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Bakker MH, de Smit MJ, Valentijn A, Visser A. Oral health assessment in institutionalized elderly: a scoping review. BMC Oral Health 2024; 24:272. [PMID: 38402181 PMCID: PMC10893687 DOI: 10.1186/s12903-024-04025-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/14/2024] [Indexed: 02/26/2024] Open
Abstract
When elderly become frail and in need for complex care, they can no longer live independently at home and may be admitted to nursing homes. Various studies have shown that oral health in this population is remarkably poor, which may lead to distressing situations and impacts quality of life. A variety of definitions or descriptions for oral health is used. Without a uniform parameter, it is impossible to determine whether oral health in institutionalized elderly is actually improving or deteriorating over time, as well as the effect of (preventive) interventions. In search for an adequate and clinically applicable parameter to determine oral health in this specific patient group, this scoping review aims to give an overview of the currently used parameters for determining oral health in institutionalized elderly. Ninety different parameters were identified, and 50 parameters were solely used by one study. Only 4 parameters were frequently used (in > 20 studies). The relevance of these parameters for this specific patient group is discussed. To aid the planning and commissioning of future research and patient care, there is an urgent need for an adequate and uniform parameter for oral health determination in institutionalized elderly.
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Affiliation(s)
- M H Bakker
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands.
| | - M J de Smit
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - A Valentijn
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
| | - A Visser
- Department of Gerodontology, Center for Dentistry and Oral Hygiene, University Medical Center Groningen and University of Groningen, Groningen, The Netherlands
- Department of Gerodontology, College of Dental Sciences, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
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Nascimento GG, Leite FR, Mesquita CM, Vidigal MTC, Borges GH, Paranhos LR. Confounding in observational studies evaluating the association between Alzheimer's disease and periodontal disease: A systematic review. Heliyon 2023; 9:e15402. [PMID: 37128313 PMCID: PMC10147971 DOI: 10.1016/j.heliyon.2023.e15402] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/03/2023] Open
Abstract
Background Studies investigating the association between periodontitis and Alzheimer's disease (AD) suggested indirect (periodontitis would increase the circulation of inflammation-inducible molecules) and direct (periodontopathogens might colonize brains affected by Alzheimer's disease) pathways. While there seems to be a positive relationship between periodontitis and AD, concerns have been raised about the role of confounding. Aim To systematically review the literature to assess confounding and their level of heterogeneity in the association between periodontitis and AD. Also, to examine data reporting and interpretation regarding confounding bias. Methods This review followed the PRISMA guidelines and was registered within PROSPERO. Electronic searches were performed in seven main databases and three others to capture the "grey literature". The PECO strategy was used to identify observational studies (cross-sectional, case-control, or cohort studies) assessing the association between periodontal disease and AD without restricting publication language and year. Critical appraisal was performed according to the Joanna Briggs Institute guidelines. Confounders were evaluated following a two-step approach. Results A total of 3255 studies were found, of which 18 (13 case-control, four cross-sectional, and one cohort) met the eligibility criteria. Participants with AD were 1399 (mean age 64 ± 9 to 84.8 ± 5.6 years), whereas those without AD were 1730 (mean age 62.6 ± 7.1 to 81.4 ± 4.6). Female patients composed most of the sample for both groups. The confounding variables "age" and "sex" were present in all studies. Four studies used the 2017 AAP/EFP periodontal classification. Most studies had a low risk of bias. Fifty percent of the articles did not consider confounding; variation in the adjustment approaches was observed. Additionally, 62% of the studies did not mention bias, and 40% did not discuss any limitations about confounders. Conclusions Given the study's limitations, caution must be taken to properly interpret the association between periodontitis and AD.Registration: CRD42022293884.
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Affiliation(s)
- Gustavo G. Nascimento
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Duke-NUS Medical School, Singapore
- Corresponding author. National Dental Research Institute Singapore National Dental Centre Singapore, 5 Second Hospital Avenue, 168938, Singapore.
| | - Fábio R.M. Leite
- National Dental Research Institute Singapore, National Dental Centre Singapore, Singapore
- Oral Health ACP, Duke-NUS Medical School, Singapore
| | - Caio Melo Mesquita
- School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Maria Tereza Campos Vidigal
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Guilherme Henrique Borges
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
| | - Luiz Renato Paranhos
- Post-Graduate Program in Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
- Department of Preventive and Community Dentistry, School of Dentistry, Federal University of Uberlândia, Uberlândia, Brazil
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Chen Y, Jin Y, Li K, Qiu H, Jiang Z, Zhu J, Chen S, Xie W, Chen G, Yang D. Is There an Association Between Parkinson's Disease and Periodontitis? A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2023; 13:1107-1125. [PMID: 37899063 PMCID: PMC10657691 DOI: 10.3233/jpd-230059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis. OBJECTIVE This systematic review and meta-analysis was conducted to ascertain their bidirectional relationship. METHODS A literature search for relevant studies was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases from inception to December 19, 2022. Effect sizes (ES) with 95% confidence intervals were pooled under the random-effects model. Then, leave-one-out sensitivity analysis and contour-enhanced funnel plot were applied to assess the stability of the results. RESULTS A total of 34 studies and 24 studies were included for systematic review and quantitative meta-analysis, respectively. Pooled ES indicated that periodontitis was not significantly associated with PD risk (HR = 1.13, 95% CI 0.88-1.45, n = 3; OR = 1.94, 95% CI 0.55-6.90, n = 7), while the Mendelian randomization study revealed no association between PD and periodontitis risk (coefficient [B] = -0.0001, standard error = 0.0001, p = 0.19). Furthermore, PD patients exhibited higher levels of periodontal pocket depth (SMD = 1.10, 95% CI 0.53-1.67), clinical attachment level (SMD = 1.40, 95% CI 0.55-2.26), plaque index (SMD = 0.81, 95% CI 0.22-1.39), and Oral Health Impact Profile-14 score (SMD = 0.91, 95% CI 0.33-1.49) compared to healthy controls. CONCLUSIONS Our meta-analysis identified no bidirectional association between PD risk and periodontitis risk, though the prevalence of periodontitis and poorer oral status was higher in PD patients.
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Affiliation(s)
- Yiqun Chen
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Yining Jin
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Kun Li
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Haojie Qiu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Zihan Jiang
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jinrong Zhu
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Siqi Chen
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Wei Xie
- The First School of Medicine, School of Information and Engineering, Wenzhou Medical University, Wenzhou, China
| | - Guangyong Chen
- Department of Neurology, The Third Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Dehao Yang
- Department of Neurology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Memory decline in older individuals predicts an objective indicator of oral health: findings from the Sydney Memory and Ageing Study. BMC Oral Health 2022; 22:93. [PMID: 35346157 PMCID: PMC8962025 DOI: 10.1186/s12903-022-02128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background Growing evidence suggests that there is an association between poor oral health and cognitive function in late adulthood. However, most studies to date have relied on cross-sectional research methods that do not permit inferences about the temporality of any association. Moreover, the few longitudinal studies that do exist have typically relied on small samples and quite limited cognitive or oral health assessments. The aim of the present study was therefore designed to provide the first direct evaluation of whether cognitive function is predictive of poor oral health in older adults. Methods This longitudinal research included data from 339 participants aged 70 years or older from The Sydney Memory and Ageing Study (MAS), a large cohort of healthy community-dwelling older adults. Cognitive function was assessed using a battery of tests at baseline (Wave 1) in 2005 and six years later (Wave 4) in 2011. In 2015 (Wave 6), participants were assessed for oral health using the Oral Health Assessment Tool (OHAT), number of functional occluding pairs of natural teeth and sublingual resting saliva pH (SRSpH). Ordinal least squares regression analysis was used to model the effect of cognitive function on total OHAT score, and binomial logistic regression used for SRSpH and occluding pairs of functional teeth. Results Two models were tested. In the partially adjusted model, age, gender and years of education were included. The fully adjusted model additionally included medical conditions, general health, depression, smoking, alcohol consumption, functionality, and dental care utilization. The key finding to emerge was that a six-year change in memory (from Wave 1 to Wave 4) was associated with lower sublingual resting saliva pH at Wave 6 in partially (Odds Ratio (OR) = 0.65) and fully adjusted model (OR = 0.63). Conclusions This longitudinal study provides further evidence that a relationship between cognitive function and oral health exists, and also points to this relationship potentially being bi-directional, as previous evidence suggests. The findings from the study also suggest that older adults who present with greater than normal memory decline at an earlier point in life were more likely to experience poor oral health when this was evaluated at a later time-point, four years later. Supplementary Information The online version contains supplementary material available at 10.1186/s12903-022-02128-y.
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Kim T, Chi SI, Kim H, Seo KS. Analysis of behavioral management for dental treatment in patients with dementia using the Korean National Health Insurance data. J Dent Anesth Pain Med 2021; 21:461-469. [PMID: 34703895 PMCID: PMC8520838 DOI: 10.17245/jdapm.2021.21.5.461] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 09/27/2021] [Accepted: 09/29/2021] [Indexed: 12/02/2022] Open
Abstract
Background The global population is aging rapidly, and accordingly, the number of patients with dementia is increasing every year. Although the need for dental treatment increases for various reasons in patients with dementia, they cannot cooperate during dental treatment. Therefore, behavioral management, including sedation (SED) or general anesthesia (GA), is required for patients with dementia. Thus, this study aimed to investigate the trends and effects of SED or GA in patients with dementia undergoing dental treatment in South Korea based on the Korean National Health Insurance claims data. Methods This study utilized customized health information data provided by the Health Insurance Review and Assessment Service. Among patients with records of using sedative drugs during dental treatment from January 2007 to September 2019, patients with the International Classification of Diseases-10 code for dementia (F00, F01, F02, F03, and G30) were selected. We then analyzed the full insurance claims data for dental care. Age, sex, sedative use, and dental treatment of patients were analyzed yearly. In addition, the number of cases of GA or SED per year was analyzed, and changes in behavioral management methods with increasing age were investigated. Results Between January 2007 and September 2019, a total of 4,383 (male, 1,454; female, 2,929) patients with dementia received dental treatment under SED or GA. The total number of SED and GA cases were 1,515 (male, 528 ; female, 987) and 3,396 (male, 1,119 ; female, 2,277) cases, respectively. The total number of cases of dental treatment for 4,383 patients with dementia was 153,051 cases, of which 2.22% were under GA and 0.98% were under SED. Midazolam was the most commonly used drug for SED. Conclusion Although gingivitis and pulpitis were the most common reasons for patients with dementia to visit the dentist, GA or SED for patients with dementia was frequently used in oral and maxillofacial or periodontal surgery.
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Affiliation(s)
- Taeksu Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Seong In Chi
- Department of Pediatric Dentistry, Dankook University Sejong Dental Hospital, Sejong, Korea
| | - Hyuk Kim
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
| | - Kwang-Suk Seo
- Department of Dental Anesthesiology, School of Dentistry, Seoul National University, Seoul, Korea
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Borsa L, Dubois M, Sacco G, Lupi L. Analysis the Link between Periodontal Diseases and Alzheimer's Disease: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179312. [PMID: 34501899 PMCID: PMC8430572 DOI: 10.3390/ijerph18179312] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/19/2021] [Accepted: 08/27/2021] [Indexed: 12/20/2022]
Abstract
The hypothesis of an infectious connection from the oro-pharyngeal sphere to the brain underlines the interest in analyzing the link between periodontal disease and Alzheimer’s disease. The aim of this systematic review was to examine the link between Alzheimer’s disease and periodontal disease in patients aged 65 and over. Databases (PubMed (MEDLINE), the Cochrane Library, and Embase) were analyzed for relevant references up to 21 June 2021. The authors independently selected the studies and extracted the data. The quality of included studies was checked using the National Institutes of Health’s quality assessment tools. Five studies were included. The selected studies described in their results an increase in F. nucleatum in Alzheimer’s disease patients (adjusted p = 0.02), and its incidence was linked to C. rectus and P. gingivalis (adjusted HR = 1.22 (1.04–1.43), p = 0.012) as well as A. naeslundii (crude HR = 2.0 (1.1–3.8)). The presence of periodontitis at baseline was associated with a six-fold increase in the rate of cognitive decline over a 6-month follow-up period (ADAS-Cog mean change = 2.9 ± 6.6). The current review suggests an association between periodontal disease and Alzheimer’s disease. The treatment of periodontal disease could be a way to explore Alzheimer’s disease prevention.
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Affiliation(s)
- Leslie Borsa
- Faculté de Chirurgie Dentaire-Odontologie, Université Côte d’Azur, 06300 Nice, France; (M.D.); (L.L.)
- Pôle Odontologie, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
- UPR7354–Laboratoire Microbiologie Orale, Immunothérapie et Santé (Micoralis), Faculté de Chirurgie Dentaire-Odontologie, Université Côte d’Azur, 06300 Nice, France
- Correspondence:
| | - Margaux Dubois
- Faculté de Chirurgie Dentaire-Odontologie, Université Côte d’Azur, 06300 Nice, France; (M.D.); (L.L.)
- Pôle Odontologie, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
| | - Guillaume Sacco
- Clinique Gériatrique du Cerveau et du Mouvement, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06003 Nice, France;
- Université Côte d’Azur, CoBTeK, 06100 Nice, France
- Univ Angers, Université de Nantes, LPPL, SFR CONFLUENCES, 49000 Angers, France
| | - Laurence Lupi
- Faculté de Chirurgie Dentaire-Odontologie, Université Côte d’Azur, 06300 Nice, France; (M.D.); (L.L.)
- Pôle Odontologie, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, 06000 Nice, France
- UPR7354–Laboratoire Microbiologie Orale, Immunothérapie et Santé (Micoralis), Faculté de Chirurgie Dentaire-Odontologie, Université Côte d’Azur, 06300 Nice, France
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Kumar S, Jha PC, Negi BS, Haidry N, Kulkarni P, Gulati S, Muttu J. Oral Health Status and Treatment Need in Geriatric Patients with Different Degrees of Cognitive Impairment and Dementia: A Cross-Sectional Study. J Family Med Prim Care 2021; 10:2171-2176. [PMID: 34322409 PMCID: PMC8284228 DOI: 10.4103/jfmpc.jfmpc_2481_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/21/2021] [Accepted: 03/17/2021] [Indexed: 12/25/2022] Open
Abstract
Background Health can be defined as more than an absence or lack of disease. It is generally related to personal, physical, social, along with spiritual wellness. However, the importance of good health is comparable with a progressive physical and cognitive limitations due to aging and hence, its clear definition is not possible. Hence, most of the important aims or goals in aging are unrelated to finding a cure but rather toward achieving an optimal function. Thus, a healthy aging process that encompasses physical, mental, psychological, and spiritual well-being is always much desired. Aim and Objectives The aim and objective of this study is to assess the oral health status and degree of cognitive impairment along with dementia, if present. Materials and Methods This is a prospective and cross-sectional analysis comprising of 300 study participants of which 150 are males while 150 are females. Cognitive ability is assessed using the Standardized Mini-Mental State Examination (SMMSE) scoring test. A score value lesser than or equal to 23 is considered as low, whereas a score of 24 and above represents normal cognitive abilities. Subjects with low score are selected for the study. Oral health status is assessed by examining a) total numbers of teeth present; b) presence or absence of denture use; and c) capacity for masticatory or chewing ability (recorded as yes or no). Demographic variables parameters include age, gender, and presence of smoking habit. Clinical parameters or variables are analyzed by employing the independent t-test and Chi-square test. Pearson's correlation analysis is used to test a correlation between impairment of cognitive capacity, oral health status, masticatory capability, and use of dentures, if present. Two-tailed t-test is used to derive a P value for significance. Results The total numbers of teeth present are significantly correlated with a lower SMMSE score (R = + 0.56; P = 0.03) while a significant association is noted between ability for mastication and lower SMMSE score (P = 0.05). Conclusion This study concluded that loss of cognition or dementia is closely related to a poor oral health status.
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Affiliation(s)
- Santosh Kumar
- Department of Conservative Dentistry and Endodontics, Patna Dental College and Hospital, Patna, Bihar, India
| | - Prakash C Jha
- Department of Dentistry, Nalanda Medical College Hospital Agamkuan, Patna, Bihar, India
| | - Bhupender S Negi
- Department of Dentistry (MDS, Oral Medicine and Radiology, GDC Calicut), Consultant and Dental Surgeon, Shree Balaji Hospital, Kangra, Himachal Pradesh, India
| | - Nazia Haidry
- Private Dental Practitioner, Patna, Bihar, India
| | | | - Saakshi Gulati
- Department of Oral Medicine and Radiology, Sathyabama Dental College and Hospital, Chennai, Tamil Nadu, India
| | - Jayalakshmi Muttu
- Private Practitioner and Consultant Oral Surgeon Thandalam, Chennai, Tamil Nadu, India
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Balasubramaniam A, Diwakar MKP, Vaitheswaran S, Santhosh Kumar MP, Sushanthi S, Pandiyan I. Determining Association Between Cognitive Function and Oral Health Status among Rural Community Dwelling Geriatrics. J Int Soc Prev Community Dent 2021; 11:281-286. [PMID: 34268190 PMCID: PMC8257007 DOI: 10.4103/jispcd.jispcd_394_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/08/2021] [Accepted: 03/27/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Numerous prospective studies worldwide investigated the association between oral health status and dementia or cognitive decline. No clear agreement has emerged on the association. This study aimed to determine the association of cognitive function and oral health status among community dwelling geriatrics in rural South India. MATERIALS AND METHODS A cross-sectional study was conducted among community dwelling geriatrics in rural South India by recruiting 211 individuals aged above 60 years. Their cognitive function was assessed using pre-validated community screening instrument for dementia (CSI-D) which has informant and cognitive scale. The data on cognitive function was collected by community health workers in electronic version (Web app). Their oral health status was assessed by World Health Organization (WHO) oral health assessment form in electronic version (Web app). RESULTS From the logistic regression analysis, it was observed that cognitive impairment showed an association with 1.6- and 1.9-times risk for root caries and a greater number of missing teeth (P ≤ 0.05). No association of other oral health parameters such as gingivitis, periodontitis, dental erosion, and dental trauma with cognitive impairment exhibited. CONCLUSION From the results, it can be concluded that cognitive impairment has an association with root caries and number of missing teeth which increases the risk for the same and vice versa.
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Affiliation(s)
- Arthi Balasubramaniam
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
| | | | - Sridhar Vaitheswaran
- Consultant Psychiatrist, Schizophrenia Research Foundation (SCARF), Chennai, India
| | - M P Santhosh Kumar
- Department of Oral and Maxillofacial Surgery, Saveetha Dental College & Hospital, Chennai, Tamil Nadu, India
| | - S Sushanthi
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
| | - Indumathy Pandiyan
- Department of Public Health Dentistry, Saveetha Dental College & Hospital, Chennai, India
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Do MT, Vu H, Lee JK, Park SM, Son JS, Kim HD. Salivary flow rate and the risk of cognitive impairment among Korean elders: a cross-sectional study. BMC Geriatr 2021; 21:245. [PMID: 33853530 PMCID: PMC8045327 DOI: 10.1186/s12877-021-02200-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 04/06/2021] [Indexed: 11/17/2022] Open
Abstract
Background Salivary function has been suggested to be associated with cognitive impairment. However, the effect of salivary flow rate (SFR) on cognitive impairment remains unclear. This study aimed to investigate whether SFR is associated with cognitive impairment among Korean elders. Methods This cross-sectional study included 649 elders aged 65 and older in the Korean community-dwelling population. Cognitive impairment was assessed using the Mini-Mental Status Examination. Unstimulated SFR was measured and dichotomized. Denture status, age, sex, education level, smoking, drinking, diabetes, hypertension, and obesity were considered confounders. Multivariable logistic regression analysis was applied to assess the adjusted association. Stratified analysis by sex and denture status was performed to clarify the effect modification. Results Participants without cognitive impairment showed a higher SFR level than those with cognitive impairment (0.81 mL/min for non-cognitive impairment versus 0.52 mL/min for cognitive impairment, p < 0.001). After controlling for confounders, participants with low SFR (< 0.3 mL/min) were more likely to have cognitive impairment by 1.5 times than participants with normal SFR (odds ratio [OR] = 1.5, confidence interval [CI] = 1.05–2.10). The association of low SFR with cognitive impairment was higher in women and dentate participants: about 10% higher in women (OR = 1.63, CI = 1.07–2.50) and about 22% higher in dentate participants (OR = 1.82, CI = 1.41–2.90). Conclusions Salivary flow rate is independently associated with cognitive impairment among Korean elders. The association was modified in females and dentate elders. Physicians and dentists should consider low SFR and cognitive impairment as a risk factor between them in clinics. Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02200-2.
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Affiliation(s)
- Minh-Tung Do
- Department of Urology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Huong Vu
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University Seoul, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jong-Koo Lee
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Sang-Min Park
- Department of Family Medicine, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Joung-Sik Son
- Department of Family Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 08308, South Korea
| | - Hyun-Duck Kim
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University Seoul, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea. .,Dental Research Institute, Seoul National University, Seoul, 03080, Republic of Korea.
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Lopez-Jornet P, Zamora Lavella C, Pons-Fuster Lopez E, Tvarijonaviciute A. Oral Health Status in Older People with Dementia: A Case-Control Study. J Clin Med 2021; 10:jcm10030477. [PMID: 33514062 PMCID: PMC7865865 DOI: 10.3390/jcm10030477] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 12/28/2022] Open
Abstract
Dementia is characterized by a range of cognitive defects with impaired activities of daily living that have implications for patient oral health. Objectives. A case-control study was made of the impact of dementia upon oral health. A total of 152 patients were included: 69 with dementia and 83 controls from the region of Murcia (Spain). The Global Deterioration Scale (GDS) was used to classify the patients and an oral exploration was carried out. Odds ratios (ORs) and confidence intervals (CIs) were estimated using regression models. The patients with more severe disease were significantly more likely to have fewer natural teeth (OR 11.00, 95%CI 1.28–23.22; p = 0.001), a higher plaque index (p = 0.001), and a greater bleeding index (p = 0.001) than the control group. These findings suggest that older adults with dementia have deficient oral health. A higher bleeding index increases the risk of deterioration of cognitive function. The oral hygiene and health of older people with dementia need to be improved.
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Affiliation(s)
- Pia Lopez-Jornet
- . Department Stomatology School of Medicine, Biomedical Research Institute (IMIB-Arrixaca), Faculty of Medicine and Odontology, University of Murcia, Adv Marques de los Velez s/n, 30008 Murcia, Spain
- Correspondence:
| | - Carmen Zamora Lavella
- . Faculty of Medicine and Odontology, University of Murcia, 30008 Murcia, Spain; (C.Z.L.); (E.P.-F.L.)
| | - Eduardo Pons-Fuster Lopez
- . Faculty of Medicine and Odontology, University of Murcia, 30008 Murcia, Spain; (C.Z.L.); (E.P.-F.L.)
| | - Asta Tvarijonaviciute
- . Interdisciplinary Laboratory of Clinical Analysis, Interlab-UMU, Regional Campus of International Excellence ‘Campus Mare Nostrum’, University of Murcia, Espinardo, 30100 Murcia, Spain;
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Is there an association between oral health-related quality of life and Alzheimer's disease? Evid Based Dent 2020; 21:124-125. [PMID: 33339969 DOI: 10.1038/s41432-020-0132-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Data sources PubMed, Medline, Embase, CINAHL, Cochrane Library database and ProQuest databases were searched.Study selection Observational and non-randomised studies in English language were considered for inclusion. Two reviewers independently selected the relevant studies. Any disagreement was resolved by discussion with a third reviewer. The outcome of interest for this review was oral health-related quality of life (OHRQoL) in patients with Alzheimer's disease.Data extraction and synthesis Data extraction was conducted independently by two reviewers. Critical appraisal was conducted by two reviewers using the Joanna Briggs Institute 'Meta-Analysis of Statistics Assessment and Review Instrument'.Results Six studies were included in the review, of which five were cross-sectional and one was a non-randomised controlled trial. OHRQoL was measured by the Oral Health Impact Profile (OHIP) in one study and the Geriatric Oral Health Assessment Index (GOHAI) in the other five included studies. All six studies were judged as methodologically strong. When the results of four studies which used the GOHAI were pooled together in a meta-analysis, no statistically significant differences in the GOHAI scores between patients with Alzheimer's disease and controls were found (SMD = 0.09; 95%CI: -0.66 to 0.85).Conclusions The results of this review showed no significant difference in OHRQoL between patients with Alzheimer's disease and healthy controls.
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12
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Ausó E, Gómez-Vicente V, Esquiva G. Biomarkers for Alzheimer's Disease Early Diagnosis. J Pers Med 2020; 10:E114. [PMID: 32899797 PMCID: PMC7563965 DOI: 10.3390/jpm10030114] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 12/11/2022] Open
Abstract
Alzheimer's disease (AD) is the most common cause of dementia, affecting the central nervous system (CNS) through the accumulation of intraneuronal neurofibrillary tau tangles (NFTs) and β-amyloid plaques. By the time AD is clinically diagnosed, neuronal loss has already occurred in many brain and retinal regions. Therefore, the availability of early and reliable diagnosis markers of the disease would allow its detection and taking preventive measures to avoid neuronal loss. Current diagnostic tools in the brain, such as magnetic resonance imaging (MRI), positron emission tomography (PET) imaging, and cerebrospinal fluid (CSF) biomarkers (Aβ and tau) detection are invasive and expensive. Brain-secreted extracellular vesicles (BEVs) isolated from peripheral blood have emerged as novel strategies in the study of AD, with enormous potential as a diagnostic evaluation of therapeutics and treatment tools. In addition; similar mechanisms of neurodegeneration have been demonstrated in the brain and the eyes of AD patients. Since the eyes are more accessible than the brain, several eye tests that detect cellular and vascular changes in the retina have also been proposed as potential screening biomarkers. The aim of this study is to summarize and discuss several potential markers in the brain, eye, blood, and other accessible biofluids like saliva and urine, and correlate them with earlier diagnosis and prognosis to identify individuals with mild symptoms prior to dementia.
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Affiliation(s)
| | | | - Gema Esquiva
- Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain; (E.A.); (V.G.-V.)
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13
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Oral Health Status and Need for Oral Care in an Aging Population: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224558. [PMID: 31752149 PMCID: PMC6888624 DOI: 10.3390/ijerph16224558] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 11/05/2019] [Accepted: 11/10/2019] [Indexed: 12/15/2022]
Abstract
Background. The world population is aging. This phenomenon is accompanied by an increase in the number of elderly with dementia, whose oral hygiene care is a challenge. Objective. This paper presents a literature review of oral health status and the need for oral care in people with dementia, as compared to people without dementia and also of the relationship between periodontal disease and cognitive impairment. Methods. A systematic review was conducted in PubMed, CINAHL, and the Cochrane Library. Fifty-six articles met the inclusion criteria and were consequently included for quality assessment and data extraction. Results. No significant differences were found between both groups with regard to the number of present teeth, DMFT Index, edentulousness/use of denture, and orofacial pain. Coronal/root caries and retained roots were more common in people with dementia than in those without dementia. Most of the participants with dementia presented gingival bleeding or inflammation and they suffered from the periodontal disease more than people without dementia. Conclusions. Poor oral health is a common condition among the elderly with dementia. The education process of caregivers might improve the oral health status of people with dementia. Finally, periodontal disease might contribute to the onset or progression of dementia.
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14
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Holmer J, Eriksdotter M, Schultzberg M, Pussinen PJ, Buhlin K. Association between periodontitis and risk of Alzheimer's disease, mild cognitive impairment and subjective cognitive decline: A case-control study. J Clin Periodontol 2019; 45:1287-1298. [PMID: 30289998 DOI: 10.1111/jcpe.13016] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 09/26/2018] [Accepted: 09/30/2018] [Indexed: 01/13/2023]
Abstract
AIMS To test the hypothesis that periodontal disease contributes to increased risk of mild cognitive impairment (MCI), subjective cognitive decline (SCD) and Alzheimer's disease (AD). MATERIALS AND METHODS This case-control study was conducted over a 3-year period in the municipality of Huddinge, Sweden. In total, 154 cases were consecutively enrolled from the Karolinska Memory Clinic at the Karolinska University Hospital and allotted to three diagnostic groups: AD, MCI and SCD, collectively referred to as "cases." Seventy-six cognitively healthy age- and gender-matched controls were randomly sampled through the Swedish population register. All cases and controls underwent clinical and radiographic oral examinations. Statistical analysis was based on logistic regression models adjusted for potential confounders. RESULTS Poor oral health and marginal alveolar bone loss were more prevalent among cases than among controls. The cases group was associated with generalized marginal alveolar bone loss (odds ratio [OR] = 5.81; 95% confidence interval [CI] = 1.14-29.68), increased number of deep periodontal pockets (OR = 8.43; CI 4.00-17.76) and dental caries (OR = 3.36; CI 1.20-9.43). CONCLUSION The results suggest that marginal periodontitis is associated with early cognitive impairment and AD. However, the study design does not preclude noncausal explanations.
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Affiliation(s)
- Jacob Holmer
- Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
| | - Maria Eriksdotter
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Stockholm, Sweden.,Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Marianne Schultzberg
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institutet, Stockholm, Sweden
| | - Pirkko J Pussinen
- Oral and Maxillofacial Diseases, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kåre Buhlin
- Department of Dental Medicine, Division of Oral Diseases, Karolinska Institutet, Huddinge, Sweden
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15
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Cerajewska TL, West NX. Dementia friendly dentistry for the periodontal patient. Part 2: ethical treatment planning and management. Br Dent J 2019; 227:570-576. [DOI: 10.1038/s41415-019-0728-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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16
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Liang D, Lu H. Salivary biological biomarkers for Alzheimer's disease. Arch Oral Biol 2019; 105:5-12. [PMID: 31203086 DOI: 10.1016/j.archoralbio.2019.06.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 01/07/2023]
Abstract
Alzheimer's disease (AD) is becoming a threat to aging population all over the world. The pathogenic process of AD is likely initiated many years before clinical onset, thus biomarkers for AD diagnosis are critical for the prevention and therapy for the disease at the early stage in order to reduce the global burden brought by the disease. Saliva is treated as a potential alternative and universal diagnostic fluid that can be collected noninvasively by participants with moderate training and without side effects. Several potential salivary biomarkers, which might prove to be significant diagnostic tools in AD, have been researched. We address here the present and the future of these salivary biological biomarkers for AD.
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Affiliation(s)
- Dan Liang
- Department of Stomatology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Hao Lu
- Department of Oral Maxillofacial-Head and Neck Oncology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Shanghai Research Institute of Stomatology and Shanghai Key Laboratory of Stomatology, Shanghai, China.
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17
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Kang J, Wu B, Bunce D, Ide M, Pavitt S, Wu J. Cognitive function and oral health among ageing adults. Community Dent Oral Epidemiol 2019; 47:259-266. [PMID: 30838683 DOI: 10.1111/cdoe.12452] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 01/08/2019] [Accepted: 02/11/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES There is inconclusive evidence that cognitive function is associated with oral health in older adults. This study investigated the association between cognitive function and oral health among older adults in England. METHODS This longitudinal cohort study included 4416 dentate participants aged 50 years or older in the English Longitudinal Study of Ageing during 2002-2014. Cognitive function was assessed at baseline in 2002/2003 using a battery of cognitive function tests. The self-reported number of teeth remaining and self-rated general oral health status was reported in 2014/2015. Ordinal logistic regression was applied to model the association between cognitive function at baseline and tooth loss or self-rated oral health. RESULTS Cognitive function at baseline was negatively associated with the risk of tooth loss (per each 1 standard deviation lower in cognitive function score, OR: 1.13, 95% CI: 1.05-1.21). When cognitive function score was categorized into quintiles, there was a clear gradient association between cognitive function and tooth loss (P-trend = 0.003); people in the lowest quintile of cognitive function had higher risk of tooth loss than those in the highest quintile (OR: 1.39, 95% CI: 1.12-1.74). A similar magnitude and direction of association were evident between cognitive function and self-rated oral health. CONCLUSION This longitudinal study in an English ageing population has demonstrated that poor cognitive function at early stage was associated with poorer oral health and higher risk of tooth loss in later life. The gradient relationship suggests that an improvement in cognitive function could potentially improve oral health and reduce the risk of tooth loss in the ageing population.
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Affiliation(s)
- Jing Kang
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds, UK
| | - Bei Wu
- Rory Meyers College of Nursing, New York University, New York City, New York
| | - David Bunce
- Faculty of Medicine and Health, School of Psychology, University of Leeds, Leeds, UK
| | - Mark Ide
- Dental Institute, Kings College London, London, UK
| | - Sue Pavitt
- Division of Clinical and Translation Research, School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- Division of Clinical and Translation Research, School of Dentistry, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
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18
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Maldonado A, Laugisch O, Bürgin W, Sculean A, Eick S. Clinical periodontal variables in patients with and without dementia—a systematic review and meta-analysis. Clin Oral Investig 2018; 22:2463-2474. [DOI: 10.1007/s00784-018-2523-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 06/11/2018] [Indexed: 12/13/2022]
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19
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Schwartz C, Vandenberghe-Descamps M, Sulmont-Rossé C, Tournier C, Feron G. Behavioral and physiological determinants of food choice and consumption at sensitive periods of the life span, a focus on infants and elderly. INNOV FOOD SCI EMERG 2018. [DOI: 10.1016/j.ifset.2017.09.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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20
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Aragón F, Zea-Sevilla MA, Montero J, Sancho P, Corral R, Tejedor C, Frades-Payo B, Paredes-Gallardo V, Albaladejo A. Oral health in Alzheimer's disease: a multicenter case-control study. Clin Oral Investig 2018; 22:3061-3070. [PMID: 29476334 DOI: 10.1007/s00784-018-2396-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 02/16/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVES The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer's patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health. MATERIALS AND METHODS A total of 70 Alzheimer's patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed. RESULTS Alzheimer's patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%). CONCLUSIONS After taking into account the influence of age, Alzheimer's patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality. CLINICAL RELEVANCE Clinicians should be aware of the implications of Alzheimer's disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.
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Affiliation(s)
- F Aragón
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, Campus Miguel de Unamuno, Calle Alfonso X El Sabio s/n, 37007, Salamanca, Spain.
| | - M A Zea-Sevilla
- Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Calle de Valderrebollo, 5, PC 28031, Madrid, Spain
| | - J Montero
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, Campus Miguel de Unamuno, Calle Alfonso X El Sabio s/n, 37007, Salamanca, Spain
| | - P Sancho
- Department of Microbiology and Genetics, University of Salamanca, Campus Miguel de Unamuno, PC 37007, Salamanca, Spain
| | - R Corral
- Department of Microbiology and Genetics, University of Salamanca, Campus Miguel de Unamuno, PC 37007, Salamanca, Spain
| | - C Tejedor
- Department of Microbiology and Genetics, University of Salamanca, Campus Miguel de Unamuno, PC 37007, Salamanca, Spain
| | - B Frades-Payo
- Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Calle de Valderrebollo, 5, PC 28031, Madrid, Spain
| | - V Paredes-Gallardo
- Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Av. de Blasco Ibáñez, 15, PC 46010, Valencia, Spain
| | - A Albaladejo
- Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, Campus Miguel de Unamuno, Calle Alfonso X El Sabio s/n, 37007, Salamanca, Spain
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21
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Sørensen CE, Hansen NL, Mortensen EL, Lauritzen M, Osler M, Pedersen AML. Hyposalivation and Poor Dental Health Status Are Potential Correlates of Age-Related Cognitive Decline in Late Midlife in Danish Men. Front Aging Neurosci 2018; 10:10. [PMID: 29441011 PMCID: PMC5797531 DOI: 10.3389/fnagi.2018.00010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/10/2018] [Indexed: 12/31/2022] Open
Abstract
Introduction: Peripheral correlates of age-associated cognitive decline are important tools in the screening for potentially abnormal courses of cognitive aging. Since salivary gland function is controlled by the autonomic and central nervous system, associations between cognitive changes and salivary gland hypofunction were tested in two groups of middle-aged men in late midlife, who differed substantially with respect to their midlife performance in verbal intelligence when compared with their performance in young adulthood. Materials and Methods: Participants (n = 193) were recruited from the Danish Metropolit Cohort of men born in 1953. Based on their individual change in performance in two previously administered intelligence tests, they were allocated to one group of positive and one group of negative outliers in midlife cognition scores, indicating no decline versus decline in test performance. All participants underwent a clinical oral examination including assessments of their dental, periodontal, and mucosal conditions. Whole and parotid saliva flow rates were measured, and the number of systemic diseases and medication intake as well as daytime and nocturnal xerostomia were registered. Results: Participants with decline in cognitive test performance in midlife had significantly lower unstimulated whole saliva flow rates, higher prevalence of hyposalivation and daytime xerostomia and a higher caries experience than participants with no decline in midlife performance. Daytime and nocturnal xerostomia were associated with daily intake of medication and alcohol. Discussion: Overall, hyposalivation, xerostomia and poor dental status distinguished a group of men displaying relative decline in cognitive performance from a group of men without evidence of cognitive decline. Thus, hyposalivation and poor dental health status may represent potential correlates of age-related cognitive decline in late midlife, provided that other causes can be excluded.
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Affiliation(s)
- Christiane E Sørensen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Naja L Hansen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Functional Imaging Unit, Diagnostic Department, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - Erik L Mortensen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Aging Research Center, Universities of Aarhus, Southern Denmark and Copenhagen, Odense, Denmark
| | - Martin Lauritzen
- Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Neuroscience and Pharmacology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Neurophysiology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Merete Osler
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Danish Aging Research Center, Universities of Aarhus, Southern Denmark and Copenhagen, Odense, Denmark.,Research Center for Prevention and Health, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Anne M L Pedersen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Emanuel R, Sorensen A. A study of oral health prevention behaviours for patients with early stage dementia. Br Dent J 2018; 224:38-42. [DOI: 10.1038/sj.bdj.2018.5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 11/09/2022]
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23
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Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F. Oral hygiene and oral health in older people with dementia: a comprehensive review with focus on oral soft tissues. Clin Oral Investig 2018; 22:93-108. [PMID: 29143189 PMCID: PMC5748411 DOI: 10.1007/s00784-017-2264-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The number of older people with dementia and a natural dentition is growing. Recently, a systematic review concerning the oral health of older people with dementia with the focus on diseases of oral hard tissues was published. OBJECTIVE To provide a comprehensive literature overview following a systematic approach of the level of oral hygiene and oral health status in older people with dementia with focus on oral soft tissues. METHODS A literature search was conducted in the databases PubMed, CINAHL, and the Cochrane Library. The following search terms were used: dementia and oral health or stomatognathic disease. A critical appraisal of the included studies was performed with the Newcastle-Ottawa scale (NOS) and Delphi list. RESULTS The searches yielded 549 unique articles, of which 36 were included for critical appraisal and data extraction. The included studies suggest that older people with dementia had high scores for gingival bleeding, periodontitis, plaque, and assistance for oral care. In addition, candidiasis, stomatitis, and reduced salivary flow were frequently present in older people with dementia. CONCLUSIONS The studies included in the current systematic review suggest that older people with dementia have high levels of plaque and many oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, stomatitis, mucosal lesions, and reduced salivary flow. SCIENTIFIC RATIONALE FOR STUDY With the aging of the population, a higher prevalence of dementia and an increase in oral health problems can be expected. It is of interest to have an overview of the prevalence of oral problems in people with dementia. PRINCIPAL FINDINGS Older people with dementia have multiple oral health problems related to oral soft tissues, such as gingival bleeding, periodontal pockets, mucosal lesions, and reduced salivary flow. PRACTICAL IMPLICATIONS The oral health and hygiene of older people with dementia is not sufficient and could be improved with oral care education of formal and informal caregivers and regular professional dental care to people with dementia.
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Affiliation(s)
- Suzanne Delwel
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands.
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands.
| | - Tarik T Binnekade
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Roberto S G M Perez
- Department of Anesthesiology and Amsterdam Public Health Research Institute, VU University Medical Centre, Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Faculty of Medicine, Department of Elderly Care Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Erik J A Scherder
- Faculty of Behavioral and Movement Sciences, Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
| | - Frank Lobbezoo
- Department of Oral Kinesiology, Academic Centre for Dentistry Amsterdam (ACTA), Faculty of Dentistry, University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahler Laan 3004, 1081, LA, Amsterdam, The Netherlands
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24
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Foley NC, Affoo RH, Siqueira WL, Martin RE. A Systematic Review Examining the Oral Health Status of Persons with Dementia. JDR Clin Trans Res 2017; 2:330-342. [PMID: 30931751 DOI: 10.1177/2380084417714789] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While the oral health of persons with dementia has been shown to be poor, no systematic reviews have been published that examined the topic in depth, including participants with dementia representing the full spectrum of disease severity, and evaluating a broad scope of oral health assessments. The aim of this study was to conduct a current literature review to fill this gap in knowledge. A systematic search of 5 databases (CINAHL, PubMed, EMBASE, Scopus, and ISI Web of Science) was conducted to identify all relevant studies published up to May 2016. There were no exclusions related to study type, severity of dementia, dentate status, or living arrangements. Results were reported descriptively and summarized. Meta-analyses were performed where possible and reported as mean difference (MD) or standardized mean difference (SMD), with a 95% confidence interval (CI). Twenty-eight studies were identified. Assessments were conducted of tooth status, active dental caries, hygiene (plaque/calculus) of natural and artificial teeth, periodontal diseases, denture status (retention, stability, denture-related mucosal lesions), and oral health-related quality of life. Across all evaluations, persons with dementia generally had scores/results suggestive of poor oral health. In meta-analyses, compared with persons without dementia, those with dementia had a significantly fewer number of teeth (MD, -1.52; 95% CI, -0.2.52 to -0.52; P = 0.003; n = 13 studies), more carious teeth (SMD, 0.29; 95% CI, 0.03 to 0.48; P = 0.028; n = 9), significantly worse oral hygiene evaluated using a broad range of assessment tools (SMD, 0.88; 95% CI, 0.57 to 1.19, P < 0.0001; n = 7), and significantly poorer periodontal health (SMD, 0.38; 95% CI, 0.06 to 0.70; P = 0.02; n = 6 studies). The oral health status of persons with mild to severe forms of dementia, who were living in both the community and residential care facilities, was found to be poor across a broad range of dental assessments. Knowledge Transfer Statement: The results of this study define the scope of oral issues and quantify the degree of impairment in individuals with dementia, evaluated using a variety of oral health measures. The results revealed that poor oral health is associated with dementia.
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Affiliation(s)
- N C Foley
- 1 Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,2 Department of Foods & Nutrition, Brescia University College, London, Ontario, Canada
| | - R H Affoo
- 3 Graduate Program of Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada
| | - W L Siqueira
- 4 Schulich Dentistry and Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - R E Martin
- 1 Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,3 Graduate Program of Health and Rehabilitation Sciences, The University of Western Ontario, London, Ontario, Canada.,4 Schulich Dentistry and Department of Biochemistry, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,5 School of Communication Sciences & Disorders, Elborn College, The University of Western Ontario, London, Ontario, Canada.,6 Departments of Physiology & Pharmacology, The University of Western Ontario, London, Ontario, Canada.,7 Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
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25
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Lee YL, Hu HY, Huang LY, Chou P, Chu D. Periodontal Disease Associated with Higher Risk of Dementia: Population-Based Cohort Study in Taiwan. J Am Geriatr Soc 2017; 65:1975-1980. [DOI: 10.1111/jgs.14944] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Ya-Ling Lee
- Department of Dentistry; School of Dentistry, National Yang-Ming University; Taipei Taiwan
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
- Department of Dentistry; Taipei City Hospital; Taipei Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
- Department of Education and Research; Taipei City Hospital; Taipei Taiwan
| | - Li-Ying Huang
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
- Department of Community Medicine; Taipei City Hospital, Zhongxing Branch; Taipei Taiwan
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
| | - Dachen Chu
- Institute of Public Health and Community Medicine Research Center; National Yang-Ming University; Taipei Taiwan
- Faculty of Medicine; School of Medicine, National Yang-Ming University; Taipei Taiwan
- Department of Health Care Management; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
- Department of Neurosurgery; Taipei City Hospital; Taipei Taiwan
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26
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Vandenberghe-Descamps M, Labouré H, Prot A, Septier C, Tournier C, Feron G, Sulmont-Rossé C. Salivary Flow Decreases in Healthy Elderly People Independently of Dental Status and Drug Intake. J Texture Stud 2016. [DOI: 10.1111/jtxs.12191] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Hélène Labouré
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
- AgroSup Dijon; F-21000 Dijon France
| | - Aurélie Prot
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
| | - Chantal Septier
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
| | - Carole Tournier
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
| | - Gilles Feron
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
| | - Claire Sulmont-Rossé
- Centre des Sciences du Goût CNRS, INRA, Univ. Bourgogne Franche-Comté; F-21000 Dijon France
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27
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Zenthöfer A, Baumgart D, Cabrera T, Rammelsberg P, Schröder J, Corcodel N, Hassel AJ. Poor dental hygiene and periodontal health in nursing home residents with dementia: an observational study. Odontology 2016; 105:208-213. [PMID: 27160268 DOI: 10.1007/s10266-016-0246-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Accepted: 04/07/2016] [Indexed: 10/21/2022]
Abstract
Poor oral health conditions are well documented in the institutionalized elderly, but the literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study, therefore, was to assess whether dementia is associated with poor oral health/denture hygiene and an increased risk of periodontal disease in the institutionalized elderly. A total of 219 participants were assessed using the Mini Mental State Examination (MMSE) to determine cognitive state. According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the groups D and ND, Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were used with the confounders age, gender, dementia, number of comorbidities and number of permanent medications. To assess the risk factors for severe periodontitis as measured by the Community Index of Periodontal Treatment Needs, a logistic regression analysis was performed. Statistical analysis revealed no significant differences of GBI as well of DHI for demented and healthy subjects (p > 0.05). Severe periodontitis was detected in 66 % of participants with dementia. The logistic regression showed a 2.9 times increased risk among demented participants (p = 0.006). Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. The severity of oral problems, primarily periodontitis, seems to be enhanced in subjects suffering from dementia. Longitudinal observations are needed to clarify the cause-reaction relationship.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | - Dominik Baumgart
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Tomas Cabrera
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Johannes Schröder
- Institute of Gerontology, University of Heidelberg, Heidelberg, Germany.,Section of Geriatric Psychiatry, University of Heidelberg, Heidelberg, Germany
| | - Nicoleta Corcodel
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Alexander Jochen Hassel
- Department of Prosthodontics, Dental School, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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28
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Wu B, Fillenbaum GG, Plassman BL, Guo L. Association Between Oral Health and Cognitive Status: A Systematic Review. J Am Geriatr Soc 2016; 64:739-51. [PMID: 27037761 DOI: 10.1111/jgs.14036] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To systematically review longitudinal studies examining the association between oral health and cognitive decline. DESIGN Studies published between January 1993 and March 2013 were identified by search of English language publications in PubMed/Medline using relevant Medical Subject Heading terms and title and abstract keywords and from CINAHL using relevant subject headings. After applying eligibility criteria and adding four studies identified from article references, 56 of the 1,412 articles identified remained; 40 were cross-sectional, and 16 were longitudinal; 11 of the latter examined the effect of oral health on change in cognitive health or dementia incidence, five examined the reverse. SETTING Sources of information included administrative data, subject evaluations in parent studies, medical and dental records, self-reports, and in-person evaluations. PARTICIPANTS Older adults. MEASUREMENTS Most studies used subjects whose oral or cognitive status was known, using standard approaches to impute for missing information. The oral health information most frequently studied included number of teeth, periodontal and caries problems, and denture use. Cognition was most frequently evaluated using the Mini-Mental State Examination or according to a diagnosis of dementia. RESULTS Some studies found that oral health measures such as number of teeth and periodontal disease were associated with risk of cognitive decline or incident dementia, whereas others did not find an association. Similarly, cognitive decline was not consistently associated with greater loss of teeth or number of decayed teeth. It is likely that methodological limitations play a major role in explaining the inconsistent findings. CONCLUSION It is unclear how or whether oral health and cognitive status are related. Additional research is needed in which there is greater agreement on how oral health and cognitive states are assessed to better examine the linkages between these two health outcomes.
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Affiliation(s)
- Bei Wu
- School of Nursing, Duke University, Durham, North Carolina
| | - Gerda G Fillenbaum
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina
| | - Brenda L Plassman
- Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina
| | - Liang Guo
- School of Nursing, Duke University, Durham, North Carolina
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29
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Steinmassl PA, Steinmassl O, Kraus G, Dumfahrt H, Grunert I. Is Cognitive Status Related to Oral Hygiene Level and Appropriate for Determining Need for Oral Hygiene Assistance? J Periodontol 2015; 87:41-7. [PMID: 26447750 DOI: 10.1902/jop.2015.150349] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With declining general health, the maintenance of oral health becomes increasingly difficult. Unfortunately, health care resources are limited. An assessment tool for detecting a patient's need for oral health care assistance would promote its adequate distribution. The aim of this study is to evaluate if the Shulman clock-drawing test score is a suitable assessment tool for determining the need for oral hygiene assistance. METHODS Data collected from recent dental checkups of 126 inhabitants of five Austrian residential care facilities were analyzed. The Shulman clock-drawing test score was used as a measure for cognitive abilities and related to tooth and denture hygiene indices, which were assessed using the approximal space plaque index (API) and the denture plaque index (DPI). RESULTS Shulman score values were distributed almost evenly in the study population. The mean API was 83.6% (SD 20.2%) for the maxilla and 94.9% (SD 15.6%) for the mandible. The mean DPI was 43.9% (SD 31.4%). Cognitive impairment was not statistically related to the dental or denture hygiene index. CONCLUSIONS A high Shulman clock-drawing test score indicates the need for oral hygiene assistance, but it is not suitable as a single tool to assess this need. Patients with other disabilities might equally qualify for assistance. Dentures, however, can be cleaned quickly and efficiently independently of patient compliance; therefore, cleaning the patients' dentures should be part of nursing personnel's daily care routine for every patient.
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Affiliation(s)
- Patricia-Anca Steinmassl
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Otto Steinmassl
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck
| | | | - Herbert Dumfahrt
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
| | - Ingrid Grunert
- Department of Dental Prosthetics and Restorative Dentistry, Medical University of Innsbruck, Innsbruck, Austria
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30
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Gurav AN. Alzheimer's disease and periodontitis--an elusive link. Rev Assoc Med Bras (1992) 2015; 60:173-80. [PMID: 24919005 DOI: 10.1590/1806-9282.60.02.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 03/27/2013] [Indexed: 12/21/2022] Open
Abstract
Alzheimer's disease is the preeminent cause and commonest form of dementia. It is clinically characterized by a progressive descent in the cognitive function, which commences with deterioration in memory. The exact etiology and pathophysiologic mechanism of Alzheimer's disease is still not fully understood. However it is hypothesized that, neuroinflammation plays a critical role in the pathogenesis of Alzheimer's disease. Alzheimer's disease is marked by salient inflammatory features, characterized by microglial activation and escalation in the levels of pro-inflammatory cytokines in the affected regions. Studies have suggested a probable role of systemic infection conducing to inflammatory status of the central nervous system. Periodontitis is common oral infection affiliated with gram negative, anaerobic bacteria, capable of orchestrating localized and systemic infections in the subject. Periodontitis is known to elicit a "low grade systemic inflammation" by release of pro-inflammatory cytokines into systemic circulation. This review elucidates the possible role of periodontitis in exacerbating Alzheimer's disease. Periodontitis may bear the potential to affect the onset and progression of Alzheimer's disease. Periodontitis shares the two important features of Alzheimer's disease namely oxidative damage and inflammation, which are exhibited in the brain pathology of Alzheimer's disease. Periodontitis can be treated and hence it is a modifiable risk factor for Alzheimer's disease.
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Affiliation(s)
- Abhijit N Gurav
- Department of Periodontics, Tatyasaheb Kore Dental College & Research Centre
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31
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Stewart R, Stenman U, Hakeberg M, Hägglin C, Gustafson D, Skoog I. Associations between oral health and risk of dementia in a 37-year follow-up study: the prospective population study of women in Gothenburg. J Am Geriatr Soc 2015; 63:100-5. [PMID: 25597561 DOI: 10.1111/jgs.13194] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the association between incident dementia and previous number of teeth measured over a long interval. DESIGN Retrospective analysis of a 37-year cohort study. SETTING Prospective Population Study of Women in Gothenburg. PARTICIPANTS Women with (n = 158) and without (n = 539) dementia in 2000 to 2005. MEASUREMENTS Tooth counts in 1968-69, 1980-81, and 1992-93. Covariates included age, education, stroke, myocardial infarction, diabetes mellitus, smoking status, blood pressure, body mass index, and cholesterol level. RESULTS After adjustment for age, odds ratios (ORs) for dementia in 2000-05, comparing first with fourth tooth count quartiles, were 1.81 (95% confidence interval (CI) = 1.03-3.19) for tooth counts measured in 1968, 2.25 (95% CI = 1.18-4.32) for those in 1980, and 1.99 (0.92-4.30) for those in 1992. After further adjustment for education, ORs were 1.40 (95% CI = 1.03-3.19) for 1968, 1.96 (95% CI = 0.98-3.95) for 1980, and 1.59 (95% CI = 0.71-3.53) for 1992, and after additional adjustment for vascular risk factors, ORs were 1.38 (95% CI = 0.74-2.58) for 1968, 2.09 (95% CI = 1.01-4.32) for 1980, and 1.61 (95% CI = 0.70-3.68) for 1992. CONCLUSION In most of the analyses, lower tooth count was not associated with dementia, although a significant association was found for one of the three examinations. Further research may benefit from more-direct measures of dental and periodontal disease.
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Affiliation(s)
- Robert Stewart
- King's College London (Institute of Psychiatry, Psychology and Neuroscience), London, UK
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32
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Zenthöfer A, Navratil SD, Rammelsberg P, Cabrera T, Gorenc L, Urbanowitsch N, Wetzel P, Schröder J, Hassel AJ. Oral health and apraxia among institutionalized elderly people--a pilot study. Acta Odontol Scand 2015; 73:150-5. [PMID: 25252592 DOI: 10.3109/00016357.2014.961956] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Poor oral hygiene and dental health are very common among the institutionalized elderly. The purpose of this study was to evaluate the association of apraxia with oral hygiene and/or health. MATERIALS AND METHODS Ninety-two residents of 13 long-term care homes in southwest Germany participated in the study. For each participant, ideomotor apraxia scoring (AS) was conducted and demographic variables were collected. Participants underwent a comprehensive dental examination to assess the oral health indices gingival bleeding index (GBI), community periodontal index of treatment needs (CPITN) and denture hygiene index (DHI). Statistical comparison of dental indices among apraxic and non-apraxic individuals (cut-off < 45) was performed by use of t-tests. In addition, linear regression models were constructed with the dental indices as dependent variables. Each model was fitted with the dichotomized variable AS (pathologic or healthy) and adjusted for age and sex. RESULTS Mean (SD) GBI of 48.5 (25.9), CPITN of 2.9 (0.7) and DHI of 82.6 (14.6) were observed among the participants. Statistical analysis revealed AS was significantly associated with all oral health indicators (p < 0.05). Linear regression models showed apraxia is a predictor of GBI (p = 0.002) and CPITN (p = 0.027), but not of denture hygiene (p = 0.916). CONCLUSIONS Although this pilot investigation has limitations, the results suggest the presence of apraxia should be considered when planning oral healthcare strategies. Further research with larger samples is encouraged to confirm these relationships.
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Zenthöfer A, Rammelsberg P, Cabrera T, Schröder J, Hassel AJ. Determinants of oral health-related quality of life of the institutionalized elderly. Psychogeriatrics 2014; 14:247-54. [PMID: 25495087 DOI: 10.1111/psyg.12077] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 08/19/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diminished oral health of the institutionalized elderly has frequently been reported. This is not only of significance with regard to nutrition and general health, but it can also affect oral health-related quality of life. This paper evaluates the effects of oral and general conditions on oral health-related quality of life for the institutionalized elderly, as measured by the Geriatric Oral Health Assessment Index (GOHAI). MATERIALS AND METHODS Ninety-four residents of four long-term care homes in southern Germany agreed to participate in this study, and interviews were conducted using the GOHAI questionnaire. The Revised Oral Health Assessment Guide was applied to allocate participants into two groups: satisfactory oral health and poor oral health. To evaluate the effects of age, gender, number of chronic diseases, frequently taken drugs, care level, Mini-Mental State Examination score, periodontitis (for participants with their own teeth), pressures caused by prostheses, and type of denture worn, a linear regression model with the total GOHAI score was calculated with these determinants. RESULTS The mean ± SD GOHAI score was 53.3 ± 6.2 in the satisfactory oral health group and 48.7 ± 7.3 in the poor oral health group. Statistical analysis showed that the GOHAI scores were significantly different in satisfactory oral health and poor oral health groups (P = 0.030) and were affected by care level (P = 0.008) and type of dentures worn (P = 0.006). CONCLUSIONS Within the limitations of this study, it can be concluded that oral health-related quality of life of the institutionalized elderly is low and is positively associated with better oral health.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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34
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Zenthöfer A, Rammelsberg P, Cabrera T, Hassel AJ. Increasing dependency of older people in nursing homes is associated with need for dental treatments. Neuropsychiatr Dis Treat 2014; 10:2285-90. [PMID: 25506220 PMCID: PMC4259561 DOI: 10.2147/ndt.s71184] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
To determine relationships between the need for dental treatments of institutionalized elderly people and cognitive impairment and the general level of care needed. Two hundred and sixty-eight residents of long-term care facilities in Germany were included in this study. Age, sex, diseases, number of frequently taken drugs, and location of the long-term care facility of the participants were recorded. For each participant, the need for care was assessed by use of the Barthel index (BI). Cognitive impairment was evaluated by use of the mini-mental state examination (MMSE). To assess dental treatment needs, the revised oral assessment guide (ROAG) was applied for different oral health conditions, which were rated "healthy" or "treatment needed". Spearman correlations were performed to evaluate associations between BI and MMSE and dental treatment needs. Statistical analysis revealed significant associations of BI (P<0.001) and MMSE (P=0.015) with the ROAG score. Increasing dependency and decreasing cognitive ability worsen oral health and increase the need for dental treatment.
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Affiliation(s)
- Andreas Zenthöfer
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
| | - Peter Rammelsberg
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
| | - Tomas Cabrera
- Department of Prosthodontics, Dental School, University of Heidelberg, Heidelberg, Germany
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35
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Elsig F, Schimmel M, Duvernay E, Giannelli SV, Graf CE, Carlier S, Herrmann FR, Michel JP, Gold G, Zekry D, Müller F. Tooth loss, chewing efficiency and cognitive impairment in geriatric patients. Gerodontology 2013; 32:149-56. [PMID: 24128078 DOI: 10.1111/ger.12079] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Patients with dementia have poorer oral health and fewer teeth than their peers without cognitive impairment. OBJECTIVE The hypothesis of this study is that the number of natural teeth and the chewing efficiency are associated with cognitive functioning. METHODS This cross-sectional study included 29 patients diagnosed with dementia aged 75 years or older and 22 controls who were either cognitively normal (n = 19) or with mild cognitive impairment (n = 3). Neuropsychological, nutritional and dental assessments were performed. The chewing efficiency was evaluated with a two-colour mixing test. RESULTS Demented patients and controls presented with a mean of 4.9 and 6.5 teeth, respectively (n.s.). The number of natural teeth was not associated with dementia (p = 0.553). Same results were found for age (p = 0.746) and sex (p = 0.901). The chewing efficiency by visual inspection proved worse in participants with dementia than in the controls (p < 0.011) and explained 9.3% of the variance in the diagnosis of dementia. Neither dental state nor chewing efficiency was related to the nutritional state. CONCLUSION Chewing efficiency seems stronger associated with cognitive impairment than the number of teeth. Hence, in a more holistic approach for the geriatric assessment, the dental examination may be complemented by a chewing efficiency test.
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Affiliation(s)
- Fanny Elsig
- Division of Gerodontology and Removable Prosthodontics, University of Geneva Dental School, Geneva, Switzerland
| | - Martin Schimmel
- Division of Gerodontology and Removable Prosthodontics, University of Geneva Dental School, Geneva, Switzerland
| | - Elena Duvernay
- Division of Gerodontology and Removable Prosthodontics, University of Geneva Dental School, Geneva, Switzerland
| | - Sandra V Giannelli
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Christoph E Graf
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Sabrina Carlier
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - François R Herrmann
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Jean-Pierre Michel
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Gabriel Gold
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Dina Zekry
- Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
| | - Frauke Müller
- Division of Gerodontology and Removable Prosthodontics, University of Geneva Dental School, Geneva, Switzerland.,Department of Internal Medicine, Rehabilitation and Geriatrics, University Hospitals Geneva, Thônex, Switzerland
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36
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Kazancioglu HO, Cakir O, Koyuncuoglu G, Ciftci A, Ak G. Oral Findings and Health Status among Turkish Geriatric Patients with or without Dementia (Oral Lesions and Dementia Patients). INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Cabras T, Pisano E, Montaldo C, Giuca MR, Iavarone F, Zampino G, Castagnola M, Messana I. Significant modifications of the salivary proteome potentially associated with complications of Down syndrome revealed by top-down proteomics. Mol Cell Proteomics 2013; 12:1844-52. [PMID: 23533003 DOI: 10.1074/mcp.m112.026708] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
People with Down syndrome, a frequent genetic disorder in humans, have increased risk of health problems associated with this condition. One clinical feature of Down syndrome is the increased prevalence and severity of periodontal disease in comparison with the general population. Because saliva plays an important role in maintaining oral health, in the present study the salivary proteome of Down syndrome subjects was investigated to explore modifications with respect to healthy subjects. Whole saliva of 36 Down syndrome subjects, divided in the age groups 10-17 yr and 18-50 yr, was analyzed by a top-down proteomic approach, based on the high performance liquid chromatography-electrospray ionization-MS analysis of the intact proteins and peptides, and the qualitative and quantitative profiles were compared with sex- and age-matched control groups. The results showed the following interesting features: 1) as opposed to controls, in Down syndrome subjects the concentration of the major salivary proteins of gland origin did not increase with age; as a consequence concentration of acidic proline rich proteins and S cystatins were found significantly reduced in older Down syndrome subjects with respect to matched controls; 2) levels of the antimicrobial α-defensins 1 and 2 and histatins 3 and 5 were significantly increased in whole saliva of older Down syndrome subjects with respect to controls; 3) S100A7, S100A8, and S100A12 levels were significantly increased in whole saliva of Down syndrome subjects in comparison with controls. The increased level of S100A7 and S100A12 may be of particular interest as a biomarker of early onset Alzheimer's disease, which is frequently associated with Down syndrome.
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Affiliation(s)
- Tiziana Cabras
- Dipartimento di Scienze della Vita e dell'Ambiente, Università di Cagliari, Monserrato (CA), Italy.
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38
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Stewart R, Weyant RJ, Garcia ME, Harris T, Launer LJ, Satterfield S, Simonsick EM, Yaffe K, Newman AB. Adverse oral health and cognitive decline: the health, aging and body composition study. J Am Geriatr Soc 2013; 61:177-84. [PMID: 23405916 PMCID: PMC3578234 DOI: 10.1111/jgs.12094] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To investigate the relationship between periodontal disease and cognitive decline. DESIGN Analysis of a prospective cohort study. SETTING The Health, Aging and Body Composition (Health ABC) Study. PARTICIPANTS One thousand fifty-three participants who were administered the Modified Mini-Mental State Examination (3MS) at Year 1 (baseline) and Year 3 and had participated in a comprehensive periodontal examination at Year 2. MEASUREMENTS The prospective association between a range of oral health parameters and cognitive function was examined. Decline in 3MS score from Year 3 to 5 was investigated in 947 (89.9%) participants. Covariates included age, sex, education, race, cardiovascular disease and risk, and depressive symptoms. RESULTS Most indicators of adverse oral health at Year 2 were associated with cognitive impairment based on averaged 3MS scores less than 80 for Years 1 and 3, but education and race substantially confounded these associations. Higher gingival index, a measure of gingival inflammation, at Year 2 remained independently associated with this definition of cognitive impairment and, in fully adjusted analyses, was also an independent predictor of a more-than-5-point cognitive decline from Year 3 to 5. CONCLUSION Periodontitis may be a risk factor for cognitive decline. Gingivitis is reversible, and periodontitis to some degree is preventable and controllable when manifest. Therefore, further research is needed to clarify potential underlying mechanisms and oral health interventions that might ameliorate cognitive decline.
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Affiliation(s)
- Robert Stewart
- King's College London, London (Institute of Psychiatry), UK.
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39
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Chen X, Clark JJ, Naorungroj S. Oral health in older adults with dementia living in different environments: a propensity analysis. SPECIAL CARE IN DENTISTRY 2013; 33:239-47. [DOI: 10.1111/scd.12006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Xi Chen
- Department of Dental Ecology; University of North Carolina; Chapel Hill; North Carolina
| | - Jennifer J.J. Clark
- Department of Biostatistics; University of North Carolina, Gillings School of Global Public Health; North Carolina
| | - Supawadee Naorungroj
- Department of Epidemiology; University of North Carolina, Gillings School of Global Public Health; North Carolina
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40
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Shi M, Sui YT, Peskind ER, Li G, Hwang H, Devic I, Ginghina C, Edgar JS, Pan C, Goodlett DR, Furay AR, Gonzalez-Cuyar LF, Zhang J. Salivary tau species are potential biomarkers of Alzheimer's disease. J Alzheimers Dis 2012; 27:299-305. [PMID: 21841250 DOI: 10.3233/jad-2011-110731] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Phosphorylation of tau protein is a critical event in the pathogenesis of Alzheimer's disease (AD). Increased phosphorylated tau and total tau levels, combined with reduced concentrations of amyloid-β 1-42 (Aβ42) in cerebrospinal fluid (CSF), but not in plasma or serum, have been generally accepted as sensitive AD diagnostic markers. However, obtaining CSF is a relatively invasive procedure that requires participation of specially trained medical professionals, i.e., CSF is not an ideal sample source for screening or early diagnosis of AD, which is essential to current and future neuroprotective treatments for the disease. Here, we identified tau, but not Aβ species, with mass spectrometry in human saliva, a body fluid that is much more accessible compared to CSF or even blood. Quantitative assessment of salivary levels of total tau, phosphorylated tau, and Aβ42 using highly sensitive Luminex assays revealed that, while Aβ42 was not detectable, the phosphorylated tau/tau ratio significantly increased in patients with AD compared to healthy controls. These results suggest that salivary tau species could be ideal biomarkers for AD diagnosis, especially at early stages of the disease or even screening asymptomatic subjects, allowing for a much larger therapeutic window for AD patients.
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Affiliation(s)
- Min Shi
- Department of Pathology, University of Washington School of Medicine, Seattle, WA, USA
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Liu B, Dion MR, Jurasic MM, Gibson G, Jones JA. Xerostomia and salivary hypofunction in vulnerable elders: prevalence and etiology. Oral Surg Oral Med Oral Pathol Oral Radiol 2012; 114:52-60. [PMID: 22727092 DOI: 10.1016/j.oooo.2011.11.014] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Revised: 11/09/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The goal of this article is to review existing research on the prevalence and etiology of dry mouth in the vulnerable elders and identify knowledge gaps. STUDY DESIGN Vulnerable elders (VE) are persons aged >65 years who have any or all of the following: limited mobility, limited resources, or complex health status. A systematic search was conducted of PubMed sources from 1989 to May 2010. Evidence was evaluated on the prevalence and etiology of xerostomia and salivary gland hypofunction (SGH) in VE. RESULTS The search identified 1,422 publications. The inclusion/exclusion criteria yielded 348 articles, 80 of which are cited herein. CONCLUSIONS Research has showed a high prevalence of xerostomia and SGH in VE. Common etiologies include medications, poor general health, female gender, and age. Gaps still exist in the evaluation of dry mouth in VE. Nonetheless, oral dryness will remain an important health issue as life expectancy increases.
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Affiliation(s)
- Bing Liu
- Department of General Dentistry, Henry M. Goldman School of Dental Medicine, Boston University, Boston, Massachusetts 02118, USA.
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Ellefsen BS, Morse DE, Waldemar G, Holm-Pedersen P. Indicators for root caries in Danish persons with recently diagnosed Alzheimer's disease. Gerodontology 2012; 29:194-202. [PMID: 22540768 DOI: 10.1111/j.1741-2358.2011.00560.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To identify indicators of root caries among persons with newly diagnosed Alzheimer's disease (AD). BACKGROUND Few studies have investigated dental caries in older adults with AD. Previously we found that persons with AD had significantly more root caries compared to persons with dementia other than AD. METHODS Participants were recruited from two university hospital clinics in Copenhagen, Denmark. A team of neurologists/geriatricians carried out the diagnostic screening. The study included an interview, oral examination and medical records. RESULTS We evaluated potential indicators of root decay across subjects with 3+ decayed surfaces vs. <3 decayed surfaces. Variables associated with increased odds of root caries were age over 80 years, 2+ decayed coronal surfaces and 5+ filled root surfaces. Among the social variables, living with someone was associated with a nearly 70% reduction in the odds of having 3+ surfaces of untreated caries. DISCUSSION Root caries is highly prevalent among individuals with new AD and there is still a strong need for active assessment of and attention to oral problems in persons with AD. Our findings document that recently diagnosed AD cases with multiple coronal caries lesions are at elevated risk of having more root caries. Also persons 81+ years and those with multiple root fillings are more likely to have numerous untreated root lesions.
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Affiliation(s)
- Birita S Ellefsen
- Copenhagen Gerontological Oral Health Research Center, School of Dentistry, University of Copenhagen, Copenhagen, Denmark
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Batty GD, Li Q, Huxley R, Zoungas S, Taylor BA, Neal B, de Galan B, Woodward M, Harrap SB, Colagiuri S, Patel A, Chalmers J. Oral disease in relation to future risk of dementia and cognitive decline: prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. Eur Psychiatry 2011; 28:49-52. [PMID: 21964484 DOI: 10.1016/j.eurpsy.2011.07.005] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 07/11/2011] [Accepted: 07/16/2011] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Examine the association of oral disease with future dementia/cognitive decline in a cohort of people with type 2 diabetes. METHODS A total of 11,140 men and women aged 55-88 years at study induction with type 2 diabetes participated in a baseline medical examination when they reported the number of natural teeth and days of bleeding gums. Dementia and cognitive decline were ascertained periodically during a 5-year follow-up. RESULTS Relative to the group with the greatest number of teeth (more than or equal to 22), having no teeth was associated with the highest risk of both dementia (hazard ratio; 95% confidence interval: 1.48; 1.24, 1.78) and cognitive decline (1.39; 1.21, 1.59). Number of days of bleeding gums was unrelated to these outcomes. CONCLUSIONS Tooth loss was associated with an increased risk of both dementia and cognitive decline.
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Affiliation(s)
- G-D Batty
- Department of Epidemiology and Public Health, University College of London, Torrington Place, London, UK.
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The association between self-reported tooth loss and cognitive function in the REasons for Geographic And Racial Differences in Stroke study: an assessment of potential pathways. J Am Dent Assoc 2011; 142:379-90. [PMID: 21454843 DOI: 10.14219/jada.archive.2011.0192] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Several mechanisms may associate tooth loss and related oral inflammation with cognitive impairment. The authors studied the relationship between tooth loss and cognitive function. METHODS The REasons for Geographic And Racial Differences in Stroke study is a national longitudinal study of more than 30,000 African American and white adults 45 years or older. Data for tooth loss, cognitive function and potential confounding variables were available for 9,853 participants at the time of analysis. The authors used incremental linear regression modeling to investigate the cross-sectional association between self-reported tooth loss and cognitive function. RESULTS In unadjusted analysis (mean learning followed by recall; α level of significance of .05), the loss of six to 16 teeth and the loss of more than 16 teeth were associated with poorer cognitive function compared with the loss of no teeth. Attenuated associations persisted after the authors adjusted for demographic and systemic risk factors. The full model, which was adjusted for socioeconomic status (SES), revealed no association between tooth loss and cognitive function. CONCLUSION Tooth loss may be associated with cognitive function; however, this association is mediated by age and SES. CLINICAL IMPLICATIONS Tooth loss due to periodontal disease may be a marker for low SES, and the interplay of these factors with advanced age may confer risk of having poorer cognitive function. Further studies are needed to clarify these associations.
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Chen X, Clark JJ. Multidimensional Risk Assessment for Tooth Loss in a Geriatric Population with Diverse Medical and Dental Backgrounds. J Am Geriatr Soc 2011; 59:1116-22. [DOI: 10.1111/j.1532-5415.2011.03425.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen X, Shuman SK, Hodges JS, Gatewood LC, Xu J. Patterns of tooth loss in older adults with and without dementia: a retrospective study based on a Minnesota cohort. J Am Geriatr Soc 2011; 58:2300-7. [PMID: 21143439 DOI: 10.1111/j.1532-5415.2010.03192.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study tooth loss patterns in older adults with dementia. DESIGN Retrospective longitudinal study. SETTING A community-based geriatric dental clinic in Minnesota. PARTICIPANTS Four hundred ninety-one older adults who presented to the study clinic as new patients during the study period, remained dentate after finishing the initial treatment plan, and returned for care at least once thereafter were retrospectively selected. One hundred nineteen elderly people with International Classification of Diseases, Ninth Revision, codes 290.x, 294.1, or 331.2 or a plain-text diagnosis of dementia, Alzheimer's disease, or chronic brain syndrome in the medical history were considered having dementia. INTERVENTION All existing dental conditions were treated before enrollment. Dental treatment was continually provided for all participants during follow-up. MEASUREMENTS Tooth loss patterns, including time to first tooth loss, number of tooth loss events, and number of teeth lost per patient-year were estimated and compared for participants with and without dementia using Cox, Poisson, and negative-binomial regressions. RESULTS Participants with dementia arrived with an average of 18 and those without dementia with an average of 20 teeth; 27% of remaining teeth in the group with dementia were decayed or retained roots, higher than in the group without dementia (P<.001). Patterns of tooth loss did not significantly differ between the two groups; 11% of participants in both groups had lost teeth by 12 months of follow-up. By 48 months, 31% of participants without dementia and 37% of participants with dementia had lost at least one tooth (P=.50). On average, 15% of participants in both groups lost at least one tooth each year. Mean numbers of teeth lost in 5 years were 1.21 for participants with dementia and 1.01 for participants without dementia (P=.89). CONCLUSION Based on data available in a community-based geriatric dental clinic, dementia was not associated with tooth loss. Although their oral health was poor at arrival, participants with dementia maintained their dentition as well as participants without dementia when dental treatment was provided.
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Affiliation(s)
- Xi Chen
- Department of Dental Ecology, University of North Carolina School of Dentistry, Chapel Hill, North Carolina 27599, USA.
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Pizzo G, Guiglia R, Lo Russo L, Campisi G. Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept. Eur J Intern Med 2010; 21:496-502. [PMID: 21111933 DOI: 10.1016/j.ejim.2010.07.011] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Accepted: 07/14/2010] [Indexed: 01/07/2023]
Abstract
During past decades the relationship between dentistry and internal medicine and especially the concept of the so-called focal infection theory have long been a matter of debate. The pathogenesis of focal diseases has been classically attributed to dental pulp pathologies and periapical infections. Nonetheless, in recent years, their role is being dismissed while increasing interest is being devoted to the possible associations between periodontal infection and systemic diseases. In fact, periodontal pathogens and their products, as well as inflammatory mediators produced in periodontal tissues, might enter the bloodstream, causing systemic effects and/or contributing to systemic diseases. On the basis of this mechanism, chronic periodontitis has been suggested as a risk factor for cardiovascular diseases associated with atherosclerosis, bacterial endocarditis, diabetes mellitus, respiratory disease, preterm delivery, rheumatoid arthritis, and, recently, osteoporosis, pancreatic cancer, metabolic syndrome, renal diseases and neurodegenerative diseases such as Alzheimer's disease. Various hypotheses, including common susceptibility, systemic inflammation, direct bacterial infection and cross-reactivity, or molecular mimicry, between bacterial antigens and self-antigens, have been postulated to explain these relationships. In this scenario, the association of periodontal disease with systemic diseases has set the stage for introducing the concept of periodontal medicine. This narrative review summarizes the evolution of focal infection theory up to the current pathophysiology of periodontal disease, and presents an update on the relationships between chronic periodontitis and systemic diseases.
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Affiliation(s)
- Giuseppe Pizzo
- Section of Oral Sciences, University of Palermo, Via del Vespro 129, 90127 Palermo, Italy
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Rai B, Kaur J, Anand SC. Possible relationship between periodontitis and dementia in a North Indian old age population: a pilot study. Gerodontology 2010; 29:e200-5. [DOI: 10.1111/j.1741-2358.2010.00441.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen X, Hodges JS, Shuman SK, Gatewood LC, Xu J. Predicting tooth loss for older adults with special needs. Community Dent Oral Epidemiol 2010; 38:235-43. [DOI: 10.1111/j.1600-0528.2009.00527.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Assessing caries increments in elderly patients with and without dementia: a one-year follow-up study. J Am Dent Assoc 2010; 140:1392-400. [PMID: 19884398 DOI: 10.14219/jada.archive.2009.0076] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The authors conducted a study to determine one-year coronal and root caries increments in patients newly diagnosed as having Alzheimer disease (AD), other dementia (OD) or no dementia. METHODS The authors recruited patients from two hospital memory clinics in Copenhagen. The oral examination included an assessment of dental status and dental caries. The authors used a structured questionnaire to obtain information regarding demographic, social and functional variables. RESULTS In the baseline study, 106 dentate patients participated. Of these, 77 completed the follow-up study. The participants' mean age was 81.9 years at baseline and 82.5 years at follow-up. At baseline, 87 (82 percent) of 106 participants had dementia and at follow-up, 64 (83 percent) of 77 participants had dementia. The mean number of decayed tooth surfaces was significantly higher at follow-up than at baseline for all participants, and the number was highest for the OD group. The one-year adjusted caries and filling increments (ADJCIs) were high for participants with and without dementia but were highest for participants in the AD and OD groups. Baseline risk factors for developing elevated coronal and root ADJCIs included having caries, having many teeth and being older than 80 years. CONCLUSIONS Elderly people referred to a memory clinic were at an elevated risk of developing high levels of coronal and root-surface caries during the first year after referral, and those with a dementia diagnosis other than AD appeared to be at a particularly high risk of developing multiple carious lesions during the first year after diagnosis. CLINICAL IMPLICATIONS These findings underscore the importance of addressing the oral health needs of elderly people suspected of having experienced cognitive decline.
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