A new survey has explained the correlation between oral health and cognitive health. In particular, he explored the possibility that the gum disease are related to an increased risk of developing dementia. Individuals with dementia are often unable to maintain proper oral hygiene and run a greater risk of poor oral health. However, recent studies suggest that this relationship may be two-way.
The results of the study were published in the scientific journal American Geriatrics Society.
Gum disease and dementia: are they related?
The new research suggests that gum disease and tooth loss may actually be associated with subsequent cognitive decline and dementia. The evidence included in the meta-analysis showed significant methodological variations and was of low quality; however, the potential effects of cognitive decline on gum disease cannot be ruled out.
The doctor Ella Cohn-Schwartz Professor at the Ben-Gurion University, Israel, not involved in this research, commented: “Poor oral health and suboptimal chewing have been found to be potentially modifiable risk factors for cognitive impairment, but previous evidence is limited. This meta-analysis provides a much-needed comprehensive synthesis of a large number of longitudinal studies on periodontal health, cognitive decline and dementia ”.
“This paper is new in several respects, such as considering reverse causation, covering the spectrum of periodontal deterioration, including tooth loss, and examining both cognitive decline and dementia as outcomes. Their findings may indicate the importance of policies and interventions that address tooth loss, even partial, in old age, ”added Dr. Cohn-Schwartz regarding gum disease.
Dementia is characterized by a gradual decline in cognitive function, including memory, thinking, and reasoning, which impairs the individual’s ability to perform daily activities. Dementia is often preceded by milder forms of cognitive decline, such as brief cognitive impairment.
Mild cognitive impairment results in a decline in cognitive function greater than that typically seen during aging. Individuals with milder forms of cognitive decline show no deficits in daily functioning but are at greater risk for dementia.
There are approximately 55 million people around the world currently living with dementia and the prevalence of this condition could rise to approximately 139 million by 2050. Effective treatments for cognitive decline and dementia are lacking, making it essential to understand the modifiable risk factors for these conditions.
Previous studies have shown that factors such as cardiovascular disease, diabetes, and an unhealthy diet can increase the risk of dementia. However, the role of oral health and gum disease in the development of dementia has received less attention.
Until recently, some experts thought that inadequate oral hygiene due to impaired daily functioning was responsible for the poor oral health seen in individuals with dementia. However, emerging evidence suggests that poor oral health, including gum disease, could contribute to cognitive decline and dementia.
A recent meta-analysis summarized data from previous longitudinal studies examining the potential role of oral health in cognitive decline and dementia. Specifically, the meta-analysis looked at the impact of periodontitis, also known as one of the gum disease, on cognitive health. Periodontitis refers to bacterial infection of the gums which causes inflammation of the gums which can damage the tissues and bones that support the teeth and can lead to tooth loss in severe cases.
Common signs of periodontitis include bleeding from the gums, loss of the alveolar bones that support the teeth, and tooth loss. Periodontitis is also characterized by an increase in the depth of the periodontal pockets, which are the spaces between the gums and teeth.
The meta-analysis included 24 longitudinal studies that carefully studied the association between cognitive decline and periodontitis and another 23 studies that evaluated the link between periodontitis and dementia. The research evaluated periodontal health as assessed by the presence of periodontitis, alveolar bone loss, increased periodontal pocket depth and tooth loss.
The meta-analysis revealed that periodontitis was associated with an increased risk of cognitive decline and dementia. Among the various criteria used to evaluate periodontitis, further analyzes revealed that tooth loss was also independently linked to cognitive decline and dementia.
Partial tooth loss, which involved the loss of some but not all teeth, was associated with cognitive decline. In contrast, complete tooth loss, but not partial tooth loss, was linked to an increased risk of dementia. Previous studies have shown that people with dementia or mild cognitive impairment could be harbingers of gum disease.
The decline in cognitive function and changes in the brain associated with mild cognitive impairment or dementia occur gradually over many years. Studies with a follow-up duration of less than 10 years may therefore reflect the impact of cognitive decline on oral health. Then, the researchers re-examined the association between cognitive health and gum disease after excluding studies with a follow-up duration of less than 10 years. After excluding these studies, the meta-analysis found a weaker association between periodontitis and dementia.
The weaker association between periodontitis and dementia in this further analysis indicates that the initial analysis results may have been partly influenced by the effects of cognitive impairment on oral health.
Although the results of the follow-up analysis indicated that poor oral health may contribute to the development of dementia, some researchers remain skeptical of the evidence linking poor oral health to cognitive decline.
This is because dementia and tooth loss share the same risk factors, such as low levels of education, socioeconomic status, and diabetes. Additionally, individuals with higher cognitive function in childhood tend to have better oral health and access to dental care in adulthood than those with lower cognitive abilities in early childhood.
Children with higher cognitive abilities are also more likely to maintain better cognitive function in old age. Therefore, poor oral health may not play a causal role in the development of dementia.
Dr Murray Thompson, Professor of Dentistry at the University of Otago, not involved in the current research, noted, “The results of this review are not surprising, as gum disease and cognitive decline share the same risk factors for lifetime. I expect any investigation at any age in adulthood to show an association between gum disease and cognitive function for this reason. The key issue is that there is no valid evidence that gum disease causes poor cognitive function, but there is very strong evidence that people with poorer cognitive function have more gum disease. “
The study authors specified that the evidence reviewed in the meta-analysis was of low quality. There was considerable variation between the studies analyzed in the measures used to assess periodontal health and in the tests used to assess cognitive function.
Furthermore, studies evaluating the impact of cognitive decline on periodontal health generally included individuals over the age of 65 and with a shorter follow-up duration. This could potentially have skewed the results in favor of a positive association between periodontal health and cognitive decline.
Therefore, more research conducted using standardized methods is needed to further evaluate the link between periodontal and cognitive health. However, these results suggest that early prevention and treatment of oral health problems could help reduce the risk of cognitive decline and dementia.
The mechanisms that could explain the impact of periodontal health on cognitive impairment are not well understood. The bacterial infection responsible for gum disease is known to cause an increase in markers of systemic inflammation.
Several studies suggest that systemic inflammation can contribute to the development of dementia. Therefore, systemic inflammation induced by periodontitis could potentially lead to a decline in cognitive function. The bacterial infection and inflammation involved in periodontitis could also weaken the blood brain barrier, which prevents toxic substances from entering the brain.
The weakening of the blood brain barrier could allow bacteria and inflammatory molecules to enter the brain via the bloodstream, subsequently contributing to brain inflammation. Periodontitis could therefore cause brain inflammation, which plays a vital role in the development of dementia.
Deficits in chewing ability due to tooth loss can also contribute to the decline in cognitive function. This is because the process of chewing food is associated with increased blood flow to the brain regions involved in cognition and helps maintain cognitive function.
Additionally, reduced ability to chew food due to tooth loss can affect eating habits, including higher sugar consumption and lower intake of dietary fiber. Unhealthy eating habits associated with decreased chewing ability due to tooth loss could also increase the risk of dementia.
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