Tooth loss in older adults linked to higher risk of dementia

Older adults with missing teeth are at higher risk for cognitive impairment and dementia, with each missing tooth increasing the risk, according to a new study published in the journal Science. Journal of the American Medical Directors Association.Outside in the garden, there was an older adult woman with a toothless smile.

Oral health problems, such as poor oral hygiene, tooth decay, gum disease, and tooth loss, are more common in older adults than in other age groups. Older adults are also more likely to have cognitive impairment or dementia, and recent studies have shown a link between oral health and these conditions. To fully understand this association, researchers led by an NIA-supported team at New York University analyzed results from several long-term studies on the link between tooth loss and risk of cognitive impairment.

The researchers conducted a detailed search of six major databases of biomedical science publications and identified 14 relevant studies. These studies use questionnaires, assessments, medical records, and death certificate information to identify participants with cognitive impairment or dementia. Of the total 34,074 participants, 4,689 had cognitive impairment or dementia. These studies used physical examinations and self-report records to assess tooth loss and classify participants as having more or less missing teeth.

The researchers found that participants with more missing teeth had an average 48% higher risk of cognitive impairment and a 28% higher risk of dementia. The relationship between missing teeth and cognitive decline is “dose-dependent”: each missing tooth is associated with a 1.4% increased risk of cognitive impairment and a 1.1% increased risk of dementia. Participants who were missing 20 or more teeth had a 31% increased risk of cognitive impairment. Participants who lost all their teeth had a 54% increased risk of cognitive impairment and a 40% increased risk of dementia. Interestingly, participants who were missing teeth but used dentures did not have a significantly higher risk of developing dementia than those who were not missing teeth.

The researchers noted that the reasons for this association between tooth loss and risk of cognitive decline are unclear. Still, tooth loss can lead to chewing problems, which can lead to nutritional deficiencies, chemical imbalances, or brain changes that affect brain function. Additionally, poor oral hygiene may lead to increased oral bacteria and gum disease, which causes inflammation and increases the risk of beta-amyloid plaques in the brain, which can lead to dementia. Tooth loss without dentures may also indicate lower socioeconomic status and lower educational attainment, both of which are independently associated with increased risk of dementia. Additionally, missing teeth may be an early sign of cognitive impairment: People with cognitive decline may be less able to maintain oral hygiene, leading to tooth loss.

The research is limited by the fact that the various publications studied used different methods of data collection and data analysis. However, the results suggest that timely interventions, such as encouraging the use of dentures and other orthodontic treatments and large-scale educational programs about the importance of oral hygiene in older adults, may help prevent or slow the cognitive decline associated with tooth loss.

This research was funded in part by NIA grant R56AG067619.

These activities are related to NIH's AD+ADRD research implementation milestone 9.M “Development of Diagnostics/Biomarkers in Asymptomatic Individuals.”

refer to: Qi X, etc. Dose-response integration analysis of edentulism and risk of cognitive impairment and dementia. Journal of the American Medical Directors Association. 2021.doi:10.1016/j.jamda.2021.05.009.

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