Dental and Other Aspects of a Possible Association Between Cerebrovascular Ischemia and Chronic Infection

To the editor: I believe that the report of Grau and colleagues1 concerning acute cerebrovascular ischemia and infections has diagnostic, statistical, dental, and terminological aspects worthy of comment. This letter will address them sequentially.All possible participants with two or more episodes of “cough with phlegm” during 3 or more months in each of 2 years were said to have “frequent or chronic bronchitis.” In addition, Table 2 tabulated people who had “two or more episodes in life so far.” That might not be too unusual in a middle-aged population. Even if major causes of cough such as tuberculosis or heart failure are ruled out, morning “cigarette cough”2 or postnasal drip syndrome, allergy, environmental irritants, vasomotor rhinitis, and sinusitis3 rather than true bronchitis quite possibly were present in some participants. Therefore, perhaps not all of the study’s productive coughers merited such classification.Although multiple statistical methods were used, no probability value for significance was stated. This unusual omission is important because it was written that “…patients with cerebrovascular ischemia tended to have a worse dental status than the control group ( P =.070 and P =.062, respectively).” By customary statistical criteria those differences, which are greater than .05, are not significant. Do the authors believe those larger probability values indicate meaningful differences? If not, their paper is largely based on that tendency rather than a significant association, despite use of the latter word in the title. This could well mislead the casual reader.Regarding the dental aspects, the discussion states, “…periodontitis and periapical lesions but not caries contributed to differences between groups.” That conclusion, apparently based on Table 5, which indicates the difference in periapical lesions between the two groups to be more significant ( P =.027) than the caries (NS) or the periodontitis ( P =.047) scores, must be …