Overview

In 2019, widely publicized findings indicated that enzymes (gingipains) secreted by a bacteria commonly thought to be one of the keystone pathogens for periodontitis, Porphrymonas gingivalis (P.g.), have been identified in the brain tissues of individuals with pathology and symptoms of Alzheimer’s Disease at higher levels than in the brains of individuals without such symptoms.1 This report has sparked interest in the potential role of periodontal diseases in development of Alzheimer’s and other dementias. It is, however, important to note that these data are based upon a cross-sectional analysis of tissues and that gingipains were found in 96% of all tissues assessed. This report also builds upon prior animal studies that have indicated that chronic oral application of P.g. or the gingipains it produces increase the production of amyloid beta, a component of the amyloid plaques whose accumulation contributes to Alzheimer’s Disease.2 While prospective trials are necessary to identify causation and/or common disease pathways, recent reports have speculated that periodontal health may be critical in this population.

Previous research has indicated that patients with periodontal disease are up to 70% more likely to present with Alzheimer’s Disease than those who are periodontally healthy.3,4 This association may be due to poorer oral hygiene over time due to deficits associated with dementia, dementia patients’ resistance to caregiver delivery of oral care resulting in a reduction of oral hygiene delivery, medication induced xerostomia, or other challendges associated with oral hygiene delivery for patients with dementia leading to larger dental plaque masses and/or more pathologic intraoral bacteria. It has also been hypothesized that this interaction may be mediated by inflammation, the periodontal microbiome, and the immune reactions to those pathogens.5,6 The elderly population (over 65 years old) in the United States is expected to nearly double from 43.1 million in 2014 to 83.7 million by the year 2050.7 Currently, over 5 million adults, approximately 13.9% of older adults, in the United States suffer with dementia.8 Additionally, the rate of total edentulism is dropping and is expected to reach as low as 2.6% by 2050, which, accounting for estimations of population growth and aging, represents a 30% decrease in overall edentulism.9 Furthermore, medications for dementia often increase symptoms of xerostomia and higher caries rates are seen in patients with dementia, in particular those with moderate to severe disease and/or those that reside in residential nursing care facilities.10,11 It follows, therefore, that a large number of older adults are dentate and suffering with dementia and will require dental care that is delivered or facilitated by primary care providers. There is a need for protocols that allow for effective oral home care for dementia patients while minimizing care resistant behaviors as well as nonsurgical interventions for patients with caries and/or periodontal diseases.12-14 This course seeks to improve the dental care provider’s understanding of the interaction between periodontal disease, dental caries, and dementia. It will also serve as an aid in the clinical decision-making process to optimize dental health for patients with dementia and periodontal disease.