Are oral hygiene behaviors associated with lower stroke risk? A systematic review

Abstract

This study aims to systematically synthesize observational evidence on the association between oral hygiene behaviors, including tooth brushing, interdental cleaning, dental visits, and professional dental cleaning, and stroke risk in adults. A PRISMA-compliant systematic review was conducted by searching PubMed, Scopus, Embase and google scholar on November 26, 2025. Observational studies evaluating oral hygiene behaviors in relation to stroke or cerebrovascular outcomes were included. Methodological quality was assessed using the Newcastle Ottawa Scale (NOS). Due to substantial heterogeneity in exposures, outcomes, and effect measures, findings were synthesized narratively. Thirteen studies (9 cohort, 4 cross-sectional) involving over 1.1 million participants were included. Eleven studies evaluated tooth brushing; six out of eight cohort studies and one of three cross sectional ones reported significant inverse associations. Interdental cleaning generally demonstrated a protective directional association with stroke risk; however, several studies reported non-significant associations following multivariable adjustment. Regular dental visits and professional dental cleaning were associated with reductions in stroke risk across cohort studies. Cross-sectional evidence for brushing alone and dental visit frequency was less consistent. Observational evidence supports an association between favorable oral hygiene behaviors, particularly frequent tooth brushing and professional dental cleaning, and reduced stroke risk. Oral hygiene may represent an underrecognized component of vascular prevention strategies.