Top

Published in:

01-09-2020 | Alzheimer's Disease | META-ANALYSIS

Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis

Authors: Rizwan Nadim, Jie Tang, Amena Dilmohamed, Siyang Yuan, Changhao Wu, Aishat T. Bakre, Martin Partridge, Jindong Ni, John R. Copeland, Kaarin J. Anstey, Ruoling Chen

Published in: European Journal of Epidemiology | Issue 9/2020

Abstract

Periodontal disease (PD) is common and increases cardiovascular diseases. However, it is unclear whether PD is associated with increased risk of dementia. We carried out a systematic review and meta-analysis to investigate the influence of PD on dementia. We projected the number of dementia cases to be saved by reducing PD prevalence in the world. We searched cohort and case–control studies reporting the association of PD with all dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI until 7th November 2018. Five cohorts and seven case–control studies were identified for review. We pooled eligible data to calculate relative risk (RR) of dementia in relation to PD and computed the number of dementia cases saved through reducing PD prevalence. Of 12 studies, six were undertaken in Asia, four in Europe and two in America. Eleven studies showed a positive association between PD and the risk of dementia, of which 10 were significant, and one reported a non-significant inverse association. Overall their quality was good. Pooled RR of dementia in relation to PD from all high quality studies was 1.38 (95%CI 1.01–1.90); in the five cohorts was 1.18 (1.06–1.31) and in the two case–control studies 2.25 (1.48–3.42). A 50% reduction in the current prevalence of 20% of PD in the population could save 850,000 (630,000–1,420,000) patients with dementia in the world. PD could increase the risk of incident dementia. Preventing and treating PD could contribute to controlling the global epidemic of dementia.

Available only for authorised users

Van Dyke TE, Van Winkelhoff AJ. Infection and inflammatory mechanisms. J Clin Periodontol. 2013;40:S1–7. https://doi.org/10.1111/jcpe.12088.CrossRefPubMed

Kassebaum N, Bernabé E, Dahiya M, Bhandari B, Murray C, Marcenes W. Global burden of severe periodontitis in 1990–2010: a systematic review and meta-regression. J Dent Res. 2014;93(11):1045–53. https://doi.org/10.1177/0022034514552491.CrossRefPubMedPubMedCentral

Schätzle M, Faddy MJ, Cullinan MP, Seymour GJ, Lang NP, Bürgin W, et al. The clinical course of chronic periodontitis: V. Predictive factors in periodontal disease. J Clin Periodontol. 2009;36(5):365–71. https://doi.org/10.1111/j.1600-051X.2009.01391.x.CrossRefPubMed

Pihlstrom BL, Michalowicz BS, Johnson NW. Periodontal diseases. Lancet. 2005;366(9499):1809–20. https://doi.org/10.1016/S0140-6736(05)67728-8.CrossRefPubMed

Hansen GM, Egeberg A, Holmstrup P, Hansen PR. Relation of periodontitis to risk of cardiovascular and all-cause mortality (from a Danish nationwide cohort study). Am J Cardiol. 2016;118(4):489–93. https://doi.org/10.1016/j.amjcard.2016.05.036.CrossRefPubMed

Lee YT, Lee HC, Hu CJ, Huang LK, Chao SP, Lin CP, et al. Periodontitis as a modifiable risk factor for dementia: a nationwide population-based cohort study. J Am Geriatr Soc. 2017;65(2):301–5. https://doi.org/10.1111/jgs.14449.CrossRefPubMed

Lee YL, Hu HY, Huang LY, Chou P, Chu D. Periodontal disease associated with higher risk of dementia: population-based cohort study in Taiwan. J Am Geriatr Soc. 2017;65(9):1975–80. https://doi.org/10.1111/jgs.14944.CrossRefPubMed

Chen C-K, Wu Y-T, Chang Y-C. Association between chronic periodontitis and the risk of Alzheimer’s disease: a retrospective, population-based, matched-cohort study. Alzheimers Res Ther. 2017;9(1):56. https://doi.org/10.1186/s13195-017-0282-6.CrossRefPubMedPubMedCentral

Tzeng NS, Chung CH, Yeh CB, Huang RY, Yuh DY, Huang SY, et al. Are chronic periodontitis and gingivitis associated with dementia? A nationwide, retrospective, matched-cohort study in Taiwan. Neuroepidemiol. 2016;47(2):82–93. https://doi.org/10.1159/000449166.CrossRef

10.

Arrivé E, Letenneur L, Matharan F, Laporte C, Helmer C, Barberger-Gateau P, et al. Oral health condition of French elderly and risk of dementia: a longitudinal cohort study. Community Dent Oral Epidemiol. 2012;40(3):230–8. https://doi.org/10.1111/j.1600-0528.2011.00650.x.CrossRefPubMed

11.

Leira Y, Domínguez C, Seoane J, Seoane-Romero J, Pías-Peleteiro JM, Takkouche B, et al. Is periodontal disease associated with Alzheimer’s disease? A systematic review with meta-analysis. Neuroepidemiology. 2017;48(1–2):21–31. https://doi.org/10.1159/000458411.CrossRefPubMed

12.

Kapellas K, Ju X, Wang X, Mueller N, Jamieson LM. The association between periodontal disease and dementia: a systematic review and meta-analysis. Dent Oral Biol Craniofac Res. 2019. https://doi.org/10.31487/j.dobcr.2019.01.005.CrossRef

13.

Syrjälä AM, Ylöstalo P, Ruoppi P, Komulainen K, Hartikainen S, Sulkava R, et al. Dementia and oral health among subjects aged 75 years or older. Gerodontology. 2012;29(1):36–42. https://doi.org/10.1111/j.1741-2358.2010.00396.x.CrossRefPubMed

14.

Iwasaki M, Kimura Y, Ogawa H, Yamaga T, Ansai T, Wada T, et al. Periodontitis, periodontal inflammation, and mild cognitive impairment: a 5-year cohort study. J Periodontal Res. 2018. https://doi.org/10.1111/jre.12623.CrossRefPubMed

15.

Chan KY, Wang W, Wu JJ, Liu L, Theodoratou E, Car J, et al. Epidemiology of Alzheimer’s disease and other forms of dementia in China, 1990–2010: a systematic review and analysis. The Lancet. 2013;381(9882):2016–23. https://doi.org/10.1016/S0140-6736(13)60221-4.CrossRef

16.

Chen R, Hu Z, Chen R-L, Zhang D, Xu L, Wang J, et al. Socioeconomic deprivation and survival after stroke in China: a systematic literature review and a new population-based cohort study. BMJ Open. 2015;5(1):e005688. https://doi.org/10.1136/bmjopen-2014-005688.CrossRefPubMedPubMedCentral

17.

Liberati A, Altman D, Tetzlaff J, Mulrow C, Gøtzsche P, Ioannidis J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions. BMJ. 2009. https://doi.org/10.1136/bmj.b2700.CrossRefPubMedPubMedCentral

18.

Bramanti E, Bramanti A, Matacena G, Bramanti P, Rizzi A, Cicciu M. Clinical evaluation of the oral health status in vascular-type dementia patients. A case-control study. Minerva Stomatol. 2015;64(4):167–75.PubMed

19.

Jureti R, Yiru W, Panlong H, Yue S, Awuti G. Survey on periodontal health status of Xinjiang Uygur and Han patients with Alzheimer’s disease. J Chongqing Med Univ. 2016;41(12):1267–71.

20.

Holmer J, Eriksdotter M, Schultzberg M, Pussinen PJ, Buhlin K. Association between periodontitis and risk of Alzheimer’s disease, mild cognitive impairment and subjective cognitive decline: a case–control study. J Clin Periodontol. 2018. https://doi.org/10.1111/jcpe.13016.CrossRefPubMed

21.

Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol. 2015;86(2):244–53. https://doi.org/10.1902/jop.2014.140340.CrossRefPubMed

22.

Stein PS, Steffen MJ, Smith C, Jicha G, Ebersole JL, Abner E, et al. Serum antibodies to periodontal pathogens are a risk factor for Alzheimer’s disease. Alzheimer’s Dementia J Alzheimer’s Dis. 2012;8(3):196–203. https://doi.org/10.1016/j.jalz.2011.04.006.CrossRef

23.

de Souza RT, Fabri GM, Nitrini R, Anghinah R, Teixeira MJ, de Siqueira JT, et al. Oral infections and orofacial pain in Alzheimer’s disease: a case-control study. J Alzheimers Dis. 2014;38(4):823–9. https://doi.org/10.3233/jad-131283.CrossRef

24.

Chu CH, Ng A, Chau AMH, Lo ECM. Oral health status of elderly chinese with dementia in Hong Kong. Oral Health Prevent Dent. 2015;13(1):51–7. https://doi.org/10.3290/j.ohpd.a32343.CrossRef

25.

Danat IM, Clifford A, Partridge M, Zhou W, Bakre AT, Chen A, et al. Impacts of overweight and obesity in older age on the risk of dementia: a systematic literature review and a meta-analysis. J Alzheimer’s Dis. 2019. https://doi.org/10.3233/jad-180763.CrossRef

26.

Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol. 2010;25(9):603–5. https://doi.org/10.1007/s10654-010-9491-z.CrossRefPubMed

27.

Zhang J, Kai FY. What’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomes. JAMA. 1998;280(19):1690–1. https://doi.org/10.1001/jama.280.19.1690.CrossRefPubMed

28.

Bakre AT, Chen R, Khutan R, Wei L, Smith T, Qin G, et al. Association between fish consumption and risk of dementia: a new study from China and a systematic literature review and meta-analysis. Public Health Nutr. 2018;21(10):1921–32. https://doi.org/10.1017/S136898001800037X.CrossRefPubMed

29.

Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34. https://doi.org/10.1136/bmj.315.7109.629.CrossRefPubMedPubMedCentral

30.

Barnes D, Yaffe K. The projected impact of risk factor reduction on Alzheimer’s disease prevalence. Alzheimer’s Dement J Alzheimer’s Assoc. 2011;7(4):S511. https://doi.org/10.1016/S1474-4422(11)70072-.CrossRef

31.

WHO (2017) Dementia: key facts. https://www.who.int/en/news-room/fact-sheets/detail/dementia. Accessed 25 Feb 2019.

32.

Petersen PE, Ogawa H. Strengthening the prevention of periodontal disease: the WHO approach. J Periodontol. 2005;76(12):2187–93. https://doi.org/10.1902/jop.2005.76.12.2187.CrossRefPubMed

33.

Watts A, Crimmins EM, Gatz M. Inflammation as a potential mediator for the association between periodontal disease and Alzheimer’s disease. Neuropsychiatr Dis Treat. 2008;4(5):865–76. https://doi.org/10.2147/ndt.s3610.CrossRefPubMedPubMedCentral

34.

Dominy SS, Lynch C, Ermini F, Benedyk M, Marczyk A, Konradi A, et al. Porphyromonas gingivalis in Alzheimer’s disease brains: evidence for disease causation and treatment with small-molecule inhibitors. Sci Adv. 2019;5(1):eaau3333. https://doi.org/10.1126/sciadv.aau3333.CrossRefPubMedPubMedCentral

35.

Ship JA. Oral health of patients with Alzheimer’s disease. J Am Dent Assoc. 1992;123(1):53–8. https://doi.org/10.14219/jada.archive.1992.0005.CrossRefPubMed

36.

Martande SS, Pradeep A, Singh SP, Kumari M, Suke DK, Raju AP, et al. Periodontal health condition in patients with Alzheimer’s disease. Am J Alzheimer’s Dis Other Dement. 2014;29(6):498–502. https://doi.org/10.1177/1533317514549650.CrossRef

37.

Jureti R. Survey on periodontal health status of Xinjiang Uygur and Han patients with Alzheimer’s diseases [Master]. Xinjiang Medical University; 2017.

38.

Hill SB. The environment and disease: association or causation? Proc R Soc Med. 1965;58:295–300.PubMedPubMedCentral

39.

Chen J, Ren C-J, Wu L, Xia L-Y, Shao J, Leng W-D, et al. Tooth loss is associated with increased risk of dementia and with a dose-response relationship. Front Aging Neurosci. 2018;10:415. https://doi.org/10.3389/fnagi.2018.00415.CrossRefPubMedPubMedCentral

40.

Janket S-J, Baird AE, Chuang S-K, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol. 2003;95(5):559–69. https://doi.org/10.1067/moe.2003.107.CrossRef

41.

Leira Y, Seoane J, Blanco M, Rodriguez-Yanez M, Takkouche B, Blanco J, et al. Association between periodontitis and ischemic stroke: a systematic review and meta-analysis. Eur J Epidemiol. 2017. https://doi.org/10.1007/s10654-016-0170-6.CrossRefPubMed

42.

Anstey KJ, von Sanden C, Salim A, O’kearney R. Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol. 2007;166(4):367–78. https://doi.org/10.1093/aje/kwm116.CrossRefPubMed

43.

Sheiham A, Watt RG. The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol Comment. 2000;28(6):399–406. https://doi.org/10.1034/j.1600-0528.2000.028006399.x.CrossRef

44.

Kamer AR, Pirraglia E, Tsui W, Rusinek H, Vallabhajosula S, Mosconi L, et al. Periodontal disease associates with higher brain amyloid load in normal elderly. Neurobiol Aging. 2015;36(2):627–33. https://doi.org/10.1016/j.neurobiolaging.2014.10.038.CrossRefPubMed

45.

Pizzo G, Guiglia R, Russo LL, Campisi G. Dentistry and internal medicine: from the focal infection theory to the periodontal medicine concept. Eur J Intern Med. 2010;21(6):496–502. https://doi.org/10.1016/j.ejim.2010.07.011.CrossRefPubMed

46.

Carter CJ, France J, Crean S, Singhrao SK. The Porphyromonas gingivalis/host interactome shows enrichment in GWASdb genes related to Alzheimer’s disease, diabetes and cardiovascular diseases. Front Aging Neurosci. 2017;9:408. https://doi.org/10.3389/fnagi.2017.00408.CrossRefPubMedPubMedCentral

47.

Newman AB, Fitzpatrick AL, Lopez O, Jackson S, Lyketsos C, Jagust W, et al. Dementia and Alzheimer’s disease incidence in relationship to cardiovascular disease in the Cardiovascular Health Study cohort. J Am Geriatr Soc. 2005;53(7):1101–7. https://doi.org/10.1111/j.1532-5415.2005.53360.x.CrossRefPubMed

48.

Fang W-l, Jiang M-j, Gu B-b, Wei Y-m, Fan S-n, Liao W, et al. Tooth loss as a risk factor for dementia: systematic review and meta-analysis of 21 observational studies. BMC Psychiatry. 2018;18(1):345. https://doi.org/10.1186/s12888-018-1927-0.CrossRefPubMedPubMedCentral

49.

Kato T, Usami T, Noda Y, Hasegawa M, Ueda M, Nabeshima T. The effect of the loss of molar teeth on spatial memory and acetylcholine release from the parietal cortex in aged rats. Behav Brain Res. 1997;83(1–2):239–42. https://doi.org/10.1016/s0166-4328(97)86078-0.CrossRefPubMed

50.

Poole S, Singhrao SK, Kesavalu L, Curtis MA, Crean S. Determining the presence of periodontopathic virulence factors in short-term postmortem Alzheimer’s disease brain tissue. J Alzheimer’s Dis. 2013;36(4):665–77. https://doi.org/10.3233/JAD-121918.CrossRef

51.

Kawahata M, Ono Y, Ohno A, Kawamoto S, Kimoto K, Onozuka M. Loss of molars early in life develops behavioral lateralization and impairs hippocampus-dependent recognition memory. BMC Neurosci. 2014;15(1):4. https://doi.org/10.1186/1471-2202-15-4.CrossRefPubMedPubMedCentral

52.

Ishida N, Ishihara Y, Ishida K, Tada H, Funaki-Kato Y, Hagiwara M, et al. Periodontitis induced by bacterial infection exacerbates features of Alzheimer’s disease in transgenic mice. NPJ Aging Mech Dis. 2017;3(1):15. https://doi.org/10.1038/s41514-017-0015-x.CrossRefPubMedPubMedCentral

53.

Ilievski V, Zuchowska PK, Green SJ, Toth PT, Ragozzino ME, Le K, et al. Chronic oral application of a periodontal pathogen results in brain inflammation, neurodegeneration and amyloid beta production in wild type mice. PLoS ONE. 2018;13(10):e0204941. https://doi.org/10.1371/journal.pone.0204941.CrossRefPubMedPubMedCentral

54.

Poole S, Singhrao SK, Chukkapalli S, Rivera M, Velsko I, Kesavalu L, et al. Active invasion of Porphyromonas gingivalis and infection-induced complement activation in ApoE-/-mice brains. J Alzheimers Dis. 2015;43(1):67–80. https://doi.org/10.3233/JAD-140315.CrossRefPubMed

55.

Kaye EK, Valencia A, Baba N, Spiro A III, Dietrich T, Garcia RI. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 2010;58(4):713–8. https://doi.org/10.1111/j.1532-5415.2010.02788.x.CrossRefPubMedPubMedCentral

Title: Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis
Authors: Rizwan Nadim
Jie Tang
Amena Dilmohamed
Siyang Yuan
Changhao Wu
Aishat T. Bakre
Martin Partridge
Jindong Ni
John R. Copeland
Kaarin J. Anstey
Ruoling Chen
Publication date: 01-09-2020
Publisher: Springer Netherlands
Keywords: Alzheimer's Disease
Dementia
Gingival Diseases
Alzheimer's Disease
Dementia
Published in: European Journal of Epidemiology / Issue 9/2020
Print ISSN: 0393-2990
Electronic ISSN: 1573-7284
DOI: https://doi.org/10.1007/s10654-020-00648-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 9/2020

Female reproductive factors and the risk of Parkinson’s disease: a nationwide cohort study

The influence of maternal mental illness on vaccination uptake in children: a UK population-based cohort study

Association of aortic stiffness with cognitive decline: Whitehall II longitudinal cohort study

Changing contribution of smoking to the sex differences in life expectancy in Europe, 1950–2014

Are women using hormonal contraceptives the risk-takers?

Smoking cessation and incident dementia in elderly Japanese: the Ohsaki Cohort 2006 Study