March 30, 2023

As a vice president and dental director at United Concordia Dental and a licensed dentist, my colleagues and I try to review the latest evidence-based research on how the health of the mouth is tied to the body. Recently, we looked at a growing body of research that is beginning to uncover a possible association between gum disease and Alzheimer’s and dementia.
The first study, conducted by the National Institute on Aging in 2020 appears to support an association between the bacteria that cause gum disease and the development of Alzheimer’s and forms of dementias. Scientists analyzed publicly available data from the Center for Disease Control’s National Center for Health Statistics to see if gum disease and oral bacterial infections were linked to dementia and death. Data from 6,000 participants of varying age groups, up to a duration of 26 years, was compared.
The bacteria that most commonly cause gum disease was one of the 19 oral bacteria analyzed against antibodies for an association with the diagnosis of Alzheimer’s or dementia and death from Alzheimer’s. The study found that older adults with signs of gum disease and mouth infections were more likely to develop Alzheimer’s during the study period.
Among those 65 years or older, both Alzheimer’s diagnoses and deaths were associated with antibodies against the gum-disease-causing bacteria, which can then cluster with other bacteria to further increase those risks.
A smaller study conducted by New York University College of Dentistry and Weill Cornell Medicine in 2021, found older adults with a higher accumulation of harmful bacteria in the mouth are more likely to have evidence for beta amyloids in the fluid found within the tissue that surrounds the brain and spinal cord. This appears to indicate that gum disease and other diseases that cause inflammation disrupt the clearance of amyloid from the brain.
While the mouth houses both protective and harmful bacteria, the body’s response to harmful bacteria can cause chronic inflammation, bleeding of the gums, loosening of teeth and eventual tooth loss — all associated with gum disease. The bacteria and molecules that cause inflammation can enter open blood vessels in wounds or inflamed gum tissue and travel from infections in the mouth through the bloodstream to other regions of the body, including the brain.
In the study, samples of gumline bacteria and fluid from tissue surrounding the spine from 48 cognitively normal adults aged 65 and older were analyzed. While a small sample size, the data showed that individuals with a harmful imbalance in bacteria were more likely to have reduced amyloid levels in the fluid taken from spinal tissue. This means higher brain amyloid levels, which is what is found in an Alzheimer’s diagnosis. Since high levels of healthy bacteria are known to help maintain bacterial balance and decrease inflammation in the mouth, there may be a positive relationship between the healthy bacteria and Alzheimer’s.
It’s important to note that dementia patients are less likely to be able to brush and floss effectively by themselves, which increases the chances of gum disease and the development of oral infections. Long-term, follow-up studies and clinical trials are being planned to get a better sense of the timing of gum disease onset in relation to the onset of dementia, and to assess if gum disease treatment can prevent the development or reduce the symptoms of dementia.
While further evaluation is needed on the interplay between gum disease and dementia, these findings appear to indicate that taking good and consistent care of your oral health — brushing and flossing at least twice a day, replacing your toothbrush every 3-4 months, consuming less sugary foods and drinks, and visiting your dentist twice a year, for example — could increase the likelihood of maintaining better overall health later in life.
Bottom line: there’s no reason to wait to start taking better care of your mouth. If you start now, your mouth, mind—and the rest of your body—will thank you years down the road.
Roosevelt Allen is vice president and dental director, Government Business, at United Concordia Dental, a national dental insurer headquartered in Camp Hill, Pa.
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