Harms, A. S., Ferreira, S. A., & Romero-Ramos, M. (2021). Periphery and brain, innate and adaptive immunity in Parkinson's disease. Acta Neuropathol, 141(4), 527-545. https://doi.org/10.1007/s00401-021-02268-5 CR - Hosomi, N., Aoki, S., Matsuo, K., Deguchi, K., Masugata, H., Murao, K., . . . Matsumoto, M. (2012). Association of serum anti-periodontal pathogen antibody with ischemic stroke. Cerebrovasc Dis, 34(5-6), 385-392. https://doi.org/10.1159/000343659 CR - Huang, J. L., Chen, W. K., Lin, C. L., Lai, C. Y., Kao, C. H., Chiang, H. H., . . . Shih, H. M. (2019). Association between intensive periodontal treatment and spontaneous intracerebral hemorrhage-a nationwide, population-based cohort study. Medicine (Baltimore), 98(10), e14814. https://doi.org/10.1097/MD.0000000000014814 CR - Ide, M., Harris, M., Stevens, A., Sussams, R., Hopkins, V., Culliford, D., . . . Holmes, C. (2016). Periodontitis and Cognitive Decline in Alzheimer's Disease. PLoS One, 11(3), e0151081. https://doi.org/10.1371/journal.pone.0151081 CR - Ilievski, V., Zuchowska, P. K., Green, S. J., Toth, P. T., Ragozzino, M. E., Le, K., . . . Watanabe, K. (2018). Chronic oral application of a periodontal pathogen results in brain inflammation, neurodegeneration and amyloid beta production in wild type mice. PLoS One, 13(10), e0204941. doi:10.1371/journal.pone.0204941 CR - Isik, S., Yeman Kiyak, B., Akbayir, R., Seyhali, R., & Arpaci, T. (2023). Microglia Mediated Neuroinflammation in Parkinson's Disease. Cells, 12(7). https://doi.org/10.3390/cells12071012 CR - Jeong, E., Park, J. B., & Park, Y. G. (2021). Evaluation of the association between periodontitis and risk of Parkinson's disease: a nationwide retrospective cohort study. Sci Rep, 11(1), 16594. https://doi.org/10.1038/s41598-021-96147-4 CR - Lafon, A., Tala, S., Ahossi, V., Perrin, D., Giroud, M., & Bejot, Y. (2014). Association between periodontal disease and non-fatal ischemic stroke: a case-control study. Acta Odontol Scand, 72(8), 687-693. https://doi.org/10.3109/00016357.2014.898089 CR - Lee, N. E., Yoo, D. M., Han, K. M., Kang, H. S., Kim, J. H., Kim, J. H., . . . Kwon, M. J. (2024). Investigating the Connection between Chronic Periodontitis and Parkinson's Disease: Findings from a Korean National Cohort Study. Biomedicines, 12(4). https://doi.org/10.3390/biomedicines12040792 CR - Lee, Y. T., Lee, H. C., Hu, C. J., Huang, L. K., Chao, S. P., Lin, C. P., . . . Chen, C. C. (2017). Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population-Based Cohort Study. J Am Geriatr Soc, 65(2), 301-305. https://doi.org/10.1111/jgs.14449 CR - Leira, Y., Dominguez, C., Seoane, J., Seoane-Romero, J., Pias-Peleteiro, J. M., Takkouche, B., . . . Aldrey, J. M. (2017). Is Periodontal Disease Associated with Alzheimer's Disease? A Systematic Review with Meta-Analysis. Neuroepidemiology, 48(1-2), 21-31. https://doi.org/10.1159/000458411 CR - Leira, Y., Seoane, J., Blanco, M., Rodriguez-Yanez, M., Takkouche, B., Blanco, J., & Castillo, J. (2017). Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol, 32(1), 43-53. https://doi.org/10.1007/s10654-016-0170-6 CR - Leira, Y., Vivancos, J., Diz, P., Martin, A., Carasol, M., & Frank, A. (2024). The association between periodontitis and cerebrovascular disease, and dementia. Scientific report of the working group of the Spanish Society of Periodontology and the Spanish Society of Neurology. Neurologia (Engl Ed), 39(3), 302-311. https://doi.org/10.1016/j.nrleng.2024.01.002 CR - Li, X., Kiprowska, M., Kansara, T., Kansara, P., & Li, P. (2022). Neuroinflammation: A Distal Consequence of Periodontitis. J Dent Res, 101(12), 1441-1449. https://doi.org/10.1177/00220345221102084 CR - Lin, H. W., Chen, C. M., Yeh, Y. C., Chen, Y. Y., Guo, R. Y., Lin, Y. P., & Li, Y. C. (2019). Dental treatment procedures for periodontal disease and the subsequent risk of ischaemic stroke: A retrospective population-based cohort study. J Clin Periodontol, 46(6), 642-649. https://doi.org/10.1111/jcpe.13113 CR - Loos, B. G., Craandijk, J., Hoek, F. J., Wertheim-van Dillen, P. M., & van der Velden, U. (2000). Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol, 71(10), 1528-1534. https://doi.org/10.1902/jop.2000.71.10.1528 CR - Lopez, N. J., Quintero, A., Casanova, P. A., Ibieta, C. I., Baelum, V., & Lopez, R. (2012). Effects of periodontal therapy on systemic markers of inflammation in patients with metabolic syndrome: a controlled clinical trial. J Periodontol, 83(3), 267-278. https://doi.org/10.1902/jop.2011.110227 CR - Lyra, P., Machado, V., Proenca, L., Domingos, J., Godinho, C., Mendes, J. J., & Botelho, J. (2020). Parkinson's Disease, Periodontitis and Patient-Related Outcomes: A Cross-Sectional Study. Medicina (Kaunas), 56(8). https://doi.org/10.3390/medicina56080383 CR - Ma, K. S., Hasturk, H., Carreras, I., Dedeoglu, A., Veeravalli, J. J., Huang, J. Y., . . . Wei, J. C. (2022). Dementia and the Risk of Periodontitis: A Population-Based Cohort Study. J Dent Res, 101(3), 270-277. https://doi.org/10.1177/00220345211037220 CR - Meyle, J., & Chapple, I. (2015). Molecular aspects of the pathogenesis of periodontitis. Periodontol 2000, 69(1), 7-17. https://doi.org/10.1111/prd.12104 CR - Mietelska-Porowska, A., Wasik, U., Goras, M., Filipek, A., & Niewiadomska, G. (2014). Tau protein modifications and interactions: their role in function and dysfunction. Int J Mol Sci, 15(3), 4671-4713. https://doi.org/10.3390/ijms15034671 CR - Murphy, M. P., & LeVine, H., 3rd. (2010). Alzheimer's disease and the amyloid-beta peptide. J Alzheimers Dis, 19(1), 311-323. https://doi.org/10.3233/JAD-2010-1221 CR - Mustapha, I. Z., Debrey, S., Oladubu, M., & Ugarte, R. (2007). Markers of systemic bacterial exposure in periodontal disease and cardiovascular disease risk: a systematic review and meta-analysis. J Periodontol, 78(12), 2289-2302. https://doi.org/10.1902/jop.2007.070140 CR - Nishi, H., Hosomi, N., Ohta, K., Aoki, S., Nakamori, M., Nezu, T., . . . Kurihara, H. (2020). Serum immunoglobulin G antibody titer to Fusobacterium nucleatum is associated with unfavorable outcome after stroke. Clin Exp Immunol, 200(3), 302-309. https://doi.org/10.1111/cei.13430 CR - Noble, J. M., Scarmeas, N., Celenti, R. S., Elkind, M. S., Wright, C. B., Schupf, N., & Papapanou, P. N. (2014). Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease. PLoS One, 9(12), e114959. https://doi.org/10.1371/journal.pone.0114959 CR - Okamoto, N., Morikawa, M., Tomioka, K., Yanagi, M., Amano, N., & Kurumatani, N. (2015). Association between tooth loss and the development of mild memory impairment in the elderly: the Fujiwara-kyo Study. J Alzheimers Dis, 44(3), 777-786. https://doi.org/10.3233/JAD-141665 CR - Palm, F., Lahdentausta, L., Sorsa, T., Tervahartiala, T., Gokel, P., Buggle, F., . . . Pussinen, P. (2014). Biomarkers of periodontitis and inflammation in ischemic stroke: A case-control study. Innate Immun, 20(5), 511-518. https://doi.org/10.1177/1753425913501214 CR - Papapanou, P. N., Sanz, M., Buduneli, N., Dietrich, T., Feres, M., Fine, D. H., . . . Tonetti, M. S. (2018). Periodontitis: Consensus report of workgroup 2 of the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Diseases and Conditions. Journal of Periodontology, 89(S1). https://doi.org/10.1002/jper.17-0721 CR - Passoja, A., Puijola, I., Knuuttila, M., Niemela, O., Karttunen, R., Raunio, T., & Tervonen, T. (2010). Serum levels of interleukin-10 and tumour necrosis factor-alpha in chronic periodontitis. J Clin Periodontol, 37(10), 881-887. https://doi.org/10.1111/j.1600-051X.2010.01602.x CR - Pazos, P., Leira, Y., Dominguez, C., Pias-Peleteiro, J. M., Blanco, J., & Aldrey, J. M. (2018). Association between periodontal disease and dementia: A literature review. Neurologia (Engl Ed), 33(9), 602-613. https://doi.org/10.1016/j.nrl.2016.07.013 CR - Pussinen, P. J., Alfthan, G., Jousilahti, P., Paju, S., & Tuomilehto, J. (2007). Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis, 193(1), 222-228. https://doi.org/10.1016/j.atherosclerosis.2006.06.027 CR - Pussinen, P. J., Alfthan, G., Rissanen, H., Reunanen, A., Asikainen, S., & Knekt, P. (2004). Antibodies to periodontal pathogens and stroke risk. Stroke, 35(9), 2020-2023. https://doi.org/10.1161/01.STR.0000136148.29490.fe CR - Rokad, F., Moseley, R., Hardy, R. S., Chukkapalli, S., Crean, S., Kesavalu, L., & Singhrao, S. K. (2017). Cerebral Oxidative Stress and Microvasculature Defects in TNF-alpha Expressing Transgenic and Porphyromonas gingivalis-Infected ApoE-/- Mice. J Alzheimers Dis, 60(2), 359-369. https://doi.org/10.3233/JAD-170304 CR - Rolim Tde, S., Fabri, G. M., Nitrini, R., Anghinah, R., Teixeira, M. J., Siqueira, J. T., . . . Siqueira, S. R. (2014). Evaluation of patients with Alzheimer's disease before and after dental treatment. Arq Neuropsiquiatr, 72(12), 919-924. https://doi.org/10.1590/0004-282X20140140 CR - Ryder, M. I. (2020). Porphyromonas gingivalis and Alzheimer disease: Recent findings and potential therapies. J Periodontol, 91 Suppl 1(Suppl 1), S45-S49. https://doi.org/10.1002/JPER.20-0104 CR - Sacco, R. L., Kasner, S. E., Broderick, J. P., Caplan, L. R., Connors, J. J., Culebras, A., . . . Metabolism. (2013). An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 44(7), 2064-2089. https://doi.org/10.1161/STR.0b013e318296aeca CR - Schenkein, H. A., & Loos, B. G. (2013). Inflammatory mechanisms linking periodontal diseases to cardiovascular diseases. J Periodontol, 84(4 Suppl), S51-69. https://doi.org/10.1902/jop.2013.134006 CR - Schwahn, C., Frenzel, S., Holtfreter, B., Van der Auwera, S., Pink, C., Bulow, R., . . . Alzheimer's Disease Neuroimaging, I. (2022). Effect of periodontal treatment on preclinical Alzheimer's disease-Results of a trial emulation approach. Alzheimers Dement, 18(1), 127-141. https://doi.org/10.1002/alz.12378 CR - Sen, S., Chung, M., Duda, V., Giamberardino, L., Hinderliter, A., & Offenbacher, S. (2017). Periodontal Disease Associated with Aortic Arch Atheroma in Patients with Stroke or Transient Ischemic Attack. J Stroke Cerebrovasc Dis, 26(10), 2137-2144. https://doi.org/10.1016/j.jstrokecerebrovasdis.2017.04.035 CR - Sen, S., Giamberardino, L. D., Moss, K., Morelli, T., Rosamond, W. D., Gottesman, R. F., . . . Offenbacher, S. (2018). Periodontal Disease, Regular Dental Care Use, and Incident Ischemic Stroke. Stroke, 49(2), 355-362. https://doi.org/10.1161/STROKEAHA.117.018990 CR - Sen, S., Redd, K., Trivedi, T., Moss, K., Alonso, A., Soliman, E. Z., . . . Offenbacher, S. (2021). Periodontal Disease, Atrial Fibrillation and Stroke. Am Heart J, 235, 36-43. https://doi.org/10.1016/j.ahj.2021.01.009 CR - Sen, S., Sumner, R., Hardin, J., Barros, S., Moss, K., Beck, J., & Offenbacher, S. (2013). Periodontal disease and recurrent vascular events in stroke/transient ischemic attack patients. J Stroke Cerebrovasc Dis, 22(8), 1420-1427. https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.06.024 CR - Shin, H. S., Shin, M. S., Ahn, Y. B., Choi, B. Y., Nam, J. H., & Kim, H. D. (2016). Periodontitis Is Associated with Cognitive Impairment in Elderly Koreans: Results from the Yangpyeong Cohort Study. J Am Geriatr Soc, 64(1), 162-167. https://doi.org/10.1111/jgs.13781 CR - Sierksma, A., Escott-Price, V., & De Strooper, B. (2020). Translating genetic risk of Alzheimer's disease into mechanistic insight and drug targets. Science, 370(6512), 61-66. https://doi.org/10.1126/science.abb8575 CR - Stein, P. S., Desrosiers, M., Donegan, S. J., Yepes, J. F., & Kryscio, R. J. (2007). Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc, 138(10), 1314-1322; quiz 1381-1312. https://doi.org/ https://doi.org/10.14219/jada.archive.2007.0046 CR - Stewart, R., Weyant, R. J., Garcia, M. E., Harris, T., Launer, L. J., Satterfield, S., . . . Newman, A. B. (2013). Adverse oral health and cognitive decline: the health, aging and body composition study. J Am Geriatr Soc, 61(2), 177-184. https://doi.org/10.1111/jgs.12094 CR - Tuominen, H., Taina, M., Puranen, M., Onatsu, J., Huumonen, S., & Vanninen, R. (2020). Serum High-Sensitive C-reactive Protein May Reflect Periodontitis in Patients With Stroke. In Vivo, 34(5), 2829-2835. https://doi.org/10.21873/invivo.12109 CR - van Stiphout, M. A. E., Marinus, J., van Hilten, J. J., Lobbezoo, F., & de Baat, C. (2018). Oral Health of Parkinson's Disease Patients: A Case-Control Study. Parkinsons Dis, 2018, 9315285. https://doi.org/10.1155/2018/9315285 CR - Verhoeff, M. C., Eikenboom, D., Koutris, M., de Vries, R., Berendse, H. W., van Dijk, K. D., & Lobbezoo, F. (2023). Parkinson's disease and oral health: A systematic review. Arch Oral Biol, 151, 105712. https://doi.org/10.1016/j.archoralbio.2023.105712 CR - Vidal, F., Cordovil, I., Figueredo, C. M., & Fischer, R. G. (2013). Non-surgical periodontal treatment reduces cardiovascular risk in refractory hypertensive patients: a pilot study. J Clin Periodontol, 40(7), 681-687. https://doi.org/10.1111/jcpe.12110 CR - Wilckens, K. A., Stillman, C. M., Waiwood, A. M., Kang, C., Leckie, R. L., Peven, J. C., . . . Erickson, K. I. (2021). Exercise interventions preserve hippocampal volume: A meta-analysis. Hippocampus, 31(3), 335-347. https://doi.org/10.1002/hipo.23292 CR - Woo, H. G., Chang, Y., Lee, J. S., & Song, T. J. (2020). Association of Tooth Loss with New-Onset Parkinson's Disease: A Nationwide Population-Based Cohort Study. Parkinsons Dis, 2020, 4760512. https://doi.org/10.1155/2020/4760512 CR - Zeng, L. N., Rao, W. W., Luo, S. H., Zhang, Q. E., Hall, B. J., Ungvari, G. S., . . . Xiang, Y. T. (2020). Oral health in patients with stroke: a meta-analysis of comparative studies. Top Stroke Rehabil, 27(1), 75-80. https://doi.org/10.1080/10749357.2019.1656413 CR - Zhang, Z., Ma, N., Zheng, Y., & Zhang, L. (2015). Association of serum immunoglobulin-G to Porphyromonas gingivalis with acute cerebral infarction in the Chinese population. J Indian Soc Periodontol, 19(6), 628-632. https://doi.org/10.4103/0972-124X.164750 UR - https://dergipark.org.tr/tr/pub/unikasaglik/issue//1612784 L1 - https://dergipark.org.tr/tr/download/article-file/4490393 ER -