Periodontitis and cognitive decline in older adults

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Periodontitis and cognitive decline in older adults

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Publication Doctoral Thesis
Doctoral Thesis, comprehensive summary
Title Periodontitis and cognitive decline in older adults
Author Nilsson, Helena
Date 2019
English abstract
As a result of ongoing demographic transitions, populations throughout the world are ageing. Cognitive decline is a leading contributor to dependence and disability among older adults. Decline in cognitive abilities can also influence lifestyle factors associated with oral health. Increasing evidence suggest that more teeth are retained throughout life and therefore an increasing number of teeth are at risk of oral diseases. Periodontitis is an inflammatory disease affecting the supportive tissues of the teeth resulting in alveolar bone loss and eventually tooth loss. Associations between periodontitis and systemic diseases with an inflammatory profile have been reported. The overall aim of the present thesis was to evaluate a potential association between tooth loss, periodontitis, and cognitive decline and to describe changes in oral health-related parameters among older adults in a twelve-year follow-up. In Paper I the impact of tooth loss on the risk for lower cognitive test score was evaluated in 1147 older adults. An examination including clinical and radiographic registration of number of teeth present was performed. Cognitive functioning was evaluated using Mini-Mental State Examination (MMSE) (cut-off <25) and Clocktest (CT) (cut-off <8). Number of teeth was categorised into edentulous, 1-19 and ≥20 teeth. The risk for low cognitive test score was statistically related to number of teeth. Results from the multiple logistic regression after adjustments for age and education demonstrated a statistically significant impact of being edentulous on cognitive functions. In addition, having 1 to 19 teeth had a significant impact on the risk for Clock-test <8 compared to the group having ≥20 teeth. In Paper II the impact of tooth loss and periodontitis on the risk for lower cognitive test outcome was evaluated in 775 dentate older adults. The clinical examination included periodontal probing and registration of number of teeth present. Panoramic radiographs were taken, and the extent of alveolar bone loss was evaluated at the mesial and distal aspect of each tooth and the proportion of readable sites ≥4mm and ≥5mm from the marginal bonelevel to cemento-enamel junction (CEJ) was assessed. Cognitive functioning was evaluated using MMSE (cut-off <25) and Clocktest (cut-off <8). Using MMSE, a sub-analysis was done between individuals with 25-27 points compared to the group with 28-30 points. Bone loss defined as having ≥4 mm distance from CEJ to marginal bone-level on ≥30% of readable sites and having 1-19 teeth had a significant impact on the cognitive test outcome using MMSE after adjustments for age, gender, and education. When excluding the individuals with the lowest test outcome <25, and then comparing the group with a score of 25-27 to the group with a score ≥ 28, bone loss was still shown to have a significant impact on cognition. Having 1 to 19 teeth also influenced the risk for lower cognitive test-outcome using Clock-test. In Paper III the impact of periodontal bone loss on the risk for cognitive decline was evaluated in 715 older adults examined both at baseline and at a six-year follow-up. Cognitive decline was defined as a ≥3-points deterioration using MMSE. All individuals included had a medical as well as a dental examination at baseline. Social variables were captured from questionnaires. One-hundred fifteen individuals experienced a ≥3-points decline in MMSEresults during the six-year follow-up. High age, elementary education, living alone, experience of ischemic heart disease, BMI <25, being edentulous, having 1-19 teeth and bone loss defined as ≥4mm from cemento-enamel junction to marginal bone level on 30% of readable sites were associated with decline in cognitive function. In the final analysis bone loss, age, education, and BMI <25 were significant predictors for cognitive decline. In Paper IV the prevalence of periodontitis and change in periodontal variables and tooth loss were assessed over a twelve-year follow-up period. Individuals included had a medical as well as a clinical and radiographic dental examination at baseline. Periodontitis defined as having ≥2 sites with ≥5mm distance from cementoenamel junction to the marginal bone level and ≥1 tooth with pockets ≥5mm was evident in 39% of the population and 23% of the individuals lost ≥3 teeth over the study period. Proportion of sites ≥ 4mm and ≥5mm from cemento-enamel junction to the marginal bone-level increased with age while proportion of teeth with pockets remained stable. Having periodontitis, living alone, and high age were significant predictors for multiple tooth loss. Individuals losing ≥3 teeth had a lower number of teeth and a higher number of sites with bone loss ≥5mm and teeth with pockets ≥5mm at baseline.
DOI https://doi.org/10.24834/isbn.9789171049988 (link to publisher's fulltext.)
Publisher Malmö university, Faculty of Odontology
Series/Issue Doctoral dissertation in odontology
ISBN 9789171049971
9789171049988
Language eng (iso)
Subject Parodontit
Medicine
Research Subject Categories::ODONTOLOGY
Included papers
  1. I. Nilsson H, Berglund J, Renvert S. Tooth loss and cognitive functions among older adults. Acta Odontologica Scandinavica 2014; 72:639-644.

  2. II. Nilsson H, Sanmartin Berglund J, Renvert S. Periodontitis, tooth loss and cognitive functions among older adults. Clinical Oral Investigations 2018; 22:2103-2109

  3. III. Nilsson H, Sanmartin Berglund J, Renvert S. Longitudinal evaluation of periodontitis and development of cognitive decline among older adults. Journal of Clinical Periodontology 2018; 45: 1142-1149

  4. IV. Nilsson H, Sanmartin Berglund J, Renvert S. Longitudinal evaluation of periodontitis and tooth loss among older adults. Accepted for publication in Journal of Clinical Periodontology

Handle http://hdl.handle.net/2043/29739 Permalink to this page
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