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Gao C, Larvin H, Bishop DT, Bunce D, Pavitt S, Wu J, Kang J. Oral diseases are associated with cognitive function in adults over 60 years old. Oral Dis 2024; 30:3480-3488. [PMID: 37811600 DOI: 10.1111/odi.14757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 08/14/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To investigate the bidirectional association between oral diseases and cognitive function comprehensively. SUBJECTS AND METHODS This cross sectional study utilized data from the National Health and Nutrition Examination Survey. Oral diseases include periodontitis, dental caries, and tooth loss (end point of oral disease resulting in tooth extraction). Cognitive function included three domains: memory, processing speed, and executive function. A global cognitive score was then derived from sum of the three cognitive domains. Oral cognition associations were examined using various statistical models: (1) Regress oral disease on cognitive function; (2) Regress cognitive function on oral disease; and (3) Structural equation modelling treating cognition and oral disease as latent variables. RESULTS There were 2508 participants aged 60+ who had both oral and cognitive information. Associations between various oral disease and global cognitive score were observed (Odds ratio ORcog->periodontitis 0.95, 95% Confidence Interval [0.92, 0.99]; βcog->caries -0.13, [-0.23, -0.04]; βcog->tooth loss -0.03 [-0.04, -0.01]; βtooth loss->cog -0.04 [-0.06, -0.02]; βcaries->cog -0.03 [-0.06, -0.01]; βperiodontitis->cog -0.39 [-0.69, -0.10]). Significant correlation was also found between these oral disease and cognitive function using structural equation model (r -0.22, [-0.34, -0.10]). CONCLUSIONS This study found robust bidirectional associations between oral disease and cognitive function using various modelling approaches among the aging population.
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Affiliation(s)
- Chenyi Gao
- School of Dentistry, University of Leeds, Leeds, UK
| | - Harriet Larvin
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - David Timothy Bishop
- Leeds Institute of Medical Research, School of Medicine, University of Leeds, Leeds, UK
| | - David Bunce
- School of Psychology, University of Leeds, Leeds, UK
| | - Susan Pavitt
- School of Dentistry, University of Leeds, Leeds, UK
| | - Jianhua Wu
- Centre for Primary Care, Wolfson Institute of Population Health, Queen Mary, University of London, London, UK
| | - Jing Kang
- School of Dentistry, University of Leeds, Leeds, UK
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2
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Takahashi T, Hatta K, Ikebe K. Risk factors of cognitive impairment: Impact of decline in oral function. JAPANESE DENTAL SCIENCE REVIEW 2023; 59:203-208. [PMID: 38152385 PMCID: PMC10751745 DOI: 10.1016/j.jdsr.2023.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 06/18/2023] [Accepted: 06/22/2023] [Indexed: 12/29/2023] Open
Abstract
Cognitive impairment and subsequent dementia are the major causes of disability and need for nursing care among older people in worldwide. The purpose is to review well-known risk factors for cognitive impairment and dementia, focusing on the relationship between decline in oral function and current prevention strategies. Various non-modifiable and modifiable risk factors are related to cognitive impairment. Effects of oral function to cognitive impairment is not yet well recognized in the medical community, although masticatory function, occlusal force, and number of teeth have been reported to be related to cognitive function. Furthermore, occlusal force rather than number of teeth was significantly related to the early stages of cognitive impairment, and that a decline in occlusal force seemed to lead to cognitive impairment directly and indirectly through dietary intake. This relationship was significant only for occlusal force, which may be associated with the early stages of cognitive decline. Nutritional change caused by reduced masticatory function is suggested as a possible explanation. Therefore, rehabilitation or maintenance of oral function should be sought to prevent cognitive impairment.
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Affiliation(s)
- Toshihito Takahashi
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kodai Hatta
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Kazunori Ikebe
- Department of Removable Prosthodontics and Gerodontology, Osaka University Graduate School of Dentistry, Osaka, Japan
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3
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Kuramoto E, Kitawaki A, Yagi T, Kono H, Matsumoto SE, Hara H, Ohyagi Y, Iwai H, Yamanaka A, Goto T. Development of a system to analyze oral frailty associated with Alzheimer's disease using a mouse model. Front Aging Neurosci 2022; 14:935033. [PMID: 35983379 PMCID: PMC9380890 DOI: 10.3389/fnagi.2022.935033] [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: 05/03/2022] [Accepted: 07/04/2022] [Indexed: 12/03/2022] Open
Abstract
The rapid aging of the population makes the detection and prevention of frailty increasingly important. Oral frailty has been proposed as a novel frailty phenotype and is defined as a decrease in oral function coexisting with a decline in cognitive and physical functions. Oral frailty has received particular attention in relation to Alzheimer's disease (AD). However, the pathomechanisms of oral frailty related to AD remain unknown. It is assumed that the mesencephalic trigeminal nucleus (Vmes), which controls mastication, is affected by AD pathology, and as a result, masticatory function may be impaired. To investigate this possibility, we included male 3 × Tg-AD mice and their non-transgenic counterpart (NonTg) of 3–4 months of age in the present study. Immunohistochemistry revealed amyloid-β deposition and excessive tau phosphorylation in the Vmes of 3 × Tg-AD mice. Furthermore, vesicular glutamate transporter 1-immunopositive axon varicosities, which are derived from Vmes neurons, were significantly reduced in the trigeminal motor nucleus of 3 × Tg-AD mice. To investigate whether the AD pathology observed in the Vmes affects masticatory function, we analyzed electromyography of the masseter muscle during feeding. The 3 × Tg-AD mice showed a significant delay in masticatory rhythm compared to NonTg mice. Furthermore, we developed a system to simultaneously record bite force and electromyography of masseter, and devised a new method to estimate bite force during food chewing in mice. Since the muscle activity of the masseter showed a high correlation with bite force, it could be accurately estimated from the muscle activity. The estimated bite force of 3 × Tg-AD mice eating sunflower seeds was predominantly smaller than that of NonTg mice. However, there was no difference in masseter weight or muscle fiber cross-sectional area between the two groups, suggesting that the decreased bite force and delayed mastication rhythm observed in 3 × Tg-AD mice were not due to abnormality of the masseter. In conclusion, the decreased masticatory function observed in 3 × Tg-AD mice was most likely caused by AD pathology in the Vmes. Thus, novel quantitative analyses of masticatory function using the mouse model of AD enabled a comprehensive understanding of oral frailty pathogenesis.
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Affiliation(s)
- Eriko Kuramoto
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Ayano Kitawaki
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takakazu Yagi
- Department of Oral Health Science, Kobe Tokiwa University, Kobe, Japan
| | - Hiroshi Kono
- Department of Biomaterials Science, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Shin-Ei Matsumoto
- Department of Immunology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiromitsu Hara
- Department of Immunology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasumasa Ohyagi
- Department of Neurology and Geriatric Medicine, Ehime University Graduate School of Medicine, Ehime, Japan
| | - Haruki Iwai
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Atsushi Yamanaka
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tetsuya Goto
- Department of Oral Anatomy and Cell Biology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
- *Correspondence: Tetsuya Goto
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4
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The Mechanistic Pathways of Periodontal Pathogens Entering the Brain: The Potential Role of Treponema denticola in Tracing Alzheimer’s Disease Pathology. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159386. [PMID: 35954742 PMCID: PMC9368682 DOI: 10.3390/ijerph19159386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 11/20/2022]
Abstract
Alzheimer’s Disease (AD) is a complex neurodegenerative disease and remains the most common form of dementia. The pathological features include amyloid (Aβ) accumulation, neurofibrillary tangles (NFTs), neural and synaptic loss, microglial cell activation, and an increased blood–brain barrier permeability. One longstanding hypothesis suggests that a microbial etiology is key to AD initiation. Among the various periodontal microorganisms, Porphyromonas gingivalis has been considered the keystone agent to potentially correlate with AD, due to its influence on systemic inflammation. P. gingivalis together with Treponema denticola and Tannerella forsythia belong to the red complex consortium of bacteria advocated to sustain periodontitis within a local dysbiosis and a host response alteration. Since the implication of P. gingivalis in the pathogenesis of AD, evidence has emerged of T. denticola clusters in some AD brain tissue sections. This narrative review explored the potential mode of spirochetes entry into the AD brain for tracing pathology. Spirochetes are slow-growing bacteria, which can hide within ganglia for many years. It is this feature in combination with the ability of these bacteria to evade the hosts’ immune responses that may account for a long lag phase between infection and plausible AD disease symptoms. As the locus coeruleus has direct connection between the trigeminal nuclei to periodontal free nerve endings and proprioceptors with the central nervous system, it is plausible that they could initiate AD pathology from this anatomical region.
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5
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Chang EJ, Woo HJ, Jeong KH. Mediating Effect of Cognitive Function on the Relationship between Geriatric Oral Health and Quality of Life. J Prev Med Public Health 2022; 55:106-113. [PMID: 35135054 PMCID: PMC8841201 DOI: 10.3961/jpmph.21.536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/12/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives Previous studies have found that the oral health of seniors can affect their physical nutrition and quality of life (QoL). Additionally, poor oral health can lead to the development of dementia, which is associated with decreased cognitive function. This study aimed to examine the impact of geriatric oral health (GOH) on the QoL of Korean seniors and the mediating effects of cognitive function. Methods We used data from the seventh Korean Longitudinal Study of Aging conducted in 2018. In total, 4049 seniors were included in our study. We analyzed the impact of GOH on QoL according to 5 mediating domains of cognitive function and control variables. To examine each path of mediating effects, bootstrapping with 5000 iterations was performed with 95% confidence intervals. Results Our findings revealed that good GOH had a positive effect on the QoL of seniors. Also, better GOH corresponded to a higher degree of cognitive function within all 5 domains: orientation, memory registration, attention/calculation, memory recall, and language and visuospatial ability. In addition, 3 domains of the 5 domains (attention/calculation, memory recall, and language and visuospatial ability) had significant mediating effects on the relationship between GOH and QoL. Conclusions This study suggests that adequate management of GOH is crucial for promoting a better QoL and a high degree of cognitive function among seniors. To prevent cognitive impairment, such as dementia, future studies should take a more targeted approach by examining data according to each cognitive domain and various socio-demographic factors.
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Affiliation(s)
- Eun Jee Chang
- Department of Preventive Medicine, Graduate School of Public Health, Seoul National University, Seoul, Korea
| | | | - Kyu-Hyoung Jeong
- Department of Social Welfare, Semyung University, Jecheon, Korea
- Corresponding author: Kyu-Hyoung Jeong Department of Social Welfare, Semyung University, 65 Semyung-ro, Jecheon 27136, Korea E-mail:
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6
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Werber T, Bata Z, Vaszine ES, Berente DB, Kamondi A, Horvath AA. The Association of Periodontitis and Alzheimer's Disease: How to Hit Two Birds with One Stone. J Alzheimers Dis 2021; 84:1-21. [PMID: 34511500 DOI: 10.3233/jad-210491] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Alzheimer's disease (AD) is the leading cause of cognitive impairment in the elderly. Recent evidence suggests that preventive interventional trials could significantly reduce the risk for development of dementia. Periodontitis is the most common dental disease characterized by chronic inflammation and loss of alveolar bone and perialveolar attachment of teeth. Growing number of studies propose a potential link between periodontitis and neurodegeneration. In the first part of the paper, we overview case-control studies analyzing the prevalence of periodontitis among AD patients and healthy controls. Second, we survey observational libraries and cross-sectional studies investigating the risk of cognitive decline in patients with periodontitis. Next, we describe the current view on the mechanism of periodontitis linked neural damage, highlighting bacterial invasion of neural tissue from dental plaques, and periodontitis induced systemic inflammation resulting in a neuroinflammatory process. Later, we summarize reports connecting the four most common periodontal pathogens to AD pathology. Finally, we provide a practical guide for further prevalence and interventional studies on the management of cognitively high-risk patients with and without periodontitis. In this section, we highlight strategies for risk control, patient information, dental evaluation, reporting protocol and dental procedures in the clinical management of patients with a risk for periodontitis and with diagnosed periodontitis. In conclusion, our review summarizes the current view on the association between AD and periodontitis and provides a research and intervention strategy for harmonized interventional trials and for further case-control or cross-sectional studies.
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Affiliation(s)
- Tom Werber
- Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zsofia Bata
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Eniko Szabo Vaszine
- Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary
| | - Dalida Borbala Berente
- Faculty of Medicine, Semmelweis University, Budapest, Hungary.,Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary
| | - Anita Kamondi
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Neurology, Semmelweis University, Budapest, Hungary
| | - Andras Attila Horvath
- Neurocognitive Research Center, National Institute of Mental Health, Neurology and Neurosurgery, Budapest, Hungary.,Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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7
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Cho MJ, Shin HE, Amano A, Song KB, Choi YH. Effect of Molar Occlusal Balance on Cognitive Function in the Elderly. Int Dent J 2021; 72:331-337. [PMID: 34376281 PMCID: PMC9275330 DOI: 10.1016/j.identj.2021.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 05/20/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Elderly people with dementia, who are increasing at a rate comparable to the rate at which theelderly population is growing, are becoming a serious social problem in Korea. Therefore, the purpose of this study was to investigate the association between molar occlusal balance and cognitive function among Koreans aged 65 years and older. METHODS A total of 308 participants aged 65 years and older who attended a senior center were recruited for the study with their consent. The Korean version of the Mini-Mental State Examination (MMSE-DS) was used to assess cognitive function, and masticatory ability was measured according to the ability to chew food, the number of remaining teeth, and the self-perceived perceived masticatory function. Relative molar occlusal balance was measured using the T-scan Ⅲ system. All collected data were analysed using SPSS version 23.0. RESULTS There was a significant association between cognitive function and molar masticatory ability (P < .05). The participants with relative molar occlusal balance had a higher MMSE-DS score when compared to those with relative incision occlusal balance, adjusted for sociodemographic factors and number of remaining teeth, subjective masticatory ability, chewing ability, occlusion time, and denture use. Cognitive function was higher when relative molar occlusion was greater compared to anterior occlusion in anterior-posterior teeth balance. CONCLUSIONS Cognitive function in elderly people was higher when the relative molar occlusal balance was greater. Mastication with posterior teeth may have a more important effect on stimulation of cognitive function. Therefore, oral health care focusing on maintenance of molar teeth may be crucial for elderly persons.
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Affiliation(s)
- Min-Jeong Cho
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea; Department of Dental Hygiene, College of Science & Technology, Kyungpook National University, Sangju, Korea
| | - Hae-Eun Shin
- Division of Health and Nutrition Survey, Korea Centers for Disease Control & Prevention, Cheongju, Korea
| | - Atsuo Amano
- Department of Preventive Dentistry, Osaka University Graduate School of Dentistry, Osaka, Japan
| | - Keun-Bae Song
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Youn-Hee Choi
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea; Institute for Translational Research in Dentistry, Kyungpook National University, Daegu, Korea.
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8
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Badewy R, Singh H, Quiñonez C, Singhal S. Impact of Poor Oral Health on Community-Dwelling Seniors: A Scoping Review. Health Serv Insights 2021; 14:1178632921989734. [PMID: 33597810 PMCID: PMC7841244 DOI: 10.1177/1178632921989734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 12/31/2020] [Indexed: 12/29/2022] Open
Abstract
The aim of this scoping review was to determine health-related impacts of poor oral health among community-dwelling seniors. Using MeSH terms and keywords such as elderly, general health, geriatrics, 3 electronic databases-Medline, CINAHL, and Age Line were searched. Title and abstracts were independently screened by 3 reviewers, followed by full-texts review. A total of 131 articles met our inclusion criteria, the majority of these studies were prospective cohort (77%, n = 103), and conducted in Japan (42 %, n = 55). These studies were categorized into 16 general health outcomes, with mortality (24%, n = 34), and mental health disorders (21%, n = 30) being the most common outcomes linked with poor oral health. 90% (n = 120) of the included studies reported that poor oral health in seniors can subsequently lead to a higher risk of poor general health outcomes among this population. Improving access to oral healthcare services for elderly can help not only reduce the burden of oral diseases in this population group but also address the morbidity and mortality associated with other general health diseases and conditions caused due to poor oral health. Findings from this study can help identify shortcomings in existing oral healthcare programs for elderly and develop future programs and services to improve access and utilization of oral care services by elderly.
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Affiliation(s)
- Rana Badewy
- Faculty of Dentistry, University of
Toronto, Toronto, ON, Canada
| | | | - Carlos Quiñonez
- Faculty of Dentistry, Director of
Graduate Program in Dental Public Health, University of Toronto, Toronto, ON,
Canada
| | - Sonica Singhal
- Faculty of Dentistry, University of
Toronto, Toronto, ON, Canada
- Public Health Ontario, Toronto, ON,
Canada
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9
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Lopez-Chaichio L, Padial-Molina M, O'Valle F, Gil-Montoya JA, Catena A, Galindo-Moreno P. Oral health and healthy chewing for healthy cognitive ageing: A comprehensive narrative review. Gerodontology 2020; 38:126-135. [PMID: 33179281 DOI: 10.1111/ger.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 09/11/2020] [Accepted: 10/24/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Ageing leads to physiological cognitive decline that it is worsened in people with neurodegenerative diseases such as Alzheimer's disease. Despite the ongoing search for a solution to this cognitive decline, no effective remedies have been established. It has been determined that modifiable external factors, such as oral health and occlusal function, prevent cognitive decline. OBJECTIVE To analyse the primary interactions between occlusal function and cognitive functions. MAIN FINDINGS Masticatory function is related to cognitive functions. In particular, current evidence, from both animal and human studies, suggests that the activation of masticatory muscles and proper mastication, with natural teeth or dental prosthesis, induces the release of several mediators and the activation of specific brain areas. Together, they result in higher neuronal activity, neurotrophic support, blood flow and the prevention of amyloid-beta plaque formation. Thus, all the components of the masticatory system must work together in order to preserve cognitive function. CONCLUSIONS Available evidence suggests that oral and cognitive health are more interconnected than previously thought. Therefore, maintenance and adequate restoration of the whole masticatory system are important for the prevention of cognitive decline. In summary, oral and chewing health lead to healthy cognitive ageing.
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Affiliation(s)
- Lucia Lopez-Chaichio
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Francisco O'Valle
- Department of Pathology and IBIMER, School of Medicine, University of Granada, Granada, Spain.,Biosanitary Institute of Granada (ibs.Granada), University of Granada, Granada, Spain
| | - Jose Antonio Gil-Montoya
- Biosanitary Institute of Granada (ibs.Granada), University of Granada, Granada, Spain.,Department of Gerodontology, School of Dentistry, University of Granada, Granada, Spain
| | - Andres Catena
- Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
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10
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Kuwajima Y, Nagai MS, Lee C, Galaburda AM, Kobayashi T, Nakasato A, Da Silva JD, Nagai SI, Nagai M. Trans-trigeminal transport of masseter-derived neprilysin to hippocampus. Arch Oral Biol 2020; 118:104861. [PMID: 32835988 DOI: 10.1016/j.archoralbio.2020.104861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/25/2020] [Accepted: 07/31/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To show the possible occurrence of exosomal transport of neprilysin from masseter muscle to hippocampus via trigeminal nerve in the living mouse. DESIGN Mouse C2C12 myotube-derived exosomes were labeled with near-infrared (NIR) dye and injected into the masseter muscle to track their fluorescence from masseter muscle to hippocampus via trigeminal nerve. A plasmid vector encoding green fluorescent protein (GFP)-tagged neprilysin (GFP-neprilysin) was transfected into masseter muscle of C57BL/6 J mice. Expression of mRNA and encoded protein of the transgene was identified in masseter muscle, trigeminal nerve and hippocampus by RT-PCR and Western blot, respectively. RESULTS Peak of exosomal NIR in masseter muscle at time 0 rapidly reduced at 3 h and 6 h along with the subsequent increases in trigeminal nerve and hippocampus. Expression of GFP-neprilysin mRNA was detected in masseter muscle, but not trigeminal nerve and hippocampus. On the other hand, the corresponding protein of GFP-neprilysin was identified in the three tissues on day 3 after transfection into masseter muscle as a single band on Western blots with anti-GFP and anti-neprilysin antibodies. CONCLUSION The appearance of GFP-neprilysin protein in trigeminal nerve and hippocampus without a corresponding mRNA expression indicated the protein's origin from the masseter muscle. Concomitant migration of NIR-exosomes from masseter muscle to hippocampus via trigeminal nerve suggested the possible occurrence of exosomal transport of neprilysin.
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Affiliation(s)
- Yukinori Kuwajima
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Manavi S Nagai
- School of Dental Medicine, Boston University, Boston, MA, USA
| | - Cliff Lee
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Albert M Galaburda
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Takuya Kobayashi
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Ayaka Nakasato
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - John D Da Silva
- Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, MA, USA
| | - Shigemi Ishikawa Nagai
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA
| | - Masazumi Nagai
- Oral Medicine Infection and Immunity, Harvard School of Dental Medicine, Boston, MA, USA.
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11
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Takehara S, Wright FAC, Waite LM, Naganathan V, Hirani V, Blyth FM, Le Couteur DG, Seibel MJ, Handelsman DJ, Cumming RG. Oral health and cognitive status in the Concord Health and Ageing in Men Project: A cross-sectional study in community-dwelling older Australian men. Gerodontology 2020; 37:353-360. [PMID: 32227607 DOI: 10.1111/ger.12469] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 02/10/2020] [Accepted: 03/06/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Several studies have examined the relationship between cognition and oral health in older populations. To further understand this relationship, we examined the associations between cognitive function, chewing capacity and the number of teeth present in community-dwelling older males in Australia. METHODS Data were obtained from cross-sectional analysis of fourth wave of the Concord Health and Ageing in Men Project (CHAMP). Participants were 369 community-dwelling males aged 78 years or over. Cognitive function was measured utilising the Mini-Mental State Examination (MMSE). Chewing capacity was determined on ability to chew food items of different textures, and oral health data were collected. Ordinal regression was used to analyse associations between MMSE (four categories) and chewing capacity and number of natural teeth present. RESULTS Overall, 67.5% of participants reported that they could chew all 11 listed food items. Participants with fewer than 20 teeth were statistically significantly more likely to have cognitive impairment (unadjusted odds ratio (OR) 1.87; 95% confidence interval (CI) 1.25-2.79, adjusted OR 1.62; 95% CI 1.07-2.43). Participants with limited chewing capacity were also more likely to have cognitive impairment (unadjusted OR 1.91; 95% CI 1.25-2.94, adjusted OR 1.61; 95% CI 1.03-2.49). CONCLUSIONS This study suggests either that older men with fewer than 20 natural teeth and those with limited chewing capacity are more likely to have an associated cognitive impairment or that those with cognitive impairment are more likely to have fewer teeth and limited chewing capacity. Further longitudinal studies should clarify these relationships.
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Affiliation(s)
- Sachiko Takehara
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan
| | - Fredrick A Clive Wright
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Louise M Waite
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Vasi Naganathan
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Vasant Hirani
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fiona M Blyth
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - David G Le Couteur
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia.,Department of Geriatric Medicine and Rehabilitation Medicine, Concord Repatriation General Hospital, Sydney Local Health District, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Markus J Seibel
- Concord Clinical School, Concord Repatriation General Hospital, The University of Sydney, Concord, NSW, Australia
| | - David J Handelsman
- ANZAC Research Institute, Concord Hospital, The University of Sydney, Sydney, NSW, Australia
| | - Robert G Cumming
- Centre for Education and Research on Ageing, Concord Clinical School, The University of Sydney, and the Ageing and Alzheimer's Institute, Concord Repatriation General Hospital, Sydney Local Health District, Concord, Concord, NSW, Australia.,School of Public Health, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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12
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Petrovsky DV, Wu B, Mao W, Dong X. Oral Health Symptoms and Cognitive Function Among US Community-Dwelling Chinese Older Adults. J Am Geriatr Soc 2019; 67:S532-S537. [PMID: 31403196 PMCID: PMC7201380 DOI: 10.1111/jgs.15748] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Limited research is available on the relationship between oral health symptoms and cognitive function among community-dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function. DESIGN Two-wave epidemiological study. SETTING Population Study of Chinese Elderly in Chicago (PINE). PARTICIPANTS US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women). MEASUREMENTS We selected self-reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure. RESULTS At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health-related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = -0.07; p = .003) and their episodic memory decrease by 0.07 units (estimate = -0.07; p = .026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p = .047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p = .069). We found no significant relationship between baseline gum symptoms and change of cognitive function. CONCLUSION Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high-risk fast-growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532-S537, 2019.
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Affiliation(s)
| | - Bei Wu
- New York University Rory Meyers College of Nursing
- New York University NYU Aging Incubator
| | - Weiyu Mao
- University of Nevada, Reno School of Social Work
| | - XinQi Dong
- Rutgers University Institute for Health, Health Care Policy and Aging Research
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13
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Gil Montoya JA, Barrios R, Sanchez‐Lara I, Ramos P, Carnero C, Fornieles F, Montes J, Santana S, Luna JDD, Gonzalez‐Moles MA. Systemic inflammatory impact of periodontitis on cognitive impairment. Gerodontology 2019; 37:11-18. [DOI: 10.1111/ger.12431] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 04/09/2019] [Accepted: 05/24/2019] [Indexed: 12/11/2022]
Affiliation(s)
| | - Rocío Barrios
- School of Dentistry Instituto de Investigación Biosanitaria de Granada Granada Spain
| | - Inés Sanchez‐Lara
- School of Dentistry Instituto de Investigación Biosanitaria de Granada Granada Spain
| | - Pablo Ramos
- School of Dentistry Instituto de Investigación Biosanitaria de Granada Granada Spain
| | - Cristobal Carnero
- Neurology Department Complejo Hospitalario Universitario de Granada Granada Spain
| | - Francisco Fornieles
- Unidad de Gestión Clínica Salud Bucodental Granada‐Metropolitano Granada Spain
| | - Juan Montes
- Neurology Department Complejo Hospitalario Universitario de Granada Granada Spain
| | - Soraya Santana
- NeuroBiolabs SL Parque Tecnológico de Ciencias de la Salud Granada Spain
| | - Juan de Dios Luna
- School of Dentistry Instituto de Investigación Biosanitaria de Granada Granada Spain
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14
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Yoo JJ, Yoon JH, Kang MJ, Kim M, Oh N. The effect of missing teeth on dementia in older people: a nationwide population-based cohort study in South Korea. BMC Oral Health 2019; 19:61. [PMID: 31023356 PMCID: PMC6485168 DOI: 10.1186/s12903-019-0750-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/31/2019] [Indexed: 01/25/2023] Open
Abstract
Background To determine the effect of missing teeth on the risk of dementia onset among individuals who received tooth extractions and those who did not, based on the number of missing teeth. Methods We selected individuals who had not been diagnosed or treated for dementia between 2002 to 2011 from the National Health Insurance Service-Elderly Cohort Database (NHIS-ECD). We divided participants into two cohorts, a tooth extraction and non-extraction cohort, based on tooth loss from 2002 to 2011. After propensity score matching, there were 104,903 individuals in each cohort, and we included a total of 209,806 individuals in this study. Each cohort was grouped by sex, age, residential area, health insurance eligibility, income level, history of dental caries, history of periodontal treatment, and number of extracted teeth. We analyzed the relationship between dementia onset and these variables using logistic regression analysis. Results Individuals with tooth loss had a higher risk for dementia than those without tooth loss (odds ratio [OR] = 1.18; 95% confidence interval [CI]: 1.146–1.215). Regarding the incidence of dementia, the OR increased as the number of missing teeth and age increased, and the OR was higher for women (OR = 1.33; 95% CI: 1.286–1.367) than for men, and this difference was statistically significant (P < 0.01). The incidence of dementia decreased with periodontal treatment (OR = 0.96; 95% CI: 0.932–0.992) and increased with dental caries (OR = 1.07; 95% CI: 1.035–1.101). Conclusions These results suggest that it is important to delay tooth loss and preserve the stable remaining teeth to help prevent dementia. Electronic supplementary material The online version of this article (10.1186/s12903-019-0750-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jin-Joo Yoo
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, Republic of Korea
| | - Joon-Ho Yoon
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, Republic of Korea
| | - Min-Jin Kang
- Department of Policy Research Affairs, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, Republic of Korea
| | - Manyong Kim
- Department of Prosthodontics, National Health Insurance Service Ilsan Hospital, 100 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, 10444, Republic of Korea
| | - Namsik Oh
- Department of Dentistry, College of Medicine, Inha University, 27, Inhang-ro, Jung-gu, Incheon, 22332, Republic of Korea.
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15
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Poor Oral Health and Its Neurological Consequences: Mechanisms of Porphyromonas gingivalis Involvement in Cognitive Dysfunction. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/s40496-019-0212-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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16
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Nangle M, Riches J, Grainger S, Manchery N, Sachdev P, Henry J. Oral Health and Cognitive Function in Older Adults: A Systematic Review. Gerontology 2019; 65:659-672. [DOI: 10.1159/000496730] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 01/09/2019] [Indexed: 11/19/2022] Open
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17
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Kobayashi T, Nagai M, Da Silva JD, Galaburda AM, Rosenberg SH, Hatakeyama W, Kuwajima Y, Kondo H, Ishikawa-Nagai S. Retrograde transport of masseter muscle-derived neprilysin to hippocampus. Neurosci Lett 2019; 698:180-185. [PMID: 30639512 DOI: 10.1016/j.neulet.2019.01.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/02/2018] [Accepted: 01/10/2019] [Indexed: 11/27/2022]
Abstract
Although the effects of neprilysin (NEP), also called CD10, on the clearance of Alzheimer's disease (AD)-associated amyloid-β (Aβ) have been reported, NEP is not made in the brain, and the mechanism for the transport of NEP to the brain has not been investigated. Our hypothesis is that muscle packages NEP in exosomes in response to a neuromuscular signal and sends it to the brain via retrograde axonal transport. The masseter muscle (MM) and the trigeminal nerve (TGN) are good candidates for this mechanism by virtue of their proximity to the brain. The aim of this study was to trace the NEP protein from the MM, through the TGN, and to the hippocampus (HPC) in muscle contraction models in vitro and in vivo. NEP expression in mouse tissue lysates was analyzed by RT-PCR and Western blot. Four-week-old mice were perfused to remove blood NEP contamination. The MM expressed substantial levels of NEP protein and mRNA. On the other hand, a remarkably high level of NEP protein was measured in the TGN in the absence of mRNA. NEP protein, without the corresponding mRNA, was also detected in the HPC. These results suggested that the MM derived NEP was taken up by the TGN, which in turn permitted NEP access to the central nervous system and within it the HPC. When the MM was induced to contract by electric stimulation in freshly euthanized mice, NEP protein decreased in the MM in a stimulus time-dependent manner, while that in the TGN and the HPC increased sequentially. Furthermore, NIR-labeled exosomes tracked along the same route. Finally, carbachol induced secretion of exosomal NEP in C2C12-derived myotube cells. These results support our hypothesis that MM-derived NEP is transported along the TGN to reach the HPC following electrical or cholinergic stimulation.
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Affiliation(s)
- Takuya Kobayashi
- Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States
| | - Masazumi Nagai
- Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States.
| | - John D Da Silva
- Department of Restorative Dentistry and Biomaterials Sciences Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States
| | - Albert M Galaburda
- Department of Neurology Harvard Medical School and Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, United States
| | - Sara H Rosenberg
- Department of Restorative Dentistry University of Illinois at Chicago, Chicago, IL, United States
| | - Wataru Hatakeyama
- Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States
| | - Yukinori Kuwajima
- Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology School of Dentistry Iwate Medical University, 1-17 Uchimal, Morioka, Iwate, Japan
| | - Shigemi Ishikawa-Nagai
- Department of Oral Medicine, Infection, and Immunity Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA, United States
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18
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Pereira LC, Nascimento JCR, Rêgo JMC, Canuto KM, Crespo-Lopez ME, Alvarez-Leite JI, Baysan A, Oriá RB. Apolipoprotein E, periodontal disease and the risk for atherosclerosis: a review. Arch Oral Biol 2018; 98:204-212. [PMID: 30503976 DOI: 10.1016/j.archoralbio.2018.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/25/2018] [Accepted: 11/10/2018] [Indexed: 12/26/2022]
Abstract
The association between cardiovascular and periodontal diseases is characterized by chronic inflammatory processes, with a high prevalence worldwide and complex genetic-environment interactions. Although apolipoprotein E4 (ApoE4), one of the isoforms coded by a polymorphic APOE gene, has been widely recognized as a risk factor for cardiovascular diseases and as an immunoinflammatory factor, less is known regarding how ApoE4 affects atherosclerosis in periodontitis patients. The aim of this review was to investigate the potential underlying mechanisms related to APOE4 that could increase the risk of periodontal disease and, ultimately, of atherosclerosis. There have only been a few studies addressing apoE polymorphisms in patients with chronic periodontitis. To date, no studies have been performed that have assessed how ApoE4 affects atherosclerotic disease in chronic periodontitis patients. Although clinical studies are warranted, experimental studies have consistently documented the presence of periodontal pathogens, which are usually found in the oral cavity and saliva, in the atherosclerotic plaques of ApoE-deficient mice. In addition, in this review, the potential role of the APOE4 allele as an example of antagonistic pleiotropy during human evolution and its relation to oral health is discussed.
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Affiliation(s)
- L C Pereira
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - J C R Nascimento
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - J M C Rêgo
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - K M Canuto
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil
| | - M E Crespo-Lopez
- Laboratory of Molecular Pharmacology, Institute of Biological Sciences, Federal University of Para, Belém, PA, Brazil
| | - J I Alvarez-Leite
- Institute of Biological Sciences, Department of Biochemistry and Immunology, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil
| | - A Baysan
- Institute of Dentistry, Barts and the London, School of Medicine and Dentistry, Queen Mary University, London, UK
| | - R B Oriá
- Laboratory of the Biology of Tissue Healing, Ontogeny and Nutrition, Department of Morphology and Institute of Biomedicine, School of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
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19
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Shin MS, Shin YJ, Karna S, Kim HD. Rehabilitation of lost teeth related to maintenance of cognitive function. Oral Dis 2018; 25:290-299. [PMID: 30129990 DOI: 10.1111/odi.12960] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/05/2018] [Accepted: 07/30/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE As the era of aging comes, cognitive impairment (CI) is increasing. The impact of rehabilitation of lost tooth on CI remains unclear. This study aimed to investigate whether non-rehabilitated lost teeth (NRLT) is associated with CI among Korean elders. METHODS A total of 280 elders comprising of 140 cases and 140 age-sex-matched controls were included in this cross-sectional study. CI was assessed using the Mini-Mental Status Examination (MMSE). NRLT was evaluated using panoramic radiograph and oral examination. NRLT was categorized into low (≤4) and high (≥5). Age, sex, education, drinking, smoking, exercise, obesity, hypertension, subclinical atherosclerosis, glucose, cholesterol, depression, and denture-wearing were considered as confounders. Conditional multivariate logistic regression analysis was applied to assess the adjusted association. RESULTS NRLT was associated with increased CI after controlling for confounders (odds ratio [OR] = 1.06, 95% confidence interval [95% CFI]: 1.00-1.13). However, lost teeth were not associated with CI. Those with high NRLT (≥5) compared to those with low NRLT (≤4) was more likely to have CI by 2.7 times (OR = 2.74, 95% CFI = 1.28-5.86). CONCLUSION Our data showed that NRLT was independently associated with CI. Hence, rehabilitation of the lost teeth could be important for the maintenance of cognitive function.
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Affiliation(s)
- Myung-Seop Shin
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea
| | - Yoo Jin Shin
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,BK21 PLUS Life Science, School of Dentistry, Seoul National University, Seoul, Korea
| | - Sandeep Karna
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,BK21 PLUS Life Science, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hyun-Duck Kim
- Department of Preventive and Social Dentistry, School of Dentistry, Seoul National University, Seoul, Korea.,Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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20
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Nilsson H, Sanmartin Berglund J, Renvert S. Longitudinal evaluation of periodontitis and development of cognitive decline among older adults. J Clin Periodontol 2018; 45:1142-1149. [PMID: 30076762 DOI: 10.1111/jcpe.12992] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/19/2018] [Accepted: 08/01/2018] [Indexed: 12/28/2022]
Abstract
AIM To determine whether having periodontitis is associated with cognitive decline among older adults. MATERIAL AND METHODS A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥4 mm bone loss at ≥30% of tooth sites. Social variables were captured from questionnaires. RESULTS The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance. CONCLUSIONS A history of periodontitis may be of importance for cognitive functions among older adults.
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Affiliation(s)
| | - Johan Sanmartin Berglund
- Blekinge Institute of Technology, Karlskrona, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Stefan Renvert
- Blekinge Institute of Technology, Karlskrona, Sweden.,School of Health and Society, Kristianstad University, Kristianstad, Sweden.,School of Dental Science, Trinity College, Dublin, Ireland
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21
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Saito S, Ohi T, Murakami T, Komiyama T, Miyoshi Y, Endo K, Satoh M, Asayama K, Inoue R, Kikuya M, Metoki H, Imai Y, Ohkubo T, Hattori Y. Association between tooth loss and cognitive impairment in community-dwelling older Japanese adults: a 4-year prospective cohort study from the Ohasama study. BMC Oral Health 2018; 18:142. [PMID: 30126407 PMCID: PMC6102919 DOI: 10.1186/s12903-018-0602-7] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 08/03/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Numerous prospective studies have investigated the association between the number of remaining teeth and dementia or cognitive decline. However, no agreement has emerged on the association between tooth loss and cognitive impairment, possibly due to past studies differing in target groups and methodologies. We aimed to investigate the association between tooth loss, as evaluated through clinical oral examinations, and the development of cognitive impairment in community-dwelling older adults while considering baseline cognitive function. METHODS This 4-year prospective cohort study followed 140 older adults (69.3% female) without cognitive impairment aged ≥65 years (mean age: 70.9 ± 4.3 years) living in the town of Ohasama, Iwate Prefecture, Japan. Cognitive function was evaluated with the Mini-Mental State Examination (MMSE) in baseline and follow-up surveys. Based on a baseline oral examination, the participants were divided into those with 0-9 teeth and those with ≥10 teeth. To investigate the association between tooth loss and cognitive impairment, we applied a multiple logistic regression analysis adjusted for age, sex, hypertension, diabetes, cerebrovascular/cardiovascular disease, hypercholesterolemia, depressive symptoms, body mass index, smoking status, drinking status, duration of education, and baseline MMSE score. RESULTS In the 4 years after the baseline survey, 27 participants (19.3%) developed cognitive impairment (i.e., MMSE scores of ≤24). Multiple logistic regression analysis indicated that participants with 0-9 teeth were more likely to develop cognitive impairment than those with ≥10 teeth were (odds ratio: 3.31; 95% confidence interval: 1.07-10.2). Age, male gender, and baseline MMSE scores were also significantly associated with cognitive impairment. CONCLUSIONS Tooth loss was independently associated with the development of cognitive impairment within 4 years among community-dwelling older adults. This finding corroborates the hypothesis that tooth loss may be a predictor or risk factor for cognitive decline.
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Affiliation(s)
- Sho Saito
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Takashi Ohi
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
- Japanese Red Cross Ishinomaki Hospital, Ishinomaki, Japan
| | - Takahisa Murakami
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Takamasa Komiyama
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Yoshitada Miyoshi
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Kosei Endo
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
| | - Michihiro Satoh
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Kei Asayama
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Ryusuke Inoue
- Department of Medical Informatics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Kikuya
- Department of Preventive Medicine and Epidemiology, Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Hirohito Metoki
- Division of Public Health, Hygiene and Epidemiology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yutaka Imai
- Department of Planning for Drug Development and Clinical Evaluation, Tohoku University Graduate School of Pharmaceutical Sciences, Sendai, Japan
| | - Takayoshi Ohkubo
- Department of Hygiene and Public Health, Teikyo University School of Medicine, Tokyo, Japan
| | - Yoshinori Hattori
- Division of Aging and Geriatric Dentistry, Department of Oral Function and Morphology, Tohoku University Graduate School of Dentistry, 4-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575 Japan
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22
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Zhang W, Yan Wu Y, Wu B. Does Oral Health Predict Functional Status in Late Life? Findings From a National Sample. J Aging Health 2018; 30:924-944. [PMID: 28553812 PMCID: PMC6457448 DOI: 10.1177/0898264317698552] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE This study aims to examine the association between oral health and the decline in functional status among middle-aged and older adults in the United States. METHOD Generalized estimation equation (GEE) Poisson regression models with robust standard errors were used to analyze the longitudinal panel data (2008-2014) from the Health and Retirement Study ( N = 1,243). Oral health was evaluated using self-rated oral health, poor mouth condition, and tooth loss. Decline in functional status was assessed by disabilities in activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS Respondents with poor oral health were more likely to experience decline in ADLs/IADLs. Adjusting for sociodemographics and comorbidities attenuated the effects of oral health. DISCUSSION Findings suggest that oral health might be one of the important predictors of functioning decline in late life, after adjusting sociodemographics and comorbidities.
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Affiliation(s)
- Wei Zhang
- University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Yan Yan Wu
- University of Hawaii at Mānoa, Honolulu, HI, USA
| | - Bei Wu
- New York University, New York, NY, USA
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23
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Jou YT. Dental deafferentation and brain damage: A review and a hypothesis. Kaohsiung J Med Sci 2018; 34:231-237. [PMID: 29655412 DOI: 10.1016/j.kjms.2018.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/07/2017] [Accepted: 01/12/2018] [Indexed: 01/04/2023] Open
Abstract
In the last few decades, neurobiological and human brain imaging research have greatly advanced our understanding of brain mechanisms that support perception and memory, as well as their function in daily activities. Knowledge of the neurobiological mechanisms behind the deafferentation of stomatognathic systems has also expanded greatly in recent decades. In particular, current studies reveal that the peripheral deafferentations of stomatognathic systems may be projected globally into the central nervous system (CNS) and become an associated critical factor in triggering and aggravating neurodegenerative diseases. This review explores basic neurobiological mechanisms associated with the deafferentation of stomatognathic systems. Further included is a discussion on tooth loss and other dental deafferentation (DD) mechanisms, with a focus on dental and masticatory apparatuses associated with brain functions and which may underlie the changes observed in the aging brain. A new hypothesis is presented where DD and changes in the functionality of teeth and the masticatory apparatus may cause brain damage as a result of altered cerebral circulation and dysfunctional homeostasis. Furthermore, multiple recurrent reorganizations of the brain may be a triggering or contributing risk factor in the onset and progression of neurodegenerative conditions such as Alzheimer's disease (AD). A growing understanding of the association between DD and brain aging may lead to solutions in treating and preventing cognitive decline and neurodegenerative diseases.
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Affiliation(s)
- Yi-Tai Jou
- Department of Endodontics School of Dental Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA.
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Harding A, Robinson S, Crean S, Singhrao SK. Can Better Management of Periodontal Disease Delay the Onset and Progression of Alzheimer's Disease? J Alzheimers Dis 2018; 58:337-348. [PMID: 28453484 DOI: 10.3233/jad-170046] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A risk factor relationship exists between periodontal disease and Alzheimer's disease (AD) via tooth loss, and improved memory following dental intervention. This links the microbial contribution from indigenous oral periodontal pathogens to the manifestation of chronic conditions, such as AD. Here, we use Porphyromonas gingivalis infection to illustrate its effect on mental health. P. gingivalis infection, in its primary sub-gingival niche, can cause polymicrobial synergy and dysbiosis. Dysbiosis describes the residency of select commensals from the oral cavity following co-aggregation around the dominant keystone pathogen, such as P. gingivalis, to gain greater virulence. The initial process involves P. gingivalis disturbing neutrophil mediated innate immune responses in the healthy gingivae and then downregulating adaptive immune cell differentiation and development to invade, and subsequently, establish new dysbiotic bacterial communities. Immune responses affect the host in general and functionally via dietary adjustments caused by tooth loss. Studies from animals orally infected with P. gingivalis confirm this bacterium can transmigrate to distant organ sites (the brain) and contribute toward peripheral and intracerebral inflammation, and compromise vascular and microvascular integrity. In another study, P. gingivalis infection caused sleep pattern disturbances by altering glial cell light/dark molecular clock activity, and this, in turn, can affect the clearance of danger associated molecular patterns, such as amyloid-β, via the glymphatic system. Since P. gingivalis can transmigrate to the brain and modulate organ-specific inflammatory innate and adaptive immune responses, this paper explores whether better management of indigenous periodontal bacteria could delay/prevent the onset and/or progression of dementia.
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25
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Okamoto N, Morikawa M, Amano N, Yanagi M, Takasawa S, Kurumatani N. Effects of Tooth Loss and the Apolipoprotein E ɛ4 Allele on Mild Memory Impairment in the Fujiwara-kyo Study of Japan: A Nested Case-Control Study. J Alzheimers Dis 2018; 55:575-583. [PMID: 27716671 PMCID: PMC5147497 DOI: 10.3233/jad-160638] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background: Several studies have suggested that periodontal disease can exacerbate the pro-inflammatory status of the brain. Tooth loss is one of the alternative evaluation indices of periodontal disease. There are few data on the relationship between tooth loss and memory impairment, depending on the apolipoprotein E (APOE) ɛ4 genotype. Objective: To determine if tooth loss is associated with mild memory impairment (MMI) and if this association is modified by the presence of the APOEɛ4 allele. Methods: A nested case-control study was conducted from 2007 to 2012 in Japan. Five hundred and thirty-seven Japanese subjects aged 65 years and over who were cognitively intact at baseline were analyzed. MMI at follow-up was evaluated. Results: The median number of teeth at baseline was significantly lower in MMI participants (n = 179) than in controls (n = 358) (MMI: median 21.0, interquartile range 10.0–25.0 versus controls: 24.0, 14.0–27.0). After adjustment for demographics, vascular risk factors, and APOEɛ4 allele, the multivariate adjusted odds ratio (OR) of ≤8 teeth was 1.97 (95% confidence interval [CI], 1.13–3.44) compared to 25–32 teeth. Participants with both the presence of at least 1 APOEɛ4 allele and ≤8 teeth had a higher risk of MMI compared with those with neither (OR, 2.82; 95% CI, 1.15–6.91). Those with either risk factor alone did not have a higher risk of MMI. Conclusions: A lower number of teeth is related to risk of MMI. This may be primarily true for those individuals with an APOEɛ4 allele.
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Affiliation(s)
- Nozomi Okamoto
- Department of Community Health and Epidemiology, Nara Medical University, Nara, Japan
| | - Masayuki Morikawa
- Mie Prefectural Mental Medical Center, Mie, Japan.,Department of Psychiatry, Nara Medical University, Nara, Japan
| | | | - Motokazu Yanagi
- Department of Food and Nutrition, Tezukayama University, Nara, Japan
| | - Shin Takasawa
- Department of Biochemistry, Nara Medical University, Nara, Japan
| | - Norio Kurumatani
- Department of Community Health and Epidemiology, Nara Medical University, Nara, Japan
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26
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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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27
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Holmstrup P, Damgaard C, Olsen I, Klinge B, Flyvbjerg A, Nielsen CH, Hansen PR. Comorbidity of periodontal disease: two sides of the same coin? An introduction for the clinician. J Oral Microbiol 2017; 9:1332710. [PMID: 28748036 PMCID: PMC5508374 DOI: 10.1080/20002297.2017.1332710] [Citation(s) in RCA: 113] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 01/07/2017] [Indexed: 12/14/2022] Open
Abstract
Increasing evidence has suggested an independent association between periodontitis and a range of comorbidities, for example cardiovascular disease, type 2 diabetes, rheumatoid arthritis, osteoporosis, Parkinson’s disease, Alzheimer’s disease, psoriasis, and respiratory infections. Shared inflammatory pathways are likely to contribute to this association, but distinct causal mechanisms remain to be defined. Some of these comorbid conditions may improve by periodontal treatment, and a bidirectional relationship may exist, where, for example, treatment of diabetes can improve periodontal status. The present article presents an overview of the evidence linking periodontitis with selected systemic diseases and calls for increased cooperation between dentists and medical doctors to provide optimal screening, treatment, and prevention of both periodontitis and its comorbidities.
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Affiliation(s)
- Palle Holmstrup
- Section for Periodontology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Damgaard
- Section for Periodontology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | - Björn Klinge
- Department of Periodontology, Faculty of Odontology, Malmö University, Malmö, Sweden.,Division of Periodontology, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Claus Henrik Nielsen
- Section for Periodontology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Institute for Inflammation Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Riis Hansen
- Section for Periodontology, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Cardiology Department, Herlev and Gentofte Hospital, Hellerup, Denmark
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28
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Tonsekar PP, Jiang SS, Yue G. Periodontal disease, tooth loss and dementia: Is there a link? A systematic review. Gerodontology 2017; 34:151-163. [DOI: 10.1111/ger.12261] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Pallavi P. Tonsekar
- Department of Periodontics; Rutgers School of Dental Medicine; Newark NJ USA
| | - Shuying S. Jiang
- Institutional Assessment and Quality Improvement; Rutgers School of Dental Medicine; Newark NJ USA
| | - Gang Yue
- Department of Periodontics; Rutgers School of Dental Medicine; Newark NJ USA
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29
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Li J, Xu H, Pan W, Wu B. Association between tooth loss and cognitive decline: A 13-year longitudinal study of Chinese older adults. PLoS One 2017; 12:e0171404. [PMID: 28158261 PMCID: PMC5291434 DOI: 10.1371/journal.pone.0171404] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 01/18/2017] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To examine the association between the number of teeth remaining and cognitive decline among Chinese older adults over a 13-year period. DESIGN A large national longitudinal survey of Chinese older adults. SETTING The Chinese Longitudinal Healthy Longevity Survey (CLHLS) (1998-2011). PARTICIPANTS A total of 8,153 eligible participants aged 60+ interviewed in up to six waves. MEASUREMENTS Cognitive function and teeth number were measured at each interview. Cognitive function was measured by the Mini-Mental Status Examination (MMSE). Number of natural teeth was self-reported. Individuals with severe cognitive impairment were excluded. Covariates included demographic characteristics, adult socioeconomic status characteristics, childhood socioeconomic status, health conditions, and health behaviors. Linear mixed models were applied in the analysis. RESULTS The mean teeth number at baseline was 17.5(SD = 0.1), and the mean of baseline cognitive function was 27.3(SD = 0.0). Cognitive function declined over time (β = -0.19, P < .001) after controlling covariates. But, regardless of time, more teeth were associated with better cognitive function (β = 0.01, P < .001). The interaction of teeth number and time was significant (β = 0.01, P < .001), suggesting that the participants who had more teeth showed a slower pace of cognitive decline over time than those with fewer teeth after controlling for other covariates. CONCLUSION This study showed that tooth loss was associated with cognitive decline among Chinese older adults. Further studies are needed to examine the linkages between cognitive decline and oral health status using clinical examination data.
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Affiliation(s)
- Juan Li
- Nursing School of Second Military Medical University, Shanghai, China
- Duke University School of Nursing, Durham, United States of America
| | - Hanzhang Xu
- Duke University School of Nursing, Durham, United States of America
- Duke Global Health Institute, Durham, United States of America
| | - Wei Pan
- Duke University School of Nursing, Durham, United States of America
| | - Bei Wu
- New York University Rory Meyers College of Nursing, New York, United States of America
- * E-mail:
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30
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Shin HE, Cho MJ, Choi YH, Song KB. Evaluation of relationship between cognitive function and occlusal status in elderly individuals using the T-scan III® system. ACTA ACUST UNITED AC 2017. [DOI: 10.11149/jkaoh.2017.41.2.96] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Hae-Eun Shin
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Min-Jeong Cho
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Youn-Hee Choi
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
| | - Keun-Bae Song
- Department of Preventive Dentistry, School of Dentistry, Kyungpook National University, Daegu, Korea
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31
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Tada A, Miura H. Association between mastication and cognitive status: A systematic review. Arch Gerontol Geriatr 2016; 70:44-53. [PMID: 28042986 DOI: 10.1016/j.archger.2016.12.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 12/07/2016] [Accepted: 12/12/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE A substantial number of elderly people suffer from cognitive impairment and dementia, which are considered to have various risk factors, including masticatory dysfunction; however, the association between mastication and cognition is inconclusive. The objectives of this systematic review were to provide an overview of the literature on (1) the association between mastication and cognitive function and (2) the association between mastication and dementia incidence, in elderly people. MATERIALS AND METHODS Searches were conducted on five electronic databases (PubMed, EMBASE, CINHL, Cochrane Library, and Pro Quest) and publications were selected that met the following criteria: published between 2005 and 2015, written in English, and assessed associations between mastication and cognitive function, cognitive decline and dementia among population over 40 years old. The included publications were analyzed for study design, main conclusions, and strength of evidence by two reviewers who screened all abstracts and full-text articles, abstracted data and performed quality assessments by using a critical appraisal tool. RESULTS A total of 33 articles (22 cross-sectional, and 11 prospective cohort studies) were evaluated. Poorer mastication was associated with lower cognitive function in 15 of the 17 cross-sectional studies and steeper decline in 5 of the 6 prospective studies. Poorer mastication was one of significant risk factors for having dementia or mild memory impairment (MMI) in 4 of 5 cross-sectional studies and for the incidence of dementia or MMI in 4 of 5 prospective studies. CONCLUSIONS Most studies point to a positive association between mastication and cognitive function, including dementia among elderly people.
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Affiliation(s)
- Akio Tada
- Department of Health Science, Hyogo University, 2301 Shinzaike Hiraoka-cho, Kakogawa, Hyogo 675-0195, Japan.
| | - Hiroko Miura
- Department of International Health and Collaboration, National Institute of Public Health, 2-3-6, Minami, Wako, Saitama 351-0197, Japan
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32
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Takeda Y, Oue H, Okada S, Kawano A, Koretake K, Michikawa M, Akagawa Y, Tsuga K. Molar loss and powder diet leads to memory deficit and modifies the mRNA expression of brain-derived neurotrophic factor in the hippocampus of adult mice. BMC Neurosci 2016; 17:81. [PMID: 27919226 PMCID: PMC5137215 DOI: 10.1186/s12868-016-0319-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 11/30/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND It is known that tooth loss is known to be a risk factor for Alzheimer's disease and soft diet feeding induces memory impairment. Recent studies have shown that brain-derived neurotrophic factor (BDNF) is associated with tooth loss or soft diet in young animal model, and that BDNF expression is decreased in patients with Alzheimer's disease. However, single or combined effect of tooth loss and/or soft diet on brain function has not fully understood. Here we examined the effect of molar loss and powder diet on memory ability and the expression of BDNF mRNA in the hippocampus of adult C57BL/6J mice. Twenty eight-weeks-old C57BL/6J mice were divided into intact molar group and extracted molar group. They were randomly divided into the I/S group (Intact upper molar teeth/Solid diet feeding), the E/S group (Extracted upper molar teeth/Solid diet feeding), the I/P group (Intact upper molar teeth/Powder diet feeding), and the E/P group (Extracted upper molar teeth/Powder diet feeding). The observation periods were 4 and 16-week. To analyze the memory ability, the step-through passive avoidance test was conducted. BDNF-related mRNA in the hippocampus was analyzed by real-time polymerase chain reaction (RT-PCR). RESULTS At 4 weeks later, we performed memory test and isolated brains to analyze. There were no differences in memory function and BDNF mRNA level between these four groups. However, at 16 weeks later, E/S and E/P group showed memory impairment, and decreased level of BDNF mRNA. Whereas, the powder diet had no effect on memory function and BDNF mRNA level even at 16 weeks later. CONCLUSIONS These results suggest that the effect of molar loss and powder diet on memory function and BDNF mRNA levels were different, molar loss may have a greater long-term effect on memory ability than powder diet does.
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Affiliation(s)
- Yosuke Takeda
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroshi Oue
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Shinsuke Okada
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akira Kawano
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Katsunori Koretake
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Makoto Michikawa
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasumasa Akagawa
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kazuhiro Tsuga
- Department of Advanced Prosthodontics, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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Cerajewska TL, Davies M, West NX. Periodontitis: a potential risk factor for Alzheimer's disease. Br Dent J 2016; 218:29-34. [PMID: 25571822 DOI: 10.1038/sj.bdj.2014.1137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2014] [Indexed: 01/12/2023]
Abstract
The role of periodontitis as a risk factor for multiple systemic diseases is widely accepted and there is growing evidence of an association between periodontitis and sporadic late onset Alzheimer's disease (SLOAD). Recent epidemiologic, microbiologic and inflammatory findings strengthen this association, indicating that periodontal pathogens are possible contributors to neural inflammation and SLOAD. The aim of this article is to present contemporary evidence of this association.
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Affiliation(s)
- T L Cerajewska
- Clinical Trials Group, School of Oral and Dental Science, Lower Maudlin Street, University of Bristol, Bristol, BS1 2LY
| | - M Davies
- Clinical Trials Group, School of Oral and Dental Science, Lower Maudlin Street, University of Bristol, Bristol, BS1 2LY
| | - N X West
- Clinical Trials Group, School of Oral and Dental Science, Lower Maudlin Street, University of Bristol, Bristol, BS1 2LY
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34
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Campos CH, Ribeiro GR, Costa JLR, Rodrigues Garcia RCM. Correlation of cognitive and masticatory function in Alzheimer’s disease. Clin Oral Investig 2016; 21:573-578. [DOI: 10.1007/s00784-016-1923-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 07/21/2016] [Indexed: 12/26/2022]
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35
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Gao W, Wang X, Wang X, Cai Y, Luan Q. Association of cognitive function with tooth loss and mitochondrial variation in adult subjects: a community-based study in Beijing, China. Oral Dis 2016; 22:697-702. [PMID: 27353124 DOI: 10.1111/odi.12529] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Revised: 06/12/2016] [Accepted: 06/21/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cognitive impairment is a common neurological problem in elderly people. In this study, we investigated whether tooth loss, periodontal parameters, and gene variations in the mitochondrial DNA displacement loop region are potential influencing factors on cognitive function. DESIGN We employed a linear regression model to estimate cross-sectional association between number of teeth lost, periodontal parameters and Mini-mental State Examination score, adjusting for demographic factors, socioeconomic factors, general health status, smoking, drinking, and life habits. PARTICIPANTS A total of 905 Han Chinese people, ≥50 years of age, with complete data, were enrolled. Blood samples of 567 of the subjects were analyzed for correlation between mitochondrial DNA variants and Mini-mental State Examination score. RESULTS The number of teeth lost (β = -0.042, 95% CI: -0.061, -0.024, P < 0.001), two single nucleotide polymorphism (SNP) points: A189G (β = -1.540, 95% CI: -2.818, -0.263, P = 0.018) and A16164G (β = -1.053, 95% CI: -2.054, -0.052, P = 0.039) in the mitochondrial DNA displacement loop region, and haplogroup Y (β = -2.152, 95% CI: -4.062, -0.242, P = 0.027) were found to be negatively associated with Mini-mental State Examination scores in the fully adjusted model. No correlation was found between periodontal parameters and Mini-mental State Examination scores. CONCLUSION Number of teeth lost, mitochondrial SNPs, and haplogroup Y were correlated with cognitive function in this study population.
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Affiliation(s)
- W Gao
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Wang
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - X Wang
- Department of Genetics, Beijing Hypertension League Institute, Beijing, China
| | - Y Cai
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China
| | - Q Luan
- Department of Periodontology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Peking University School and Hospital of Stomatology, Beijing, China.
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36
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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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Peres MA, Bastos JL, Watt RG, Xavier AJ, Barbato PR, D'Orsi E. Tooth loss is associated with severe cognitive impairment among older people: findings from a population-based study in Brazil. Aging Ment Health 2015; 19:876-84. [PMID: 25407512 DOI: 10.1080/13607863.2014.977770] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A consistent and low-to-moderate association between markers of oral infection and loss of cognitive function has been demonstrated in the literature. However, such evidence comes from population studies carried out mainly in the USA. OBJECTIVES To assess the association between tooth loss and loss of cognitive function in older people from Southern Brazil, with particular interest on how age may modify such association. In addition, we also test the association between loss of cognition (exposure) and tooth loss (outcome). METHODS Data from a baseline population-based cohort study were cross-sectionally analyzed, including tooth loss, cognitive impairment, sex, income, educational attainment, color/race, smoking status and a range of self-reported chronic diseases. Participants (n = 1705) were 60 years of age and over, from a midsized Southern Brazilian city. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable logistic and partial ordinal logistic analyses. RESULTS Edentate status was associated (OR 3.3; 95%CI 1.2-9.3) with severe cognitive impairment in the fully adjusted model. Moreover, there was an interaction between number of teeth and age on severe cognitive impairment. A weak association between severe cognitive impairment (exposure) and tooth loss (outcome) was identified after the adjustment for potential covariates. CONCLUSIONS This study lends support to hypothesized association between tooth loss and severe cognitive impairment. Older adults seem to be particularly vulnerable to such effects. However, the bidirectional association between tooth loss and severe cognitive impairment cannot be ruled out.
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Affiliation(s)
- Marco A Peres
- a Australian Research Centre for Population Oral Health, School of Dentistry , The University of Adelaide , Adelaide , Australia
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Olsen I, Singhrao SK. Can oral infection be a risk factor for Alzheimer's disease? J Oral Microbiol 2015; 7:29143. [PMID: 26385886 PMCID: PMC4575419 DOI: 10.3402/jom.v7.29143] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 07/21/2015] [Accepted: 08/21/2015] [Indexed: 12/19/2022] Open
Abstract
Alzheimer's disease (AD) is a scourge of longevity that will drain enormous resources from public health budgets in the future. Currently, there is no diagnostic biomarker and/or treatment for this most common form of dementia in humans. AD can be of early familial-onset or sporadic with a late-onset. Apart from the two main hallmarks, amyloid-beta and neurofibrillary tangles, inflammation is a characteristic feature of AD neuropathology. Inflammation may be caused by a local central nervous system insult and/or by peripheral infections. Numerous microorganisms are suspected in AD brains ranging from bacteria (mainly oral and non-oral Treponema species), viruses (herpes simplex type I), and yeasts (Candida species). A causal relationship between periodontal pathogens and non-oral Treponema species of bacteria has been proposed via the amyloid-beta and inflammatory links. Periodontitis constitutes a peripheral oral infection that can provide the brain with intact bacteria and virulence factors and inflammatory mediators due to daily, transient bacteremias. If and when genetic risk factors meet environmental risk factors in the brain, disease is expressed, in which neurocognition may be impacted, leading to the development of dementia. To achieve the goal of finding a diagnostic biomarker and possible prophylactic treatment for AD, there is an initial need to solve the etiological puzzle contributing to its pathogenesis. This review therefore addresses oral infection as the plausible etiology of late-onset AD (LOAD).
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Affiliation(s)
- Ingar Olsen
- Department of Oral Biology, Faculty of Dentistry, University of Oslo, Oslo, Norway;
| | - Sim K Singhrao
- Oral & Dental Sciences Research Group, College of Clinical and Biomedical Sciences, University of Central Lancashire, Preston, UK
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Cross-sectional associations of oral health measures with cognitive function in late middle-aged adults: a community-based study. J Am Dent Assoc 2015; 144:1362-71. [PMID: 24282266 DOI: 10.14219/jada.archive.2013.0072] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND It has not been established to what extent oral health is associated with cognitive function in late middle-aged adults. In this study, which is part of the national Atherosclerosis Risk in Communities (ARIC) study, the authors investigated whether tooth loss and periodontitis are associated with lower cognitive function. METHODS The authors analyzed ARIC data measuring cognitive function in 11,097 participants from 1996 through 1998 according to tests of delayed word recall, digit-symbol substitution (DSS) and word fluency; 9,874 participants answered dental screening questions. Of the 8,554 dentate participants, 5,942 received oral examinations. The authors used measures of dental status, number of teeth and periodontitis (classified according to the Biofilm-Gingival Interface Index) in multiple linear regression models to estimate these factors' cross-sectional association with cognitive scores, adjusting for sociodemographic factors, cigarette smoking, alcohol use and diabetes. RESULTS Approximately 13 percent of participants were edentulous. Of the dentate participants, 27.3 percent had fewer than 20 teeth and 12.4 percent had pocket depth of 4 millimeters or more with severe bleeding. Compared with dentate participants, edentulous participants had lower scores for all cognitive tests. Among the dentate participants, having fewer teeth and gingival bleeding were associated with lower DSS and word fluency test scores, although periodontal pocket depth was not. CONCLUSIONS In this cohort, edentulism was correlated with lower cognitive status. Tooth loss and gingival bleeding were markers of poorer executive function among dentate people. Practical Implications. The association of lower cognitive scores with edentulism suggests that past oral diseases may be a risk indicator for cognitive decline, whereas the association with gingival inflammation indicates a possible effect of cognitive decline on oral health. Practitioners should be aware that both current and historical markers of oral disease might be associated with decline in cognitive function, even in adults of late middle age.
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Naorungroj S, Schoenbach VJ, Wruck L, Mosley TH, Gottesman RF, Alonso A, Heiss G, Beck J, Slade GD. Tooth loss, periodontal disease, and cognitive decline in the Atherosclerosis Risk in Communities (ARIC) study. Community Dent Oral Epidemiol 2014; 43:47-57. [PMID: 25363061 DOI: 10.1111/cdoe.12128] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Accepted: 08/22/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The purpose of this prospective study was to investigate whether poor oral health predicted 8-year cognitive function change in predominantly late middle adults in the Atherosclerosis Risk in Communities (ARIC) study. METHODS Participants included a subset of ARIC participants aged 52-75 years at 1996-1998 from two study sites: Forsyth County NC and Jackson MS. All subjects completed cognitive function assessments both in 1996-1998 and 2004-2006, and the same subjects received a dental examination at the initial visit. Cognitive assessment consisted of delayed word recall (DWR), digit symbol substitution (DSS), and word fluency (WF) tests. In the analysis, cognitive function for 911 dentally screened participants was evaluated, and 558 of 785 dentate participants received comprehensive oral examinations, including periodontal probing. Measures of oral health included dental status, number of teeth, and periodontal disease classified by the biofilm-gingival interface (BGI) index. The generalized estimating equations (GEE) method was used to analyze repeated measures of cognitive scores with adjustment for socio-demographic characteristics and cardiovascular risk factors. RESULTS Of 911 study participants, 13.8% were edentulous. About 13% of dentally examined participants had periodontal pockets (≥ 4 mm) with severe bleeding. At the follow-up visit, DWR and WF scores were lower in edentulous compared to dentate people, whereas other oral health measures were not associated with cognitive function. Mean values declined over time for all three cognitive measures, although poor oral health conditions were not associated with greater degree of decline in cognitive function. CONCLUSIONS In these late middle-aged adults, complete tooth loss was significantly associated with lower cognitive performance. However, neither edentulism, number of teeth, nor periodontal disease predicted greater subsequent cognitive decline.
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Affiliation(s)
- Supawadee Naorungroj
- Department of Conservative Dentistry, School of Dentistry, Prince of Songkla University, Hat Yai, Songkla, Thailand; Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Oue H, Miyamoto Y, Koretake K, Okada S, Doi K, Jung CG, Michikawa M, Akagawa Y. Tooth loss might not alter molecular pathogenesis in an aged transgenic Alzheimer's disease model mouse. Gerodontology 2014; 33:308-14. [DOI: 10.1111/ger.12153] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Hiroshi Oue
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical & Health Sciences; Hiroshima Japan
| | - Yasunari Miyamoto
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical & Health Sciences; Hiroshima Japan
| | - Katsunori Koretake
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical & Health Sciences; Hiroshima Japan
| | - Shinsuke Okada
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical & Health Sciences; Hiroshima Japan
| | - Kazuya Doi
- Department of Advanced Prosthodontics; Hiroshima University Graduate School of Biomedical & Health Sciences; Hiroshima Japan
| | - Cha-Gyun Jung
- Department of Neurophysiology and Brain Science; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Makoto Michikawa
- Department of Biochemistry; Nagoya City University Graduate School of Medical Sciences; Nagoya Japan
| | - Yasumasa Akagawa
- Department of Prosthetic Dentistry; Ohu University School of Dentistry; Koriyama Japan
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Noble JM, Scarmeas N, Papapanou PN. Poor oral health as a chronic, potentially modifiable dementia risk factor: review of the literature. Curr Neurol Neurosci Rep 2013; 13:384. [PMID: 23963608 PMCID: PMC6526728 DOI: 10.1007/s11910-013-0384-x] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Poor oral health, including caries, tooth loss, and periodontitis, is ubiquitous worldwide, and is potentially treatable and preventable. Like adverse oral health conditions, Alzheimer disease and related disorders are also very common among aging populations. Established risk factors for Alzheimer disease include cerebrovascular disease and its vascular risk factors, many of which share associations with evidence of systemic inflammation also identified in periodontitis and other poor oral health states. In this review, we present epidemiologic evidence of links between poor oral health and both prevalent and incident cognitive impairment, and review plausible mechanisms linking these conditions, including evidence from compelling animal models. Considering that a large etiologic fraction of dementia remains unexplained, these studies argue for further multidisciplinary research between oral health conditions, including translational, epidemiologic, and possibly clinical treatment studies.
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Affiliation(s)
- James M Noble
- Department of Neurology, Columbia University, New York, NY 10032, USA.
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Ebersole JL, Dawson DR, Morford LA, Peyyala R, Miller CS, Gonzaléz OA. Periodontal disease immunology: 'double indemnity' in protecting the host. Periodontol 2000 2013; 62:163-202. [PMID: 23574466 PMCID: PMC4131201 DOI: 10.1111/prd.12005] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
During the last two to three decades our understanding of the immunobiology of periodontal disease has increased exponentially, both with respect to the microbial agents triggering the disease process and the molecular mechanisms of the host engagement maintaining homeostasis or leading to collateral tissue damage. These foundational scientific findings have laid the groundwork for translating cell phenotype, receptor engagement, intracellular signaling pathways and effector functions into a 'picture' of the periodontium as the host responds to the 'danger signals' of the microbial ecology to maintain homeostasis or succumb to a disease process. These findings implicate the chronicity of the local response in attempting to manage the microbial challenge, creating a 'Double Indemnity' in some patients that does not 'insure' health for the periodontium. As importantly, in reflecting the title of this volume of Periodontology 2000, this review attempts to inform the community of how the science of periodontal immunology gestated, how continual probing of the biology of the disease has led to an evolution in our knowledge base and how more recent studies in the postgenomic era are revolutionizing our understanding of disease initiation, progression and resolution. Thus, there has been substantial progress in our understanding of the molecular mechanisms of host-bacteria interactions that result in the clinical presentation and outcomes of destructive periodontitis. The science has embarked from observations of variations in responses related to disease expression with a focus for utilization of the responses in diagnosis and therapeutic outcomes, to current investigations using cutting-edge fundamental biological processes to attempt to model the initiation and progression of soft- and hard-tissue destruction of the periodontium. As importantly, the next era in the immunobiology of periodontal disease will need to engage more sophisticated experimental designs for clinical studies to enable robust translation of basic biologic processes that are in action early in the transition from health to disease, those which stimulate microenvironmental changes that select for a more pathogenic microbial ecology and those that represent a rebalancing of the complex host responses and a resolution of inflammatory tissue destruction.
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Cockburn AF, Dehlin JM, Ngan T, Crout R, Boskovic G, Denvir J, Primerano D, Plassman BL, Wu B, Cuff CF. High throughput DNA sequencing to detect differences in the subgingival plaque microbiome in elderly subjects with and without dementia. INVESTIGATIVE GENETICS 2012; 3:19. [PMID: 22998923 PMCID: PMC3488532 DOI: 10.1186/2041-2223-3-19] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 08/30/2012] [Indexed: 12/20/2022]
Abstract
Background To investigate the potential association between oral health and cognitive function, a pilot study was conducted to evaluate high throughput DNA sequencing of the V3 region of the 16S ribosomal RNA gene for determining the relative abundance of bacterial taxa in subgingival plaque from older adults with or without dementia. Methods Subgingival plaque samples were obtained from ten individuals at least 70 years old who participated in a study to assess oral health and cognitive function. DNA was isolated from the samples and a gene segment from the V3 portion of the 16S bacterial ribosomal RNA gene was amplified and sequenced using an Illumina HiSeq1000 DNA sequencer. Bacterial populations found in the subgingival plaque were identified and assessed with respect to the cognitive status and oral health of the participants who provided the samples. Results More than two million high quality DNA sequences were obtained from each sample. Individuals differed greatly in the mix of phylotypes, but different sites from different subgingival depths in the same subject were usually similar. No consistent differences were observed in this small sample between subjects separated by levels of oral health, sex, or age; however a consistently higher level of Fusobacteriaceae and a generally lower level of Prevotellaceae was seen in subjects without dementia, although the difference did not reach statistical significance, possibly because of the small sample size. Conclusions The results from this pilot study provide suggestive evidence that alterations in the subgingival microbiome are associated with changes in cognitive function, and provide support for an expanded analysis of the role of the oral microbiome in dementia.
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Affiliation(s)
- Andrew F Cockburn
- Microbiology, Immunology & Cell Biology, School of Medicine, Robert C, Byrd Health Sciences Center, West Virginia University, P,O, Box 4622, Morgantown, WV, 26506-4622, USA.
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Sparks Stein P, Steffen MJ, Smith C, Jicha G, Ebersole JL, Abner E, Dawson D. Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease. Alzheimers Dement 2012; 8:196-203. [PMID: 22546352 DOI: 10.1016/j.jalz.2011.04.006] [Citation(s) in RCA: 286] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Revised: 02/25/2011] [Accepted: 04/05/2011] [Indexed: 01/16/2023]
Abstract
BACKGROUND Chronic inflammation in periodontal disease has been suggested as a potential risk factor in Alzheimer's disease (AD). The purpose of this study was to examine serum antibody levels to bacteria of periodontal disease in participants who eventually converted to AD compared with the antibody levels in control subjects. METHODS Serum samples from 158 participants in the Biologically Resilient Adults in Neurological Studies research program at the University of Kentucky were analyzed for immunoglobulin G antibody levels to seven oral bacteria associated with periodontitis, including Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Campylobacter rectus, Treponema denticola, Fusobacterium nucleatum, Tannerella forsythia, and Prevotella intermedia. All 158 participants were cognitively intact at baseline venous blood draw. In all, 81 of the participants developed either mild cognitive impairment (MCI) or AD or both, and 77 controls remained cognitively intact in the years of follow-up. Antibody levels were compared between controls and subjects with AD at baseline draw and after conversion and controls and subjects with MCI at baseline draw and after conversion using the Wilcoxon rank-sum test. AD and MCI participants were not directly compared. Linear regression models were used to adjust for potential confounding. RESULTS Antibody levels to F nucleatum and P intermedia were significantly increased (α = 0.05) at baseline serum draw in the patients with AD compared with controls. These results remained significant when controlling for baseline age, Mini-Mental State Examination score, and apolipoprotein epsilon 4 status. CONCLUSIONS This study provides initial data that demonstrate elevated antibodies to periodontal disease bacteria in subjects years before cognitive impairment and suggests that periodontal disease could potentially contribute to the risk of AD onset/progression. Additional cohort studies profiling oral clinical presentation with systemic response and AD and prospective studies to evaluate any cause-and-effect association are warranted.
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Affiliation(s)
- Pamela Sparks Stein
- Department of Oral Health Science, College of Dentistry, University of Kentucky, Lexington, USA.
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Aida J, Kondo K, Hirai H, Nakade M, Yamamoto T, Hanibuchi T, Osaka K, Sheiham A, Tsakos G, Watt RG. Association between dental status and incident disability in an older Japanese population. J Am Geriatr Soc 2011; 60:338-43. [PMID: 22211817 DOI: 10.1111/j.1532-5415.2011.03791.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine the association between dental health status and onset of functional disability in older Japanese people. DESIGN Prospective cohort study. SETTING Six Japanese municipalities. PARTICIPANTS Four thousand four hundred twenty-five community-dwelling individuals aged 65 and over. MEASUREMENTS The outcome measure was the onset of functional disability based on public records of people receiving long-term care insurance benefits, determined through a standardized multistep assessment of functional and cognitive impairment including a personal interview and an examination by a physician. Disability data were analyzed for 4,425 respondents during 2003 to 2007. Self-reported number of remaining teeth and eating ability were used as measures of dental health status. Age, sex, body mass index, self-rated health, present illness, smoking, alcohol, exercise, and equivalent income were used as covariates. RESULTS In the age- and sex-adjusted Cox proportional hazard models, there were significant associations between number of remaining teeth, eating ability, and onset of disability. After adjusting for sociodemographic, behavioral, and health status variables, respondents with 19 or fewer teeth had a significant 1.21 (95% confidence interval = 1.06-1.40) times higher hazard ratio for the onset of functional disability. In contrast, eating ability was not significantly associated with the onset of disability. CONCLUSION Poor dental status was associated with a higher risk of onset of functional disability in older Japanese people. Sociodemographic, behavioral, and health status covariates explained the association between eating ability and onset of disability.
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Affiliation(s)
- Jun Aida
- Department of Epidemiology and Public Health, University College London, London, UK.
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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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Okamoto N. Effect of occlusal support by implant prostheses on brain function. J Prosthodont Res 2011; 55:206-13. [DOI: 10.1016/j.jpor.2011.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 01/08/2011] [Accepted: 01/18/2011] [Indexed: 11/28/2022]
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