Gum Disease Associated With Mild Cognitive Impairment and Dementia

Dentistry Today
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Gum disease may be associated with mild cognitive impairment and dementia 20 years later, according to researchers at the University of Minnesota School of Public Health.

“We looked at people’s dental health over a 20-year period and found that people with the most severe gum disease at the start of our study had about twice the risk for mild cognitive impairment or dementia by the end,” said author Ryan T. Demmer, PhD, MPH.

“However, the good news was that people with minimal tooth loss and mild gum disease were no more likely to develop thinking problems or dementia than people with no dental problems,” said Demmer, an associate professor with the Division of Epidemiology and Community Health.

The study involved 8,275 people with an average of 63 who did not have dementia at the start of the study. Participants were assessed for mild cognitive impairment and dementia. They received a full periodontal exam including gum probing depth, bleeding, and recession.

Participants then were grouped based on the severity and extent of their gum disease and number of lost teeth, including implants. At the start of the study:

  • 22% had no gum disease
  • 12% had mild gum disease
  • 12% had severe gum inflammation
  • 8% had some tooth loss
  • 12% had disease in their molars
  • 11% had severe tooth loss
  • 6% had severe gum disease
  • 20% had no teeth at all

The study assessed 4,559 people, following them for an average of 18 years. Overall, 1,569 people developed dementia during the study, or 19%. This was the equivalent of 11.8 cases per every 1,000 person-years.

Of the people who had healthy gums and all of their teeth at the start of the study, 264 out of 1,826, or 14%, developed dementia by the end of the study. For those with mild gum disease, 623 out of 3,470, or 18%, developed dementia.

For participants with severe gum disease, 306 out of 1,368, or 22%, developed dementia. And, 376 out of 1,611, or 23%, developed dementia in the group that had no teeth. This was equal to a rate of 16.9 cases per 1,000 person-years.

When looking at both mild cognitive impairment and dementia, the group with no teeth had about twice the risk compared to participants with healthy gums and all their teeth.

People with intermediate or severe gum disease, but who still had some teeth, had a 20% greater risk of developing mild cognitive impairment or dementia compared to the healthy group.

These risks were after researchers accounted for other factors that could affect dementia risk, such as diabetes, high cholesterol, and smoking.  

“Good dental hygiene is a proven way to keep healthy teeth and gums throughout your lifetime. Our study does not prove that an unhealthy mouth causes dementia and only shows an association,” said Demmer.

“Further study is needed to demonstrate the link between microbes in your mouth and dementia and to understand if treatment for gum disease can prevent dementia,” said Demmer.

A limitation of the study is the fact that initial gum examinations were made when the participants had an average age of 63, and it is possible that cognitive decline might have begun before the start of gum disease and tooth loss, the researchers said.

The study was published by Neurology.

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