What is it?
A stroke is a sudden failure of the blood supply to brain tissue. There are two main forms: a blood vessel blocked by a clot, and a blood vessel tearing and bleeding. Both can start with the same symptoms from the outside; which one it is can only be worked out in hospital with a brain scan, and the treatment path changes completely with that distinction.
There is a concrete reason why this heading appears on the information pages of a dental clinic. One side of the face dropping, speech becoming disturbed and sudden numbness around the mouth may first be described to a dentist. The symptoms can also start in the waiting room or in the treatment chair. Recognising the picture is therefore the responsibility of the clinic team.
Time here matters as much as the treatment itself. Brain cells are lost within minutes, and the window in which a clot-busting drug or an interventional method can be used is narrow. The time the symptoms started is used directly in the decision made in hospital. Even if the symptoms pass by themselves, an assessment is still needed.
Signs
You will not necessarily have all of these at once.
Why does it happen?
- 01
A vessel blocked by a clot
A clot breaking away from the heart or from the neck vessels can block an artery in the brain. In people with a heart rhythm problem this mechanism is looked into particularly, and the prevention plan is built around it.
- 02
The vessel wall deteriorating over time
High blood pressure, diabetes, high cholesterol and smoking wear the vessel wall down. A narrowed and hardened vessel becomes more prone both to blocking and to tearing.
- 03
A vessel tearing and bleeding
Uncontrolled high blood pressure, ballooning of the vessel wall and the use of blood thinners are the known background to a bleeding stroke. In this form the treatment path is completely different from a blockage.
- 04
Established conditions that raise the risk
Older age, a family history of stroke, an inactive life, being very overweight and untreated sleep apnoea raise the risk. Some of these can be changed, which is why they are targeted in prevention.
How does it progress?
- Type 1
Stroke caused by a blocked vessel
It happens when an artery in the brain is closed off by a clot, and this is the form seen most often. In suitable patients, treatments to open the clot come onto the agenda in the early period.
- Type 2
Stroke caused by bleeding in the brain
It happens when a vessel tears and blood fills the brain tissue. A severe headache and quickly worsening consciousness can go with it; the treatment approach is entirely different.
- Type 3
Transient ischaemic attack
The symptoms pass by themselves within minutes or hours. It is not reassuring but a warning; it should not be ignored, because it points to the risk of a real stroke in the near future.
- Afterwards
Mouth health after a stroke
Because hand movement and swallowing can be affected, mouth care becomes harder. Keeping that care going matters both for mouth health and for the risk of a chest infection.
How is it treated?
A dentist has no treating role in this condition. When there is sudden drooping of the face, disturbed speech or weakness in an arm, the only thing to do is to call 112 straight away. The person is not sent off in their own car, no one waits to see whether it passes, and nothing is given by mouth, not even water. What is done in the clinic is to recognise the picture, write down the time the symptoms started, keep the person in a safe position and pass this information on to the ambulance crew.
In hospital a neurological assessment is carried out and a brain scan separates a blockage from a bleed. In a stroke caused by a blockage, and if the conditions are right, a clot-busting drug or removal of the clot by an interventional procedure comes onto the agenda. In a bleeding stroke the path is entirely different. Because giving medication without making this distinction can do harm, no medication at all is given outside hospital.
After the first period, follow-up in a stroke unit, investigations into the cause and rehabilitation begin. To prevent a second stroke, blood pressure, heart rhythm and blood results are brought under control. Decisions about the timing of dental treatment and about any blood thinners you take are made in discussion with the doctor looking after you; be sure to tell your dentist about this.
- One side of the face dropping suddenly, the mouth pulling to one side when smiling
- Sudden weakness in an arm or a leg, not being able to hold the arm up
- Slurred speech, not being able to find words, or not being able to understand what is said
- Sudden loss of vision, double vision, loss of balance, or a headache that starts suddenly and is worse than any before
How is it prevented?
- Do not miss your blood pressure, blood sugar and cholesterol checks, and do not stop the medicines you take on your own decision.
- Stopping smoking clearly lowers the risk of a stroke; talk to your doctor about support while you are giving up.
- If you have a heart rhythm problem or take blood thinners, tell your dentist as well; the treatment plan is made accordingly.
- If you snore and are very sleepy during the day, ask for an assessment for sleep apnoea; untreated apnoea raises the risk to your blood vessels.
Frequently asked questions
- The symptoms passed in a few minutes, should I still go to hospital?
- Yes. Symptoms that pass by themselves can be a transient ischaemic attack, and this points to the risk of a real stroke in the near future. Them passing does not show that the danger has gone. An assessment on the same day and investigation of the cause are needed.
- How do I tell whether facial drooping is a stroke or a facial palsy?
- Do not try to make this distinction at home. Findings such as weakness in an arm, disturbed speech and movement of the forehead are used in the assessment, but the decision is made by examination and, where needed, by scans. The right thing to do is the same for everyone whose face drops suddenly: get emergency help without losing time.
- Can aspirin or blood pressure medicine be given while waiting?
- No. Because the picture may be caused by bleeding, a medicine that thins the blood can do harm. Swallowing may also be affected, so anything given by mouth carries the risk of going into the airway. The decision about medication is made in hospital after a scan.
This content is for general information and does not replace an in-person examination. Symptoms overlap between conditions, and a diagnosis can only be made clinically.