Numerous studies have linked gum disease to a variety of health problems, including heart disease, heart attack, stroke, diabetes, and rheumatoid arthritis. Several recent studies add to the potential clinical impact of gum disease and tooth loss with data suggesting an association with cognitive decline in seniors.
At this time, there is no solid evidence linking oral health and overall health, according to John Pfail, DDS, chief of Mount Sinai’s department of dentistry. “Multiple possible factors have been proposed,” he explains. “Although it is not possible to say that regular tooth brushing can prevent dementia, it is clear that overall health will likely benefit from a thorough oral hygiene regimen.”
What the Studies Found Three recent studies examined possible links between oral health and cognitive function. In the first (PLOS ONE, March 10), 60 older adults were followed for six months. All of the participants had mild-to-moderate dementia, and some had gum disease. The presence of gum disease was associated with a six-fold increase in cognitive decline at the end of the study period.
In the second study (JDR Clinical and Translational Research, April) researchers analyzed eight previous studies assessing the association between oral health and cognitive decline. They found that participants with suboptimal dentition (which was defined as having fewer than 20 teeth) had a 20 percent greater risk for developing cognitive decline and dementia than those with optimal dentition (20 or more teeth).
The final study (Journal of the American Geriatrics Society, April 1), which reviewed 56 previous studies, had mixed results. Although there were studies suggesting that the number of teeth and periodontal disease were associated with the risk for cognitive decline or incident dementia, others found no association.
Multiple Factors at Play There is evidence that inflammation raises the risk for cognitive decline. “Researchers have found higher levels of inflammatory markers in people with Alzheimer’s disease,” says Sandra Molinas, DDS, a clinical instructor in dentistry at Mount Sinai who specializes in periodontics. “Gum disease and cavities are infectious conditions that introduce inflammatory proteins into the blood, and it is possible that the gum inflammation that accompanies gum disease is one of the sources.”
Dr. Pfail says that an important question arising from study data is which comes first: gum disease or dementia. “Does gum disease and inflammation develop first and then contribute to cognitive decline and dementia, or does cognitive decline lead to gum disease because people with dementia forget to regularly brush and floss their teeth?” he explains.
Dr. Molinas adds that other factors also may cause seniors to lapse when it comes to oral hygiene. “For example, arthritis may result in gum disease simply because an older adult might find it difficult to grip and maneuver a toothbrush,” she observes. “Gum disease and tooth loss often affect an older adult’s diet because they make it more difficult to chew food. Poor diet has been associated with cardiovascular disease and diabetes, which, in turn, seem to raise the risk for cognitive impairment.” In addition, tooth loss may affect an older adult’s self esteem and cause them to withdraw socially, which also is linked to a greater risk for cognitive impairment.
Although the exact nature of the relationship between oral health and brain health is unclear at this time, Dr. Pfail says it is vital that seniors be aware of the various factors that can adversely affect cognition as they age. “It is not possible to say that treating gum disease may delay the development and progression of dementia,” he emphasizes. “However, good dental care will help maintain an older person’s teeth and allow for better function, nutrition, and overall wellbeing.”
A thorough oral care regimen should include brushing and flossing twice a day, as well as regular dental check-ups.
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