Gum problems, tooth loss found to increase risk of dementia

Jeremy Booth, Dental Tribune International

Fri. 14. October 2022

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KUOPIO, Finland: Researchers at the University of Eastern Finland have added to scientific evidence of a link between periodontal health problems and cognitive decline. According to a systematic review, poor periodontal health and tooth loss substantially increase the risk of dementia and underscore the importance of oral care as a preventive tool.

The researchers reviewed 47 longitudinal studies from around the world and found that poor periodontal health—the incidence of periodontitis, tooth loss, deep periodontal pockets or alveolar bone loss—was linked to cognitive decline and dementia. Their analysis found that poor periodontal health increased the risk of cognitive decline and dementia by 23% and 21%, respectively. Tooth loss alone increased the risk of cognitive decline by 23% and the risk of dementia by 13%, the review found.

The authors cautioned that the quality of the reviewed evidence was low and that the interplay between periodontal health and cognitive health requires further investigation; however, they drew attention to the significance of the findings. They wrote: “From a clinical perspective, our findings emphasise the importance of monitoring and management of periodontal health in the context of dementia prevention, although the available evidence is not yet sufficient to point out clear ways for early identification of at-risk individuals, and the most efficient measures to prevent cognitive deterioration.”

“[Our] findings emphasise the importance of monitoring and management of periodontal health in the context of dementia prevention”

The review findings suggest the involvement of multiple mechanisms in the association between periodontal and cognitive health. The authors explained: “Periodontitis is suggested to facilitate the development of neuro-inflammation via systemic inflammation, evident by increased systemic pro-inflammatory mediators. Systemic inflammation per se is an independent determinant of cognitive deterioration and links other risk factors including diabetes, hypertension, hypercholesterolaemia, and even ageing to cognitive deterioration.” They added that a more direct role of periodontal pathogens has been suggested. Tooth loss, the researchers wrote, may independently impair cognitive function by reducing sensorimotor stimulation.

Clinical recommendations made by the authors included monitoring periodontal health in the context of dementia prevention, particularly in the treatment of older patients, and providing oral and periodontal care to patients with cognitive impairment or dementia.

Earlier this year, Dental Tribune International reported on a University of Birmingham study that found that periodontal disease was associated with chronic diseases such as cardiovascular disease, cardiometabolic disease, autoimmune disease and mental ill health. In 2011, researchers from the University of Greifswald confirmed previous findings regarding a connection between inflammatory gingival recession owing to periodontitis and Alzheimer’s disease.

The review article, titled “Periodontal health, cognitive decline, and dementia: A systematic review and meta-analysis of longitudinal studies”, was published in the September 2022 issue of the Journal of the American Geriatrics Society.