Evidence summary: the relationship between oral health and dementia

Abstract

This is the fourth and final paper of a series of reviews undertaken to explore the relationships between oral health and general medical conditions, in order to support teams within Public Health England, health practitioners and policy makers. This review aimed to explore the most contemporary evidence on whether poor oral health and dementia occurs in the same individuals or populations, to outline the nature of the relationship between these two health outcomes and to discuss the implication of any findings for health services and future research. The review was undertaken by a working group comprising consultant clinicians from medicine and dentistry, trainees, public health and academic staff. Whilst other rapid reviews in the current series limited their search to systematic reviews, this review focused on primary research involving cohort and case-control studies because of the lack of high level evidence in this new and important field. The results suggest that poor oral hygiene is associated with dementia, and more so amongst people in advanced stages of the disease. Suboptimal oral health (gingivitis, dental caries, tooth loss, edentulousness) appears to be associated with increased risk of developing cognitive impairment and dementia. The findings are discussed in relation to patient care and future research.

Prevalence of oral hygiene tools amongst hospitalised elders: A cross‐sectional survey

“…Studies indicate that brushing twice daily was less likely to have been practiced by participants with mild onset of AD . Although in the present study, some participants have reported brushing their teeth thrice and even four times a day, it has to be considered with caution as self‐reported activities of oral hygiene are of substantial risk of error due to the diminished cognitive performance in this cohort; or could have just been an “eager to please” response or trying to fulfil expectations in order to avoid judgement. However, it was interesting to note that 3% of the participants did not brush their teeth since they had been hospitalised.…”

“…Presence of dental plaque increases the oral bacterial load, thus making the dependent elder more susceptible to infections and associated complications, including aspiration pneumonia . Elders with cognitive impairment and dementia have often been associated with poor oral hygiene . Interestingly, deteriorated oral health and untreated oral infections have been suggested as risk factors for developing cognitive impairment, and even for clinical manifestations attributable to Alzheimer's Disease (AD) …”

“…Elders with cognitive impairment and dementia have often been associated with poor oral hygiene . Interestingly, deteriorated oral health and untreated oral infections have been suggested as risk factors for developing cognitive impairment, and even for clinical manifestations attributable to Alzheimer's Disease (AD) …”

Microbiological evaluation of LOCATOR® Legacy attachments: A cross‐sectional clinical study

“…Moreover, accumulated debris and biofilm are a potential nidus for propagating oral or more distant general infections. This is of particular importance in the compromised elderly patient who is dependent for care as it could lead to potential complications such as aspiration pneumonia, especially when swallowing disorders are present (Daly et al, 2018;Iinuma et al, 2015;Müller, 2015;Pritchard, Crean, Olsen, & Singhrao, 2017;Yoneyama, Yoshida, Matsui, & Sasaki, 1999).…”

Under cover

“…4 Not quite the 'poison' of the Ministry's dire warning but given our knowledge at the time, and more pertinently the knowledge of the general population -for example, who knew then that plaque caused gum disease? -it is not a bad approximation of our 'modern' mantra.…”