Poor Oral Health May Increase Risk of Cognitive Decline

Evidence showing the connection between poor oral health and cognitive decline in older adults is mounting. While the exact cause of Alzheimer disease (AD) and other dementias remains unknown, current research identifies chronic inflammation as a possible suspect.

One recent study, conducted at Rutgers University, found a significant correlation between dental health and cognition in nearly 50% of 2,700 subjects ages 60 and older.¹ Most striking appeared to be the effect on the ability to retain new information, commonly an indicator of AD progression.

In another study, Porphyromonas gingivalis, the primary pathogen in chronic periodontitis, as well as toxic enzymes called gingipains were found in the brains of patients with AD. The presence of such pathogens is associated with increased production of a component of amyloid plaques, which have been implicated in the development of AD and in neurotoxicity.²

ORAL CARE STRATEGIES

Patients with AD or other types of cognitive decline may struggle to maintain their oral health. These patients may not be able to maintain a high level of oral hygiene, making biofilm control of the utmost importance. Antimicrobial mouthrinses may be helpful in addition to those containing delmopinol hydrochloride, which hinders biofilm adhesion. Recommendations for toothbrushes designed for those with special needs and interdental cleaners that do not require the level of dexterity needed to use traditional floss are helpful.

The high medication use by patients with AD may cause xerostomia. Oral health professionals may recommend salivary substitutes, oral lubricants, and sugarless gum with xylitol. Products containing hyaluronic acid, a high-viscosity humectant, will improve tissue hydration and support patient comfort. It may also be helpful for patients to avoid caffeinated drinks, tobacco, and spicy or salty foods, and to sip water frequently. Nighttime use of a humidifier can also help.^3,4

Interdisciplinary collaboration is necessary to help patients with dementia improve their oral health. A multipronged approach includes maintenance of comprehensive medical histories; consultation with primary health care providers; and education of caregivers, on whom such patients may depend for help with oral care. Likewise, dental teams should receive training in how to treat and accommodate older adults with impairments.^3,4

References

1. 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.
2. Dominy SS, Lynch C, Ermini F, et al. Porphyromonas gingivalis in Alzheimer’s disease brains: evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5:eaau3333.
3. Shepherd JG, Claiborne DM, Goodman K, Johnson KF. Dealing with dementia. Dimensions of Dental Hygiene. 2015;13(7):37–40.
4. Alderson S. Improving the oral health of older adults. Dimensions of Dental Hygiene. 2016;14:48–53.