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Poor Oral Health as a Chronic, Potentially Modifiable Dementia Risk Factor: Review of the Literature


Poor oral health, including caries, tooth loss, and periodontitis, is ubiquitous worldwide, and is potentially treatable and preventable. Like adverse oral health conditions, Alzheimer disease and related disorders are also very common among aging populations. Established risk factors for Alzheimer disease include cerebrovascular disease and its vascular risk factors, many of which share associations with evidence of systemic inflammation also identified in periodontitis and other poor oral health states. In this review, we present epidemiologic evidence of links between poor oral health and both prevalent and incident cognitive impairment, and review plausible mechanisms linking these conditions, including evidence from compelling animal models. Considering that a large etiologic fraction of dementia remains unexplained, these studies argue for further multidisciplinary research between oral health conditions, including translational, epidemiologic, and possibly clinical treatment studies.

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Paper of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Gurland BJ, Wilder DE, Lantigua R, et al. Rates of dementia in three ethnoracial groups. Int J Geriatr Psychiatry. 1999;14:481–93.

  2. 2.

    Mayeux R. Epidemiology of neurodegeneration. Annu Rev Neurosci. 2003;26:81–104.

  3. 3.

    Hebert LE, Scherr PA, Bienias JL, Bennett DA, Evans DA. Alzheimer disease in the US population: prevalence estimates using the 2000 census. Arch Neurol. 2003;60:1119–22.

  4. 4.

    Mayeux R, Apolipoprotein E. Alzheimer disease, and African Americans. Arch Neurol. 2003;60:161–3.

  5. 5.

    Tang MX, Stern Y, Marder K, et al. The APOE-e4 allele and the risk of Alzheimer disease among African Americans, whites, and Hispanics. JAMA. 1998;279:751–5.

  6. 6.

    • Barnes DE, Yaffe K. The projected effect of risk factor reduction on Alzheimer's disease prevalence. Lancet Neurol. 2011;10:819–28. This review places into perspective the etiologic fraction of several lifestyle and vascular risk factors for AD and underscores the impact that identification and elimination of others factors, such as oral health, could have on disease prevalence.

  7. 7.

    Noble JM, Scarmeas N. Cognitive impairment. In: Lamster IB, Northridge ME, editors. Improving oral health for the elderly. New York: Springer Books; 2008.

  8. 8.

    Miller AJ, Brunelle JA, Carlos JP, Brown LJ, Löe H. Oral health of United States adults. Bethesda: US Department of Health & Human Services, Public Health Service, National Institutes of Health; 1987.

  9. 9.

    Beck JD, Koch GG, Rozier RG, Tudor GE. Prevalence and risk indicators for periodontal attachment loss in a population of older community-dwelling blacks and whites. J Periodontol. 1990;61:521–8.

  10. 10.

    Petersen PE. The world oral health report 2003: continuous improvement of oral health in the 21st century – the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31 Suppl 1:3–23.

  11. 11.

    Petersen PE, Yamamoto T. Improving the oral health of older people: the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2005;33:81–92.

  12. 12.

    Machtei EE, Hausmann E, Dunford R, et al. Longitudinal study of predictive factors for periodontal disease and tooth loss. J Clin Periodontol. 1999;26:374–80.

  13. 13.

    Rosling B, Serino G, Hellstrom MK, Socransky SS, Lindhe J. Longitudinal periodontal tissue alterations during supportive therapy. Findings from subjects with normal and high susceptibility to periodontal disease. J Clin Periodontol. 2001;28:241–9.

  14. 14.

    Demmer RT, Papapanou PN. Epidemiologic patterns of chronic and aggressive periodontitis. Periodontol 2000. 2010;53:28–44.

  15. 15.

    Offenbacher S, Barros SP, Singer RE, Moss K, Williams RC, Beck JD. Periodontal disease at the biofilm-gingival interface. J Periodontol. 2007;78:1911–25.

  16. 16.

    • Eke PI, Dye BA, Wei L, Thornton-Evans GO, Genco RJ. Prevalence of periodontitis in adults in the United States: 2009 and 2010. J Dent Res. 2012;91:914–20. This is a thorough appraisal of current epidemiologic estimates of periodontitis.

  17. 17.

    Kulekci G, Leblebicioglub B, Keskina F, Ciftcia S, Badurc S. Salivary detection of periodontopathic bacteria in periodontally healthy children. Anaerobe. 2008;14:49–54.

  18. 18.

    Preus HR, Zambon JJ, Dunford RG, Genco RJ. The distribution and transmission of Actinobacillus actinomycetemcomitans in families with established adult periodontitis. J Periodontol. 1994;65:2–7.

  19. 19.

    Papapanou PN, Neiderud AM, Disick E, Lalla E, Miller GC, Dahlen G. Longitudinal stability of serum immunoglobulin G responses to periodontal bacteria. J Clin Periodontol. 2004;31:985–90.

  20. 20.

    Joshipura K, Zevallos JC, Ritchie CS. Strength of evidence relating periodontal disease and atherosclerotic disease. Compend Contin Educ Dent. 2009;30:430–9.

  21. 21.

    Kebschull M, Demmer RT, Papapanou PN. "Gum bug, leave my heart alone!"–epidemiologic and mechanistic evidence linking periodontal infections and atherosclerosis. J Dent Res. 2010;89:879–902.

  22. 22.

    Pussinen PJ, Alfthan G, Jousilahti P, Paju S, Tuomilehto J. Systemic exposure to Porphyromonas gingivalis predicts incident stroke. Atherosclerosis. 2007;193:222–8.

  23. 23.

    Pussinen PJ, Alfthan G, Rissanen H, Reunanen A, Asikainen S, Knekt P. Antibodies to periodontal pathogens and stroke risk. Stroke. 2004;35:2020–3.

  24. 24.

    Johansson A, Johansson I, Eriksson M, Ahren AM, Hallmans G, Stegmayr B. Systemic antibodies to the leukotoxin of the oral pathogen Actinobacillus actinomycetemcomitans correlate negatively with stroke in women. Cerebrovasc Dis. 2005;20:226–32.

  25. 25.

    Ford PJ, Gemmell E, Timms P, Chan A, Preston FM, Seymour GJ. Anti-P. gingivalis response correlates with atherosclerosis. J Dent Res. 2007;86:35–40.

  26. 26.

    Desvarieux M, Demmer RT, Rundek T, et al. Periodontal microbiota and carotid intima-media thickness: the Oral Infections and Vascular Disease Epidemiology Study (INVEST). Circulation. 2005;111:576–82.

  27. 27.

    Luchsinger JA, Mayeux R. Cardiovascular risk factors and Alzheimer's disease. Curr Atheroscler Rep. 2004;6:261–6.

  28. 28.

    Luchsinger JA, Reitz C, Honig LS, Tang MX, Shea S, Mayeux R. Aggregation of vascular risk factors and risk of incident Alzheimer disease. Neurology. 2005;65:545–51.

  29. 29.

    Leibson CL, Rocca WA, Hanson VA, et al. Risk of dementia among persons with diabetes mellitus: a population-based cohort study. Am J Epidemiol. 1997;145:301–8.

  30. 30.

    Ott A, Stolk RP, van Harskamp F, Pols HA, Hofman A, Breteler MM. Diabetes mellitus and the risk of dementia: The Rotterdam Study. Neurology. 1999;53:1937–42.

  31. 31.

    Peila R, Rodriguez BL, Launer LJ. Type 2 diabetes, APOE gene, and the risk for dementia and related pathologies: the Honolulu-Asia Aging Study. Diabetes. 2002;51:1256–62.

  32. 32.

    Luchsinger JA, Tang MX, Stern Y, Shea S, Mayeux R. Diabetes mellitus and risk of Alzheimer's disease and dementia with stroke in a multiethnic cohort. Am J Epidemiol. 2001;154:635–41.

  33. 33.

    Cheng D, Noble J, Tang MX, Schupf N, Mayeux R, Luchsinger JA. Type 2 diabetes and late-onset Alzheimer's disease. Dement Geriatr Cogn Disord. 2011;31:424–30.

  34. 34.

    Jick H, Zornberg GL, Jick SS, Seshadri S, Drachman DA. Statins and the risk of dementia. Lancet. 2000;356:1627–31.

  35. 35.

    Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996;347:1141–5.

  36. 36.

    Hofman A, Ott A, Breteler MM, et al. Atherosclerosis, apolipoprotein E, and prevalence of dementia and Alzheimer's disease in the Rotterdam Study. Lancet. 1997;349:151–4.

  37. 37.

    Ott A, Slooter AJ, Hofman A, et al. Smoking and risk of dementia and Alzheimer's disease in a population-based cohort study: the Rotterdam Study. Lancet. 1998;351:1840–3.

  38. 38.

    Merchant C, Tang MX, Albert S, Manly J, Stern Y, Mayeux R. The influence of smoking on the risk of Alzheimer's disease. Neurology. 1999;52:1408–12.

  39. 39.

    Aggarwal NT, Bienias JL, Bennett DA, et al. The relation of cigarette smoking to incident Alzheimer's disease in a biracial urban community population. Neuroepidemiology. 2006;26:140–6.

  40. 40.

    Seshadri S, Beiser A, Selhub J, et al. Plasma homocysteine as a risk factor for dementia and Alzheimer's disease. N Engl J Med. 2002;346:476–83.

  41. 41.

    Gustafson D, Rothenberg E, Blennow K, Steen B, Skoog I. An 18-year follow-up of overweight and risk of Alzheimer disease. Arch Intern Med. 2003;163:1524–8.

  42. 42.

    Whitmer RA, Gunderson EP, Barrett-Connor E, Quesenberry Jr CP, Yaffe K. Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study. BMJ. 2005;330:1360.

  43. 43.

    Rosengren A, Skoog I, Gustafson D, Wilhelmsen L. Body mass index, other cardiovascular risk factors, and hospitalization for dementia. Arch Intern Med. 2005;165:321–6.

  44. 44.

    Kalmijn S, Foley D, White L, et al. Metabolic cardiovascular syndrome and risk of dementia in Japanese-American elderly men. The Honolulu-Asia aging study. Arterioscler, Thromb, Vasc Biol. 2000;20:2255–60.

  45. 45.

    Gorospe EC, Dave JK. The risk of dementia with increased body mass index: a systematic review. Age Ageing. 2006;36:23–9.

  46. 46.

    Honig LS, Kukull W, Mayeux R. Atherosclerosis and AD: analysis of data from the US National Alzheimer's Coordinating Center. Neurology. 2005;64:494–500.

  47. 47.

    Langa KM, Foster NL, Larson EB. Mixed dementia: emerging concepts and therapeutic implications. JAMA. 2004;292:2901–8.

  48. 48.

    van Oijen M, de Jong FJ, Witteman JC, Hofman A, Koudstaal PJ, Breteler MM. Atherosclerosis and risk for dementia. Ann Neurol. 2007;61:403–10.

  49. 49.

    Syrjala AM, Ylostalo P, Ruoppi P, et al. Dementia and oral health among subjects aged 75 years or older. Gerodontology. 2012;29:36–42.

  50. 50.

    Yamamoto T, Kondo K, Hirai H, Nakade M, Aida J, Hirata Y. Association between self-reported dental health status and onset of dementia: a 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project. Psychosom Med. 2012;74:241–8.

  51. 51.

    Yoneyama T, Yoshida M, Ohrui T, et al. Oral care reduces pneumonia in older patients in nursing homes. J Am Geriatr Soc. 2002;50:430–3.

  52. 52.

    Takahashi N, Nyvad B. The role of bacteria in the caries process: ecological perspectives. J Dent Res. 2011;90:294–303.

  53. 53.

    Takahashi N, Nyvad B. Caries ecology revisited: microbial dynamics and the caries process. Caries Res. 2008;42:409–18.

  54. 54.

    Ship JA. Oral health of patients with Alzheimer's disease. J Am Dent Assoc. 1992;123:53–8.

  55. 55.

    Jones JA, Lavallee N, Alman J, Sinclair C, Garcia RI. Caries incidence in patients with dementia. Gerodontology. 1993;10:76–82.

  56. 56.

    Syrjala AM, Ylostalo P, Sulkava R, Knuuttila M. Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland. Acta Odontol Scand. 2007;65:103–8.

  57. 57.

    Chalmers JM, Carter KD, Spencer AJ. Caries incidence and increments in community-living older adults with and without dementia. Gerodontology. 2002;19:80–94.

  58. 58.

    Stewart R, Hirani V. Dental health and cognitive impairment in an English national survey population. J Am Geriatr Soc. 2007;55:1410–4.

  59. 59.

    Grabe HJ, Schwahn C, Volzke H, et al. Tooth loss and cognitive impairment. J Clin Periodontol. 2009;36:550–7.

  60. 60.

    Kondo K, Niino M, Shido K. A case–control study of Alzheimer's disease in Japan – significance of life-styles. Dementia. 1994;5:314–26.

  61. 61.

    Okamoto N, Morikawa M, Okamoto K, et al. Tooth loss is associated with mild memory impairment in the elderly: the Fujiwara-kyo study. Brain Res. 2010;1349:68–75.

  62. 62.

    Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, Winblad B. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontology. 2004;21:17–26.

  63. 63.

    Kaye EK, Valencia A, Baba N, Spiro 3rd A, Dietrich T, Garcia RI. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 2010;58:713–8.

  64. 64.

    Gatz M, Mortimer JA, Fratiglioni L, et al. Potentially modifiable risk factors for dementia in identical twins. Alzheimers Dement. 2006;2:110–7.

  65. 65.

    Stein PS, Desrosiers M, Donegan SJ, Yepes JF, Kryscio RJ. Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc. 2007;138:1314–22. quiz 1381–2.

  66. 66.

    •• Stein PS, Kryscio RJ, Desrosiers M, Donegan SJ, Gibbs MB. Tooth loss, apolipoprotein E, and decline in delayed word recall. J Dent Res. 2010;89:473–7. This is a rather compelling epidemiologic study of tooth loss predicting memory loss, including APOE effect modification, within a well-described aging cohort (Religious Orders Study).

  67. 67.

    Anderson DJ. Measurement of stress in mastication. I J Dent Res. 1956;35:664–70.

  68. 68.

    Yurkstas A. The effect of masticatory exercise on the maximum force tolerance of individual teeth. J Dent Res. 1953;32:322–7.

  69. 69.

    Lexomboon D, Trulsson M, Wardh I, Parker MG. Chewing ability and tooth loss: association with cognitive impairment in an elderly population study. J Am Geriatr Soc. 2012;60:1951–6.

  70. 70.

    Kim JM, Stewart R, Prince M, et al. Dental health, nutritional status and recent-onset dementia in a Korean community population. Int J Geriatr Psychiatry. 2007;22:850–5.

  71. 71.

    Sheiham A, Steele J. Does the condition of the mouth and teeth affect the ability to eat certain foods, nutrient and dietary intake and nutritional status amongst older people? Public Health Nutr. 2001;4:797–803.

  72. 72.

    Walls AW, Steele JG, Sheiham A, Marcenes W, Moynihan PJ. Oral health and nutrition in older people. J Public Health Dent. 2000;60:304–7.

  73. 73.

    Scarmeas N, Stern Y, Mayeux R, Luchsinger JA. Mediterranean diet, Alzheimer disease, and vascular mediation. Arch Neurol. 2006;63:1709–17.

  74. 74.

    Scarmeas N, Stern Y, Tang MX, Mayeux R, Luchsinger JA. Mediterranean diet and risk for Alzheimer's disease. Ann Neurol. 2006;59:912–21.

  75. 75.

    Krall EA, Garvey AJ, Garcia RI. Alveolar bone loss and tooth loss in male cigar and pipe smokers. J Am Dent Assoc. 1999;130:57–64.

  76. 76.

    Department of Health and Human Services. Oral health in America: a report of the Surgeon General. Rockville: National Institutes of Health, National Institute of Dental and Craniofacial Research; 2000.

  77. 77.

    Hutton B, Feine J, Morais J. Is there an association between edentulism and nutritional state? J Can Dent Assoc. 2002;68:182–7.

  78. 78.

    Socransky SS, Haffajee AD, Cugini MA, Smith C, Kent Jr RL. Microbial complexes in subgingival plaque. J Clin Periodontol. 1998;25:134–44.

  79. 79.

    Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002;15:167–93.

  80. 80.

    Noble JM, Borrell LN, Papapanou PN, Elkind MS, Scarmeas N, Wright CB. Periodontitis is associated with cognitive impairment among older adults: analysis of NHANES-III. J Neurol Neurosurg Psychiatry. 2009;80:1206–11.

  81. 81.

    Noble J, Scarmeas N, Celentia R, et al. Serum antibodies to periodontal pathogens are associated with incident Alzheimer disease. Alzheimers Dement. 2012;8:498.

  82. 82.

    Sparks Stein P, Steffen MJ, Smith C, et al. Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease. Alzheimers Dement. 2012;8:196–203.

  83. 83.

    Kamer AR, Craig RG, Pirraglia E, et al. TNF-alpha and antibodies to periodontal bacteria discriminate between Alzheimer's disease patients and normal subjects. J Neuroimmunol. 2009;216:92–7.

  84. 84.

    Querfurth HW, LaFerla FM. Alzheimer's disease. N Engl J Med. 2010;362:329–44.

  85. 85.

    Silva TA, Garlet GP, Fukada SY, Silva JS, Cunha FQ. Chemokines in oral inflammatory diseases: apical periodontitis and periodontal disease. J Dent Res. 2007;86:306–19.

  86. 86.

    Bodet C, Chandad F, Grenier D. Porphyromonas gingivalis-induced inflammatory mediator profile in an ex vivo human whole blood model. Clin Exp Immunol. 2006;143:50–7.

  87. 87.

    D'Aiuto F, Parkar M, Andreou G, et al. Periodontitis and systemic inflammation: control of the local infection is associated with a reduction in serum inflammatory markers. J Dent Res. 2004;83:156–60.

  88. 88.

    Loos BG, Craandijk J, Hoek FJ, Wertheim-van Dillen PM, van der Velden U. Elevation of systemic markers related to cardiovascular diseases in the peripheral blood of periodontitis patients. J Periodontol. 2000;71:1528–34.

  89. 89.

    Wu T, Trevisan M, Genco RJ, Falkner KL, Dorn JP, Sempos CT. Examination of the relation between periodontal health status and cardiovascular risk factors: serum total and high density lipoprotein cholesterol, C-reactive protein, and plasma fibrinogen. Am J Epidemiol. 2000;151:273–82.

  90. 90.

    Roberts FA, McCaffery KA, Michalek SM. Profile of cytokine mRNA expression in chronic adult periodontitis. J Dent Res. 1997;76:1833–9.

  91. 91.

    Murata T, Miyazaki H, Senpuku H, Hanada N. Periodontitis and serum interleukin-6 levels in the elderly. Jpn J Infect Dis. 2001;54:69–71.

  92. 92.

    Bretz WA, Weyant RJ, Corby PM, et al. Systemic inflammatory markers, periodontal diseases, and periodontal infections in an elderly population. J Am Geriatr Soc. 2005;53:1532–7.

  93. 93.

    Dye BA, Choudhary K, Shea S, Papapanou PN. Serum antibodies to periodontal pathogens and markers of systemic inflammation. J Clin Periodontol. 2005;32:1189–99.

  94. 94.

    Colombo AP, Boches SK, Cotton SL, et al. Comparisons of subgingival microbial profiles of refractory periodontitis, severe periodontitis, and periodontal health using the human oral microbe identification microarray. J Periodontol. 2009;80:1421–32.

  95. 95.

    Schmidt AM, Weidman E, Lalla E, et al. Advanced glycation endproducts (AGEs) induce oxidant stress in the gingiva: a potential mechanism underlying accelerated periodontal disease associated with diabetes. J Periodontal Res. 1996;31:508–15.

  96. 96.

    Lalla E, Papapanou PN. Diabetes mellitus and periodontitis: a tale of two common interrelated diseases. Nat Rev Endocrinol. 2011;7:738–48.

  97. 97.

    Elter JR, Hinderliter AL, Offenbacher S, et al. The effects of periodontal therapy on vascular endothelial function: a pilot trial. Am Heart J. 2006;151:47.

  98. 98.

    Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol. 2008;35:277–90.

  99. 99.

    Tonetti MS, D'Aiuto F, Nibali L, et al. Treatment of periodontitis and endothelial function. N Engl J Med. 2007;356:911–20.

  100. 100.

    Seinost G, Wimmer G, Skerget M, et al. Periodontal treatment improves endothelial dysfunction in patients with severe periodontitis. Am Heart J. 2005;149:1050–4.

  101. 101.

    Mercanoglu F, Oflaz H, Oz O, et al. Endothelial dysfunction in patients with chronic periodontitis and its improvement after initial periodontal therapy. J Periodontol. 2004;75:1694–700.

  102. 102.

    Armitage GC. Periodontal infections and cardiovascular disease—how strong is the association? Oral Dis. 2000;6:335–50.

  103. 103.

    Janket SJ, Baird AE, Chuang SK, Jones JA. Meta-analysis of periodontal disease and risk of coronary heart disease and stroke. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95:559–69.

  104. 104.

    Cueto A, Mesa F, Bravo M, Ocana-Riola R. Periodontitis as risk factor for acute myocardial infarction. A case control study of Spanish adults. J Periodontal Res. 2005;40:36–42.

  105. 105.

    Behle JH, Papapanou PN. Periodontal infections and atherosclerotic vascular disease: an update. Int Dent J. 2006;56:256–62.

  106. 106.

    Takeda M, Ojima M, Yoshioka H, et al. Relationship of serum advanced glycation end products with deterioration of periodontitis in type 2 diabetes patients. J Periodontol. 2006;77:15–20.

  107. 107.

    Shlossman M, Knowler WC, Pettitt DJ, Genco RJ. Type 2 diabetes mellitus and periodontal disease. J Am Dent Assoc. 1990;121:532–6.

  108. 108.

    Lalla E, Kaplan S, Chang SM, et al. Periodontal infection profiles in type 1 diabetes. J Clin Periodontol. 2006;33:855–62.

  109. 109.

    Craft S. Insulin resistance syndrome and Alzheimer's disease: age- and obesity-related effects on memory, amyloid, and inflammation. Neurobiol Aging. 2005;26 Suppl 1:65–9.

  110. 110.

    de Luca C, Olefsky JM. Inflammation and insulin resistance. FEBS Lett. 2008;582:97–105.

  111. 111.

    Singer G, Granger DN. Inflammatory responses underlying the microvascular dysfunction associated with obesity and insulin resistance. Microcirculation. 2007;14:375–87.

  112. 112.

    Yanbaeva DG, Dentener MA, Creutzberg EC, Wesseling G, Wouters EF. Systemic effects of smoking. Chest. 2007;131:1557–66.

  113. 113.

    Libby P, Ridker PM, Maseri A. Inflammation and atherosclerosis. Circulation. 2002;105:1135–43.

  114. 114.

    Hansson GK, Robertson AK, Soderberg-Naucler C. Inflammation and atherosclerosis. Annu Rev Pathol. 2006;1:297–329.

  115. 115.

    DeGraba TJ. Immunogenetic susceptibility of atherosclerotic stroke: implications on current and future treatment of vascular inflammation. Stroke. 2004;35:2712–9.

  116. 116.

    Noble JM, Manly JJ, Schupf N, Tang MX, Mayeux R, Luchsinger JA. Association of C-reactive protein with cognitive impairment. Arch Neurol. 2010;67:87–92.

  117. 117.

    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;83:239–42.

  118. 118.

    Gobel S. An electron microscopic analysis of the trans-synaptic effects of peripheral nerve injury subsequent to tooth pulp extirpations on neurons in laminae I and II of the medullary dorsal horn. J Neurosci. 1984;4:2281–90.

  119. 119.

    Gobel S, Binck JM. Degenerative changes in primary trigeminal axons and in neurons in nucleus caudalis following tooth pulp extirpations in the cat. Brain Res. 1977;132:347–54.

  120. 120.

    Yamazaki K, Wakabayashi N, Kobayashi T, Suzuki T. Effect of tooth loss on spatial memory and trkB-mRNA levels in rats. Hippocampus. 2008;18:542–7.

  121. 121.

    Watanabe K, Tonosaki K, Kawase T, et al. Evidence for involvement of dysfunctional teeth in the senile process in the hippocampus of SAMP8 mice. Exp Gerontol. 2001;36:283–95.

  122. 122.

    Onozuka M, Watanabe K, Mirbod SM, et al. Reduced mastication stimulates impairment of spatial memory and degeneration of hippocampal neurons in aged SAMP8 mice. Brain Res. 1999;826:148–53.

  123. 123.

    Onozuka M, Watanabe K, Nagasaki S, et al. Impairment of spatial memory and changes in astroglial responsiveness following loss of molar teeth in aged SAMP8 mice. Behav Brain Res. 2000;108:145–55.

  124. 124.

    Watanabe K, Ozono S, Nishiyama K, et al. The molarless condition in aged SAMP8 mice attenuates hippocampal Fos induction linked to water maze performance. Behav Brain Res. 2002;128:19–25.

  125. 125.

    Oue H, Miyamoto Y, Okada S, Koretake K, Michikawa M, Akagawa Y. Tooth loss induces memory impairment and neuronal cell loss in APP transgenic mice. Behav Brain Res. 2013;252:318–25.

  126. 126.

    Ishida N, Ishihara Y, Ishida K, et al. Periodontitis induced by bacterial infection exacerbates features of Alzheimer's disease in transgenic mice. Poster session presented at: Alzheimer's Association International Conference; 2013 Jul 17; Boston.

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James M. Noble has received grant support from the Taub Institute (internal funding mechanism), and some of the prior research described was supported through this grant. He has also received grant support from the National Institute of Dental and Craniofacial Research. Nikolaos Scarmeas has received grant support from the National Institute on Aging (grant AG028506) and the Alzheimer’s Association (grant IIRG-04-1353).

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Conflict of Interest

James M. Noble has received honoraria from Barclays for a single consulting event regarding intravenous immunoglobulin as an AD therapeutic (the trial has since been reported as a failure).

Nikolaos Scarmeas and Panos N. Papapanou declare that they have no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to James M. Noble.

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This article is part of the Topical Collection on Dementia

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Noble, J.M., Scarmeas, N. & Papapanou, P.N. Poor Oral Health as a Chronic, Potentially Modifiable Dementia Risk Factor: Review of the Literature. Curr Neurol Neurosci Rep 13, 384 (2013). https://doi.org/10.1007/s11910-013-0384-x

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  • Periodontitis
  • Periodontal disease
  • Tooth loss
  • Oral health
  • Caries
  • Dentures
  • Alzheimer disease
  • Cerebrovascular disease
  • Vascular dementia
  • Dementia
  • Epidemiology