But gum disease, especially the more advanced type known as periodontal disease, can affect much more than our mouths. Periodontal disease is associated with a wide range of health conditions, including heart disease, stroke, diabetes, and dementia, making reduced access to dental care during the coronavirus pandemic a major concern, dentists say.
A new study published Wednesday in Neurology, the medical journal of the American Academy of Neurology, has added to that body of knowledge. There is a link between the stages of periodontal disease, which can ultimately cause tooth and bone loss, and mild cognitive decline and dementia 20 years later, the study found.
“We looked at people’s dental health over a 20-year period and found that people with the most severe gum disease at the beginning of our study had approximately twice the risk of mild cognitive impairment or dementia at the end,” said the Study author Ryan Demmer, Associate Professor at the University of Minnesota School of Public Health in Minneapolis.
At this point, significant dental cleaning procedures performed under anesthesia, such as root planing and flaking, can reverse the disease. If no intervention is performed, the disease develops into advanced periodontitis, which can cause complete destruction of the bone support structure of the tooth and eventual loss of the tooth.
People with more advanced periodontal disease have been found to be at increased risk for cardiovascular disease, diabetes, stroke, chronic respiratory disease, complications of pregnancy, and dementia.
However, it is not clear whether periodontal disease really causes dementia or other health problems. It could be explained by certain bacteria in the mouth, the oral microbiome, Demmer said.
“The oral microbiome is central. My central hypothesis is that bacteria in the mouth that cause periodontal disease are also the cause of systemic results (cardiovascular disease, dementia, etc.),” he said by email.
“We use periodontal measurements in many of our studies because they are a surrogate marker for chronic exposure to adverse oral bacteria.”
He said another possible link between periodontal disease and dementia was more indirect, with cardiometabolic diseases, such as cardiovascular disease and diabetes, serving as the intermediate cause.
“There is a large body of literature suggesting that chronic periodontal infections could contribute to insulin resistance, prediabetes, incident diabetes and incident stroke,” said Demmer. “Consequently, insulin resistance, diabetes, and stroke are strong predictors of future cognitive decline.”
While good dental hygiene is a “proven way to maintain healthy teeth and gums throughout your life,” Demmer said his study only shows an association between an unhealthy mouth and dementia, and cannot prove any cause and effect.
“More studies are needed to demonstrate the link between microbes in the mouth and dementia, and to understand whether treatment for gum disease can prevent dementia,” he added.
The researchers followed a total of 8,275 people for an average of 18 years. At the start of the study, participants were assessed for mild cognitive impairment and dementia and underwent a comprehensive periodontal examination that included measurement of the depth of probing of the gums, the amount of bleeding, and the number of gums that had receded.
Overall, 1,569 people, or 19%, developed dementia during the study. Of the people who had healthy gums and all their teeth at the start of the study, 264 of 1,826, or 14%, developed dementia at the end of the study.
For those with mild gum disease at baseline, 623 of 3,470, or 18%, developed dementia. For participants with severe gum disease, 306 of 1,368, or 22%, developed dementia. And 376 of 1,611, or 23%, developed dementia in the group without teeth.
The study took into account other factors that could affect the risk of dementia, such as diabetes, high cholesterol, and smoking.
More than one type of dementia.
Analysis of a smaller group of participants found that gum disease was linked to Alzheimer’s and vascular dementia, Demmer said.
Alzheimer’s disease is the most common form of dementia, characterized by memory loss that worsens over time. The condition is believed to be caused by a buildup of beta amyloid plaques and tau protein in the brain. Until now, there is no cure for the disease.
Vascular dementia is caused by brain damage caused by impaired blood flow to the brain, which can affect executive functions such as reasoning, planning, judgment, and memory.
A limitation of the study, the authors noted, was the fact that the initial examinations were performed when the participants were an average age of 63 years, and it is possible that cognitive decline began before the onset of gum disease and tooth loss.
For anyone concerned about the health of their gums, London-based dentist Dr. Richard Marques encouraged people to do regular dental check-ups and see a hygienist for a deep cleaning. He said some dentists may offer video consultations or phone assistance if you are unable or unwilling to go in person.
The most important thing, he said, was taking care of his teeth and gums to maintain his periodontal and body health in the long term. This should include brushing regularly, flossing (or using interdental brushes or a water cleaner), using a mouthwash with fluoride or chlorhexidine, and maintaining a low sugar intake (since harmful bacteria in the mouth feed on sugar) .
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