Research Suggests Good Oral Health May Reduce Risk of Cognitive Decline

Illustration of woman flossing teeth
Illustrations by Jenny Penn

Going to the dentist may not be everyone's favorite thing to do, but recent research findings provide new reasons to prioritize dental checkups. There is growing evidence that poor oral health, especially gum disease, is linked to a higher risk of Alzheimer's disease and other dementias. Mild gum disease (gingivitis) is when plaque and bacteria build up on the teeth and cause infection. A more serious disease called periodontitis can involve chronic inflammation that damages the gums and the bone that holds the teeth in place.

A study from Japan, published in Neurology For example, in September 2023, periodontitis and tooth loss were found to be associated with reduced volume in the hippocampus, a part of the brain associated with memory. To measure oral health, the researchers counted each participant's teeth and examined their gums for signs of periodontitis. None of the participants aged 55 or older showed signs of cognitive decline while participating in the study. Each person underwent two MRI brain scans at least four years apart to detect a decrease in hippocampal volume.

The researchers found that subjects with mild periodontitis had fewer teeth and a faster left hippocampus shrinkage, whereas subjects with severe periodontitis had more teeth and a faster left hippocampus shrinkage. In other words, just keeping your teeth is not enough. The key is that the mouth is free of periodontal disease, said study author Dr. Satoshi Yamaguchi, associate professor at Tohoku University Graduate School of Dentistry in Sendai, Japan. Replacing missing teeth with well-fitting dentures can help maintain chewing function, which is important not only for good nutrition but also for brain health, he added.

Researchers at Yale University also found a link between various indicators of poor oral health and brain health, as measured by MRI scans. They analyzed data from more than 40,000 adults participating in the UK Biobank research project. Participants were screened for 105 genetic variants known to predispose people to cavities, tooth loss and the need for dentures later in life. They also performed MRI scans of the brain to check for white matter hyperintensities, a sign of damage to the brain's white matter. White matter lesions are considered possible signs of cognitive decline and gait and balance dysfunction, and may be associated with an increased risk of cerebrovascular disease, including stroke. The researchers also looked for changes in the microstructure of the brain.

The researchers presented their findings last February at the American Stroke Association's International Stroke Conference, reporting that people with poor oral health are at higher risk for white matter hyperintensities and microstructural damage, both of which are associated with brain health. signs of decline. The authors will publish more detailed findings in the journal Neurology in early 2024.

“The exact connection is not clear yet. All we have are hypotheses,” said study co-author Cyprien Rivier, MD, MS, a postdoctoral fellow in neurology at Yale University School of Medicine in New Haven, Connecticut. One theory is that the inflammatory characteristics of gum disease “cause the entire body to release inflammatory factors,” including the brain. Another theory is that poor oral health may allow bacteria in the mouth to enter the bloodstream. Once there, the bacteria and their toxins may disrupt the blood-brain barrier, causing increased inflammation in the brain, Dr. Revere said.

Scientists agree that more research is needed to prove a cause-and-effect relationship between oral health and brain health, including clinical trials demonstrating that improvements in oral health can significantly improve brain health markers or reduce the risk of dementia and stroke, said Dr. Revere. . Although periodontal disease often occurs in midlife, it is also unclear whether there is a critical period when poor oral health may affect the brain.

“We want to know how poor oral health might affect the onset of dementia,” said Dr. Bei Wu, professor of global health at New York University and co-director of the Aging Incubator, who is seeking funding for a study to identify potential influencing factors. Mechanisms and pathways by which oral health affects brain health.

An increased risk of heart disease and stroke may also be associated with poor oral health. Dr. Wu believes that doctors, including neurologists, should educate their patients about the importance of good oral hygiene as part of overall disease prevention. Many dental advertisements focus on cosmetic results, but Dr. Wu says keeping teeth and gums in good condition is “not just for aesthetics, but also for functionality.”

It is known that people with diabetes should have regular dental checkups as this disease increases the chances of gum disease. In some cases, the dentist may flag a patient as possibly having diabetes because of red and swollen gums. In July 2023, Dr. Wu Journal of Dental Research Researchers followed more than 5,000 people aged 64 to 75 for 12 years to explore the interplay between dental disease, diabetes and cognitive health. The study found that participants with diabetes and missing teeth were at greater risk for poorer cognitive function and faster cognitive decline than participants without diabetes or missing teeth.

People may not know they have gum disease because it doesn't always cause pain, especially mild pain. Obvious signs include red, swollen and sensitive gums, bleeding when brushing, and “sockets” where the teeth meet the gums. (That's why dentists and dental hygienists use probes to press around the mouth.) Bad breath can also be a sign.

“Periodontitis can be a silent disease,” says June Sadowsky, DDS, MPH, a professor at UTHealth School of Dentistry in Houston, so regular dental checkups are crucial. Dr. Sadowsky added that in addition to studies looking specifically at brain factors, evidence from epidemiological studies suggests that tooth loss is associated with a shortened overall lifespan.

“We don't want to scare people with a scary message that if your oral health is poor, your brain will deteriorate,” Dr. Revere said. But he hopes people will respond to the idea that making simple habits of daily brushing, flossing and regular dental check-ups might lead to more health reasons.

Make care within reach

Dr. Wu said that as evidence of the link between oral health and brain health continues to grow, increasing access to dental care is critical.She is the senior author of a longitudinal study published in Aging research A 2019 study found that among U.S. people age 50 or older, white people visit the dentist more frequently than black people or Hispanics, while people born in the U.S. visit the dentist more often than people born elsewhere . After age 80, utilization of dental services declines.

Barriers to accessing dental care include a lack of insurance coverage and a possible shortage of dental professionals in low-income communities, Dr. Wu said. Traditional health insurance does not cover the cost of dental care, and even add-on policies may only cover part of the cost.

Dr. Wu said dental care may not be a priority for people with health problems or just trying to get by. But she said that risk may be exacerbated by people who are at higher risk for heart and brain disease because they don't have affordable or convenient access to dental care. “We need to raise awareness,” she said.

Neuroscientist Dr. Cameron Jeter said a study linking National Health and Nutrition Examination Survey data with Medicare and National Death Index data found an association between periodontal disease in midlife and an increased risk of death related to Alzheimer's disease and dementia. closely related. She added that some autopsy studies have found bacteria normally found in the mouth in the brains of Alzheimer's patients.

“We're getting closer to understanding cause and effect,” Dr. Jeter said, but she acknowledged that more research is needed. Still, she doesn't think it's an exaggeration to think that poor oral health can shorten people's lives and reduce their quality of life.

This should inspire people to take care of their oral health,” she said. “This should be a public health issue.”

Oral Health and Neurological Diseases

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“The relationship between the mouth and the brain is a two-way street,” said Dr. Cameron Jeter, a neuroscientist at the Kansas College of Osteopathic Medicine who studies oral health and brain health.

Poor oral health, including on the teeth, gums, tongue, and inside of the cheeks, may indicate an increased risk of future neurological disease,” said Dr. Jeter, whose father has Parkinson's disease and struggles with oral health. . But some neurological conditions may interfere with proper care of your teeth. People with dementia may not remember to brush their teeth. If this is the case, she said, caregivers can place their loved one in front of a mirror, stand behind them, and then reach over to brush their teeth, making it feel as if the loved one's own hands are brushing their teeth. For those who suffer from tremors or muscle stiffness that make it difficult to hold and use a toothbrush, an adaptable toothbrush may be helpful.

People with neurological disorders should tell their dentist about anything that might affect their oral health, said Seth Keller, a New Jersey neurologist and former president of the American Academy of Neurology's Division on Adult Intellectual and Developmental Disabilities.

Dr. Keller says many medications used to treat neurological conditions can cause dryness in the mouth and increase the chance of tooth decay. People with Parkinson's disease or other conditions that affect swallowing may experience drooling or difficulty eating, leading to malnutrition and weight loss. Symptoms such as clenching and mouth breathing can be harmful to dental health and can be caused by a variety of neurological conditions, he added.

Going to the dentist can be scary for people with dementia or autism, but it's important to keep your teeth healthy. Oral problems may cause discomfort or pain and may worsen symptoms such as anxiety or depression. “Even with dementia, your mouth is important,” Dr. Keller said.

Dr. Keller recommends that if people are anxious about dental exams, they should seek out a dentist who specializes in providing care for certain disabilities. He also recommends scheduling appointments at a time of day that works best for your loved one, seeing the same dentist or hygienist each time, and discussing any concerns with the dental team beforehand.

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