Beyond the mouth: the impact of periodontal disease on dementia

Gerodontology, 2017

It has been suggested that dementia is caused by neuronal damage due to chronic inflammation from peripheral sources such as the oral cavity in periodontal disease. Objective: The aim of our review was to assess the risk of dementia or cognitive impairment associated with chronic periodontitis and multiple tooth loss. Materials and methods: An extensive search of electronic databases of articles on the relation between periodontitis, tooth loss and dementia published on or before April 2016 was conducted. Experimental and human studies that provided a description consistent with multiple tooth loss, chronic periodontal disease and cognitive impairment obtained by validated methods were selected. The data extracted from the articles included study design, country of origin, sample size, methods used to assess periodontitis and cognition, average age at the baseline and number of years of followup. The Newcastle-Ottawa scale was used to assess the quality of human studies. Results: The literature search yielded 756 articles which were independently screened, and 16 articles were included in the review. Four human studies reported an association of subsequent dementia with multiple tooth loss. One human study reported that chronic periodontal disease was associated with dementia. Eight experimental studies demonstrated an association between cognitive impairment and tooth loss. Conclusion: The literature on chronic periodontitis and multiple tooth loss as risk factors to dementia remains inconclusive. More randomised clinical trials on the association between periodontitis and dementia with uniform criteria for evaluation and diagnosis of periodontitis are warranted.

Neurology, 2020

ObjectiveTo test the hypothesis that periodontal disease would be associated with increased risk for dementia and mild cognitive impairment (MCI) by assessing dementia/MCI outcomes after a baseline periodontal examination.MethodsParticipants enrolled in the Atherosclerosis Risk in Communities study with a clinical periodontal examination (or edentulous participants) at visit 4 (1996–1998; mean ± SD age 63 ± 6 years, 55% female, 21% black) and adjudicated dementia outcomes through 2016 were included (n = 8,275). A subgroup of 4,559 participants had adjudicated dementia and MCI assessments at visit 5 (2011–2013). Participants received a full-mouth periodontal examination and were classified into periodontal profile classes (PPCs) based on the severity and extent of gingival inflammation and attachment loss. MCI and dementia were determined via neurocognitive testing, neurological examination and history, informant interviews, and brain MRI in a subset. Cox proportional hazards models ...

Journal of Periodontology, 2014

Background. Dementia is a multi-etiologic syndrome characterized by multiple cognitive deficits but not always by the presence of cognitive impairment. Cognitive impairment is associated with multiple non-modifiable risk factors but few modifiable factors. Epidemiological studies have shown an association between periodontitis, a potentially modifiable risk factor, and cognitive impairment. Objectives. To determine whether clinical periodontitis is associated with the diagnosis of cognitive impairment/dementia after controlling for known risk factors, including age, sex, and educational level. Methods. A case-control study was conducted in Granada, Spain, in two groups of dentate individuals over 50 years of age: cases with a firm diagnosis of mild cognitive impairment or dementia of any type or severity, and controls with no subjective memory loss complaints and a score >30 in the "Phototest" cognitive test (screening test for cognitive impairment). Periodontitis was evaluated by measuring tooth loss, plaque and bleeding indexes, pocket depths, and clinical attachment loss. Results. The study included 409 dentate adults, 180 with cognitive impairment and 229 without. A moderate and statistically significant association was observed between clinical attachment loss and cognitive impairment after controlling for age, sex, educational level, oral hygiene habits, and hyperlipidemia (p=0.049). No significant association was found between tooth loss and cognitive impairment. Conclusion. Periodontitis appears to be associated with cognitive impairment after controlling for confounders such as age, sex, and educational level.

Clinical oral investigations, 2018

Considering the increasing number of elderly people, dementia has gained an important role in today's society. Although the contributing factors for dementia have not been fully understood, chronic periodontitis (CP) seems to have a possible link to dementia. To conduct a systematic review including meta-analysis in order to assess potential differences in clinical periodontal variables between patients with dementia and non-demented individuals. The following focused question was evaluated: is periodontitis associated with dementia? Electronic searches in two databases, MEDLINE and EMBASE, were conducted. Meta-analysis was performed with the collected data in order to find a statistically significant difference in clinical periodontal variables between the group of dementia and the cognitive normal controls. Forty-two articles remained for full text reading. Finally, seven articles met the inclusion criteria and only five studies provided data suitable for meta-analysis. Period...

Archives of gerontology and geriatrics

Despite clinical trials and reviews attempt to assess a possible relationship between dementia and periodontal disease, no meta-analysis has been performed and this issue remains undetermined. The aim of this study is to conduct a systematic review and meta-analysis to assess severity of periodontitis in subjects with dementia. The search was conducted in Pubmed, Embase/MEDLINE. Two independent reviewers extracted data and assessed the risk bias (Newcastle-Ottawa scale). Meta-analyses were performed using the means of probing depth (PD) and clinical attachment loss (CAL) in patients with or without dementia. The mean difference were analyzed (P ≤ 0.05). Fourteen studies were included in the systematic review. In the qualitative analysis, most studies reported higher prevalence of periodontal disease in dementia patients. The studies had low risk of bias and two meta-analyses were performed for each parameter, including or not a cross-sectional study. The meta-analyses including the ...

Medicine and Pharmacy Reports, 2022

The relationship between periodontitis (or periodontal disease) with Alzheimer’s disease has been reported by various primary sources in the past decade, but not with a solid secondary research statement. A systematic review and meta-analysis was conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and registered (Reference number: CRD42020185264) with PROSPERO (International prospective register for systematic reviews). A literature search was conducted on specific databases for suitable articles in English language. Out of 612 studies selected, 41 underwent full-text analysis; five studies were eligible for systematic review, and 3 for meta-analysis. Meta-analysis was performed with tests for sensitivity and statistical heterogeneity followed by calculation of summary effect measures in terms of odds ratio (OR) and 95% confidence interval (CI). The results of this review showed a significant associ...

Alzheimer's Research & Therapy

Background: Although recent short-term cross-sectional studies have revealed that chronic periodontitis (CP) may be a risk factor for increased cognitive impairment in patients with Alzheimer's disease (AD), systematic reviews and long-term longitudinal studies have provided less clear evidence regarding the relationship between CP and AD. Therefore, we conducted a retrospective cohort study using the National Health Insurance Research Database (NHIRD) of Taiwan to determine whether patients with CP are at increased risk of developing AD. Methods: We conducted a retrospective matched-cohort study using the NHIRD of Taiwan. We identified 9291 patients newly diagnosed with CP between 1997 and 2004. A total of 18,672 patients without CP were matched to the patient cohort according to sex, age, index year, co-morbidity and urbanisation level. Cox proportional hazards regression analyses were performed to evaluate the subsequent risk of AD. Results: Patients with CP had a higher prevalence of hyperlipidaemia, depression, traumatic brain injury and co-morbidities, as well as higher urbanisation levels, than those in the unexposed cohort (all p < 0.01). At the final follow-up, totals of 115 (1.24%) and 208 (1.11%) individuals in the CP exposed and unexposed groups, respectively, had developed AD. Patients with 10 years of CP exposure exhibited a higher risk of developing AD than unexposed groups (adjusted HR 1.707, 95% CI 1.152-2.528, p = 0.0077). Conclusions: Our findings demonstrate that 10-year CP exposure was associated with a 1.707-fold increase in the risk of developing AD. These findings highlight the need to prevent progression of periodontal disease and promote healthcare service at the national level.

International Journal of Environmental Research and Public Health, 2023

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Frontiers in Neurology, 2019

Periodontitis is an oral inflammatory disease and may contribute to low-grade systemic inflammation. Based on the contribution of periodontitis to systemic inflammation and the potential role of systemic inflammation in neuroinflammation, many epidemiological studies have investigated a possible association between periodontitis and mild cognitive impairment or dementia. The purpose of this study was to evaluate the clinical/epidemiological evidence regarding the association between periodontitis and cognitive decline in adult patients. A search conducted between September and October 2018 was performed in the electronic databases PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar, with no publication date or language restrictions. Analytical observational studies in adults (P-Participants), with (E-Exposure) and without periodontitis (C-Comparison) were included in order to determine the association between periodontitis and cognitive decline (O-Outcome). The search identified 509 references, of which eight observational studies were accorded with the eligibility criteria and evaluated. The results should, however, be interpreted cautiously due to the limited number of studies. This systematic review points to the need for further well-designed studies, such as longitudinal observational studies with control of modifiable variables, as diagnostic criteria and time since diagnosis of periodontitis and cognitive impairment, to confirm the proposed association.

Evidence-based Dentistry, 2023

Periodontitis is an oral inflammatory disease and may contribute to low-grade systemic inflammation. Based on the contribution of periodontitis to systemic inflammation and the potential role of systemic inflammation in neuroinflammation, many epidemiological studies have investigated a possible association between periodontitis and mild cognitive impairment or dementia. The purpose of this study was to evaluate the clinical/epidemiological evidence regarding the association between periodontitis and cognitive decline in adult patients. A search conducted between September and October 2018 was performed in the electronic databases PubMed, Scopus, Web of Science, The Cochrane Library, LILACS, OpenGrey, and Google Scholar, with no publication date or language restrictions. Analytical observational studies in adults (P-Participants), with (E-Exposure) and without periodontitis (C-Comparison) were included in order to determine the association between periodontitis and cognitive decline (O-Outcome). The search identified 509 references, of which eight observational studies were accorded with the eligibility criteria and evaluated. The results should, however, be interpreted cautiously due to the limited number of studies. This systematic review points to the need for further well-designed studies, such as longitudinal observational studies with control of modifiable variables, as diagnostic criteria and time since diagnosis of periodontitis and cognitive impairment, to confirm the proposed association.