J Korean Med Sci.  2013 Jun;28(6):929-933. 10.3346/jkms.2013.28.6.929.

Tooth Loss Is Associated with Brain White Matter Change and Silent Infarction among Adults without Dementia and Stroke

• Minn YK
• Suk SH
• Park H
• Cheong JS
• Yang H
• Lee S
• Do SY
• Kang JS

• KMID: 2158043
• DOI: http://doi.org/10.3346/jkms.2013.28.6.929

Abstract

Periodontal disease is a predictor of stroke and cognitive impairment. The association between the number of lost teeth (an indicator of periodontal disease) and silent infarcts and cerebral white matter changes on brain CT was investigated in community-dwelling adults without dementia or stroke. Dental examination and CT were performed in 438 stroke- and dementia-free subjects older than 50 yr (mean age, 63 +/- 7.9 yr), who were recruited for an early health check-up program as part of the Prevention of Stroke and Dementia (PRESENT) project between 2009 and 2010. In unadjusted analyses, the odds ratio (OR) for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 and > 10 lost teeth was 2.3 (95% CI, 1.38-4.39; P = 0.006) and 4.2 (95% CI, 1.57-5.64; P < 0.001), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the ORs were 1.7 (95% CI, 1.08-3.69; P = 0.12) and 3.9 (95% CI, 1.27-5.02; P < 0.001), respectively. These findings suggest that severe tooth loss may be a predictor of silent cerebral infarcts and cerebral white matter changes in community-dwelling, stroke- and dementia-free adults.

Keyword

Tooth Loss; Periodontitis; Dental Caries; Health Promotion; Preventive Health Service; Risk Factors; Dementia; Alzheimer Disease; Leukoencephalopathy; Tomography, X-ray Computed

MeSH Terms

Age Factors
Aged
Alzheimer Disease/diagnosis
Brain/*radiography
Cross-Sectional Studies
Dementia/pathology/prevention & control
Diabetes Complications/diagnosis
Female
Humans
Hyperlipidemias/complications
Hypertension/complications
Interviews as Topic
Male
Middle Aged
Odds Ratio
Periodontal Diseases/complications/*diagnosis
Predictive Value of Tests
Risk Factors
Stroke/pathology/prevention & control
Tomography, X-Ray Computed
Tooth Loss

Figure

• 

  Fig. 1 Odds ratios (OR) of unadjusted (A) and adjusted (B) multivariate analysis. The OR for silent cerebral infarcts and cerebral white matter changes for subjects with 6-10 teeth and >10 lost teeth was 2.3 (95% CI, 1.38-4.39; P < 0.01) and 4.2 (95% CI, 1.57-5.64; P < 0.01), respectively, as compared to subjects with 0-5 lost teeth. After adjustment for age, education, hypertension, diabetes mellitus, hyperlipidemia, and smoking, the OR was 1.7 (95% CI, 1.08-3.69; P = 0.12) for subjects with 6-10 lost teeth and 3.9 (95% CI, 1.27-5.02; P < 0.01) for subjects with >10 lost teeth.

Reference

1. Kamer AR, Morse DE, Holm-Pedersen P, Mortensen EL, Avlund K. Periodontal inflammation in relation to cognitive function in an older adult Danish population. J Alzheimers Dis. 2012; 28:613–624.

2. Batty GD, Li Q, Huxley R, Zoungas S, Taylor BA, Neal B, de Galan B, Woodward M, Harrap SB, Colagiuri S, et al. Oral disease in relation to future risk of dementia and cognitive decline: prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) Trial. Eur Psychiatry. 2013; 28:49–52.

3. Stein PS, Desrosiers M, Donegan SJ, Yepes JF, Kryscio RJ. Tooth loss, dementia and neuropathology in the Nun Study. J Am Dent Assoc. 2007; 138:1314–1322.

4. Kaye EK, Valencia A, Baba N, Spiro A 3rd, Dietrich T, Garcia RI. Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc. 2010; 58:713–718.

5. Stewart R, Sabbah W, Tsakos G, D'Aiuto F, Watt RG. Oral health and cognitive function in the Third National Health and Nutrition Examination Survey (NHANES III). Psychosom Med. 2008; 70:936–941.

6. Okamoto N, Morikawa M, Okamoto K, Habu N, Iwamoto J, Tomioka K, Saeki K, Yanagi M, Amano N, Kurumatani N. Relationship of tooth loss to mild memory impairment and cognitive impairment: findings from the Fujiwara-kyo Study. Behav Brain Funct. 2010; 6:77.

7. Makiura T, Ikeda Y, Hirai T, Terasawa H, Hamaue N, Minami M. Influence of diet and occlusal support on learning memory in rats behavioral and biochemical studies. Res Commun Mol Pathol Pharmacol. 2000; 107:269–277.

8. Fillit H, Nash DT, Rundek T, Zuckerman A. Cardiovascular risk factors and dementia. Am J Geriatr Pharmacother. 2008; 6:100–118.

9. Lee DY, Fletcher E, Martinez O, Ortega M, Zozulya N, Kim J, Tran J, Buonocore M, Carmichael O, DeCarli C. Regional pattern of white matter microstructural changes in normal aging, MCI, and AD. Neurology. 2009; 73:1722–1728.

10. Fernando MS, Ince PG. MRC Cognitive Function and Ageing Neuropathology Study Group. Vascular pathologies and cognition in a population-based cohort of elderly people. J Neurol Sci. 2004; 226:13–17.

11. Inaba M, White L, Bell C, Chen R, Petrovitch H, Launer L, Abbott RD, Ross GW, Masaki K. White matter lesions on brain magnetic resonance imaging scan and 5-yr cognitive decline: the Honolulu-Asia Aging Study. J Am Geriatr Soc. 2011; 59:1484–1489.

12. Gorelick PB, Scuteri A, Black SE, Decarli C, Greenberg SM, Iadecola C, Launer LJ, Laurent S, Lopez OL, Nyenhuis D, et al. Vascular contributions to cognitive impairment and dementia: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42:2672–2713.

13. Zoellner H. Dental infection and vascular disease. Semin Thromb Hemost. 2011; 37:181–192.

14. Holmlund A, Holm G, Lind L. Number of teeth as a predictor of cardiovascular mortality in a cohort of 7,674 subjects followed for 12 years. J Periodontol. 2010; 81:870–876.

15. Wu T, Trevisan M, Genco RJ, Dorn JP, Falkner KL, Sempos CT. Periodontal disease and risk of cerebrovascular disease: the first national health and nutrition examination survey and its follow-up study. Arch Intern Med. 2000; 160:2749–2755.

16. Stewart R, Dufouil C, Godin O, Ritchie K, Maillard P, Delcroix N, Crivello F, Mazoyer B, Tzourio C. Neuroimaging correlates of subjective memory deficits in a community population. Neurology. 2008; 70:1601–1607.

17. Joshipura KJ, Hung HC, Rimm EB, Willett WC, Ascherio A. Periodontal disease, tooth loss, and incidence of ischemic stroke. Stroke. 2003; 34:47–52.

18. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, Jones DW, Materson BJ, Oparil S, Wright JT Jr, et al. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003; 289:2560–2572.

19. National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation. 2002; 106:3143–3421.

20. Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care. 2003; 26:S5–S20.

21. Wahlund LO, Barkhof F, Fazekas F, Bronge L, Augustin M, Sjögren M, Wallin A, Ader H, Leys D, Pantoni L, et al. A new rating scale for age-related white matter changes applicable to MRI and CT. Stroke. 2001; 32:1318–1322.

22. Giele JL, Witkamp TD, Mali WP, van der Graaf Y. SMART Study Group. Silent brain infarcts in patients with manifest vascular disease. Stroke. 2004; 35:742–746.

23. Beck JD, Sharp T, Koch GG, Offenbacher S. A 5-year study of attachment loss and tooth loss in community-dwelling older adults. J Periodontal Res. 1997; 32:516–523.

24. Chin UJ, Ji S, Lee SY, Ryu JJ, Lee JB, Shin C, Shin SW. Relationship between tooth loss and carotid intima-media thickness in Korean adults. J Adv Prosthodont. 2010; 2:122–127.

25. Nakano K, Inaba H, Nomura R, Nemoto H, Takeda M, Yoshioka H, Matsue H, Takahashi T, Taniguchi K, Amano A, et al. Detection of cariogenic Streptococcus mutans in extirpated heart valve and atheromatous plaque specimens. J Clin Microbiol. 2006; 44:3313–3317.