People with gingivitis (gum disease) have worse mental function than their peers whose gums are in better shape, a new analysis of US data shows.

The findings raise the possibility that system-wide inflammation due to gum disease could have harmful effects on brain function. However, because the study only looked at a single time point it could not gauge whether or not there is a causal relationship between oral health and cognitive performance.

Older people with bad teeth are more likely to have dementia and cognitive impairment, Dr. Robert Stewart of the Institute of Psychiatry in London and colleagues note, but it isn't known whether a similar relationship is present in younger people, and whether factors that can affect both dental health and mental function such as heart disease, high blood pressure or smoking may be involved.

To investigate, the researchers analyzed data from the Third National Health and Nutrition Examination Survey III. Stewart and his team looked at 5,138 adults aged 20 to 59 who had completed two tests of cognitive function, and another 1,555 adults aged 70 and older given a different mental function test.

After the researchers adjusted for the effects of age, they found associations between worse performance on any of the three cognitive tests and bleeding gums, loss of periodontal attachment (meaning the ligament that attaches teeth to bone), and tooth loss.

Oral health could influence cognitive function through several mechanisms, the researchers note; for example, periodontal disease can cause inflammation throughout the body, a risk factor for loss of mental function, while poor oral health can lead to a worse diet, which could affect mental function by leading to nutritional deficiency.

The fact that the association between poor oral health and worse mental function was not influenced by age suggests that "later life associations do not arise purely because of adverse effects of dementia on oral health care," the researchers conclude.

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For Your Ready Reference: Periodontal (gum) diseases

Untreated gingivitis can advance to periodontitis and eventually lead to tooth loss and other health problems.

Periodontal (gum) diseases, including gingivitis and periodontitis, are serious infections that, left untreated, can lead to tooth loss. The word periodontal literally means "around the tooth." Periodontal disease is a chronic bacterial infection that affects the gums and bone supporting the teeth. Periodontal disease can affect one tooth or many teeth. It begins when the bacteria in plaque (the sticky, colorless film that constantly forms on your teeth) causes the gums to become inflamed.


Gingivitis

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.


Periodontitis

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.


Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.

Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.

Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.

Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

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