Friday March 11 2016
Gum illness has actually been linked to conditions such as heart disease
“Exactly how brushing your teeth properly can easily ward of the symptoms of dementia,” is the misleading headline in the Everyday Mail.
In the study it reports on, all of the participants already had dementia related to Alzheimer’s disease. Exactly what the researchers wanted to do was investigate whether gum disease worsened the symptoms.
Sixty people along with mild or moderate dementia were included in the study and followed for 6 months. Assessments of dementia severity and dental good health were earned at the start and end of the study.
Researchers found that the presence of gum illness at the start of the study was not related to participants’ cognitive state at that point. However, it did appear to be associated to a six-fold raise in cognitive decline over a six-month follow-up period.
However, we can’t say for certain whether the gum illness is causing the cognitive decline. all of the participants had dementia at the start of the study, yet only some had gum disease. This muddles the picture, as we are not able to find out a “direction of travel”. It would certainly have actually been a lot more helpful if all of the participants had dementia, yet did not have actually gum illness (or vice versa).
Factors others compared to gum illness might be contributing to the differences, and the small sample size means that any type of result could be as a result of chance.
Therefore, we don’t already know whether keeping much better care of teeth could have actually a useful effect for those along with dementia. That said, it surely wouldn’t hurt.
Where did the story come from?
The study was carried out by researchers from a number of institutions, including Kings College London and the University of Southampton.
Funding was offered by the Dunhill Medical Trust – a UK-based charitable company that makes research grants related to ageing and older people.
The study was published in the open-access, peer-reviewed medical diary PLOS ONE, which can easily be read for free online or downloaded as a PDF.
Competing passions were reported by two members of the study team, one of whom received research support from the Dunhill Medical Trust. The others had received research support from the Dunhill Medical Trust, the Oral and Dental Research Trust, Colgate Palmolive and GlaxoSmithKline.
Many of the UK’s media’s headlines – such as the Mail’s “Exactly how brushing your teeth properly can easily ward of the symptoms of dementia” or The Everyday Telegraph’s “Brushing teeth regularly could ward off Alzheimer’s disease” – are misleading. They provide the impression that the study was looking at whether preventing gum illness would certainly avoid Alzheimer’s disease. In fact, everyone that took portion in the study already had Alzheimer’s.
Headlines aside, the actual outcomes have actually largely been reported accurately in the media.
The Telegraph included a quote from Dr Doug Brown, Director of Research and Development at the Alzheimer’s Society. He said: “This small study suggests that people that have actually the 2 Alzheimer’s and gum illness declined in memory and thinking a lot more promptly compared to those that had much better dental health. It’s unclear however, whether this is trigger or effect – if the gum illness is triggering the faster decline of dementia, or vice versa.” This highlights an crucial limitation of the study.
What type of research was this?
This was a cohort study which aimed to assess whether periodontitis (the medical term for gum disease) is associated along with an raise in severity of dementia and cognitive decline in people along with Alzheimer’s disease.
As the study recruited people that already had Alzheimer’s disease, it is unclear whether the gum illness could have actually contributed to causing the condition, as we cannot tell which condition occurred first. While the presence of gum illness could have actually affected the price of cognitive decline after this point, it is additionally feasible that others factors could be having an effect. For example, if those along with gum illness additionally have actually poorer general health, this could have actually an impact.
However, this study does offer a feasible link for further investigation.
What did the research involve?
The researchers included 60 non-smoking people along with mild to moderate dementia that were not living in nursing homes. Participants were included if they had:
- at least 10 teeth
- not received treatment for gum illness in the previous 6 months
- capacity to consent for themselves to take portion in the study
At the study’s start, cognition (mental functioning, such as memory and language skills) was tested using two accepted tools: the Alzheimer’s illness Assessment Scale (ADAS-cog) as the main measure and the standardized Mini-Mental State Examination (sMMSE) as a secondary measure. Complying with these assessments, a blood sample was taken and tested for antibodies versus bacteria related to gum disease.
The dental good health of participants was assessed by a research dental hygienist. The measures of dental good health assessed included:
- number of teeth
- measure of gum illness (including number of sites affected)
- plaque scores
- depth of any type of gaps between the gum and the root of the tooth (pockets)
- number of sites showing gum bleeding
Interviews along with the participants’ main caregivers were conducted to assess medical and dental history, including treatment for gum illness and medication use over the previous 6 months.
These assessments were carried out again at the end of the study, 6 months later.
Statistical analyses were performed to consider whether people along with gum illness showed a various pattern of cognitive decline to those that did not have actually the condition. The analyses took in to account the following confounding factors at the start of the study:
- participants’ age
- gender
- cognitive status
What were the easy results?
The participants were, on average, 77.7 years old and the group was evenly split between men and women. At the start of the study, 22 participants (37.3%) had gum disease. There was no partnership between Exactly how major a person’s cognitive impairment was and the presence of gum illness at the start of the study.
Six months later, at the last assessment, 52 participants were able to be assessed. Of the participants along with gum illness at the start, 15 (75%) continued to have actually the condition and two brand-new cases were found in participants that had previously not had it.
People that had gum illness at the start of the study were found to have, on average, concerning a six-point worsening of their ADAS-cog score after the six-month follow-up period, whereas those that did not have actually gum illness only had concerning a one-point worsening, on average. This association still remained after adjustment for participants’ age, gender and cognitive score at the start of the study.
Gum illness initially showed a similar partnership to adjustment in the secondary cognitive measure, the sMMSE, yet this was no longer statistically significant after adjustment.
How did the researchers interpret the results?
The researchers conclude: “Our data showed that periodontitis is associated along with an raise in cognitive decline in Alzheimer’s Disease, independent to baseline cognitive state.”
Conclusion
This cohort study aimed to assess whether the presence of gum illness is associated along with an raise in severity of dementia and cognitive decline in people along with Alzheimer’s.
Researchers found the presence of gum illness at the start of the study was not related to cognitive state, yet did appear to be associated along with a six-fold better cognitive decline over a six-month follow-up period.
The study has actually a number of limitations – for example, it was pretty small, so it is feasible the findings are not representative of Exactly what would certainly be seen in a larger sample. Most importantly, it is not able to prove trigger and effect.
The participants already had dementia at the study’s start, and some had gum disease, so we are not able to tell which occurred very first and could be contributing to the other. While the presence of gum illness was linked to faster decline of one measure of cognitive ability (the ADAS-cog) it was not the case for a second measure (the sMMSE). Also, despite the fact that some factors which could influence outcomes were taken in to account, such as age, others factors that could have actually had an impact were not.
It is feasible that people along with gum illness additionally have actually poorer general good health compared to those free of the condition, or have actually others differences. Therefore, these differences could be having an impact on cognitive decline, pretty compared to gum illness itself (called confounding).
There have actually been a number of others studies that have actually assessed this link, and there is growing interest in whether dental good health could have actually an impact on wider health.
These findings do include to the growing physique of evidence, yet a lot more research is needed to confirm the findings.
People along with symptoms of dementia regularly disregard the basics of personal hygiene. If you are caring for a person along with dementia, it is crucial that you encourage them to:
- wash their hands after using the toilet
- wash their “private parts” (including their anus) every day
- wash their face once a day
- take a shower or bath at least two times a week
- brush their teeth two times a day
Read a lot more about personal hygiene for cared-for people.