Gum health could be a risk factor for dementia, study suggests


(CNN) Anyone who suffers from gum disease is probably familiar with the discomfort and embarrassment of poor oral health, such as bad breath, bleeding, tooth discoloration and even tooth loss.

But gum disease, especially the more severe form of periodontal disease, affects much more than just our mouths. Dentists say periodontal disease is linked to a variety of health conditions, including heart disease, stroke, diabetes and dementia, making reduced access to dental care during the coronavirus pandemic a significant issue.

A new study published Wednesday in Neurology , the medical journal of the American Academy of Neurology, adds to this body of knowledge. Research has found a link between various stages of periodontal disease, which ultimately leads to tooth and bone loss, and mild cognitive impairment and dementia 20 years later.

“We looked at people's dental health over 20 years and found that people who had the most severe gum disease at the beginning of the study had mild cognitive impairment by the end of the study,” said study author Ryan Demmer. The risk of dementia was about twice as high as it was at the end of the study.

The dangers of gum disease

Gum disease progresses. It starts with gingivitis, where the gums are red, swollen and sensitive, and they may start to bleed when you brush and floss. If left untreated, this damage will lead to early periodontal disease, in which periodontal pockets containing tartar, plaque and bacteria form in the gums around the teeth, leading to inflammation, decay and bone loss.

At this point, important tooth cleaning procedures such as root planing and scaling under anesthesia may reverse the disease. Without intervention, the disease progresses to advanced periodontitis, which leads to complete destruction of the bony supporting structures of the teeth and ultimately tooth loss.

Studies have found that people with more severe periodontal disease are at higher risk of cardiovascular disease, diabetes, stroke, chronic respiratory disease, pregnancy complications and dementia.

However, it's unclear whether periodontal disease actually causes dementia or other health problems. Demer said this could be explained by certain bacteria in the mouth – the oral microbiome.

“The oral microbiome is central. My core hypothesis is that the bacteria in the mouth that cause periodontal disease are also a cause of systemic consequences (cardiovascular disease, dementia, etc.),” ​​he said via email.

“We use periodontal measurements in many studies because they are surrogate markers of long-term exposure to undesirable oral bacteria.”

Another possible link between periodontal disease and dementia is more indirect, with cardiometabolic diseases such as cardiovascular disease and diabetes as intermediate causes, he said.

“There is a large body of literature showing that chronic periodontal infection may lead to insulin resistance, prediabetes, diabetes, and stroke,” Demer said. “Thus, insulin resistance, diabetes, and stroke are strong predictors of future cognitive decline.”

Dermer said that while good dental hygiene is “an effective way to keep your teeth and gums healthy throughout your life,” his study only shows an association between an unhealthy mouth and dementia and does not prove any cause-and-effect relationship.

“Further research is needed to demonstrate the link between the microbes in the mouth and dementia, and to understand whether treatment of gum disease can prevent dementia,” he added.

The researchers followed 8,275 people for an average of 18 years. At the start of the study, participants were assessed for mild cognitive impairment and dementia and underwent a comprehensive periodontal examination, which included measurements of gum probing depth, bleeding volume, and the extent of gum recession.

Overall, 1,569 people, or 19%, developed dementia during the study period. Of those who had healthy gums and all teeth at the start of the study, 264 of 1,826, or 14%, developed dementia by the end of the study.

For those who started with mild gum disease, 623 of 3,470, or 18%, developed dementia. For participants with severe gum disease, 306 of 1,368, or 22%, developed dementia. Of the 1,611 people without teeth, 376, or 23%, developed dementia.

The study considered other factors that may affect dementia risk, such as diabetes, high cholesterol and smoking.

More than one type of dementia

An analysis of a small group of participants found a link between gum disease and Alzheimer's disease and vascular dementia, Demer said.

Alzheimer's disease, the most common form of dementia, is characterized by memory loss that becomes more severe over time. The condition is thought to be caused by the buildup of beta-amyloid plaques and tau proteins in the brain. So far, there is no cure for this disease.

Vascular dementia is caused by brain damage caused by impaired blood flow to the brain, which affects executive functions such as reasoning, planning, judgment and memory.

The authors note that one limitation of the study is that the initial examination was conducted when the participants were, on average, 63 years old, and cognitive decline may have begun before gum disease and tooth loss.

For anyone concerned about their gum health, London dentist Dr. Richard Marks encourages people to have regular dental checkups and see their dentist for a deep cleaning. If you can't or don't want to go in person, some dentists may offer video consultations or phone support, he said.

The most important thing, he says, is to take good care of your teeth and gums to maintain long-term periodontal and physical health. This should include regular brushing, flossing (or using an interdental brush or water flosser), using a fluoride or chlorhexidine mouthwash, and keeping sugar intake low (as harmful oral bacteria feed on sugar).



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