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Oral health in Alzheimer’s disease: a multicenter case-control study

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Abstract

Objectives

The aim of this case-control study was to carry out an oral health assessment on a group of Alzheimer’s patients and to establish a hypothesis regarding the implication of the characteristics of the disease and the treatment of oral health.

Materials and methods

A total of 70 Alzheimer’s patients, residents at the Alzheimer Center Reina Sofia Foundation (Madrid, Spain) and at the Alzheimer State Reference Center (Salamanca, Spain), and 36 controls (companions/acquaintances), were studied by oral examination and saliva sampling. The oral health indices DMFT/DMFS, CPI, the prosthetic condition, oral hygiene, saliva volume, and pH, as well as the specific microbiological parameters governing the risk of developing caries were assessed.

Results

Alzheimer’s patients exhibited, as compared to the control group, (1) fewer teeth (10.9 ± 10.5 vs 23.7 ± 6.5), (2) fewer obturations (2.2 ± 3.4 vs 6.6 ± 5.6), (3) fewer periodontally healthy sextants (0.1 ± 0.4 vs 1.4 ± 2.2), (4) worse oral hygiene (43.1 vs 72.2% brushed), (5) greater use of removable prostheses (47.8 vs 8.4%), (6) higher incidence of candida infection (11.8 vs 0.0%) and cheilitis (15.9 vs 0.0%), (7) lower salivary flow (0.6 ± 0.6 vs 1.1 ± 0.6), and (8) lower buffering capacity (46 vs 80%).

Conclusions

After taking into account the influence of age, Alzheimer’s patients had worse oral health (caries and periodontal disease), more mucosal lesions (cheilitis and candidiasis), and worse saliva quantity and quality.

Clinical relevance

Clinicians should be aware of the implications of Alzheimer’s disease in oral health, in order to stablish the effective preventive measures and the optimal treatment plan.

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References

  1. Jellinger KA, Attems J (2010) Prevalence of dementia disorders in the oldest-old: an autopsy study. Acta Neuropathol 119:421–433. https://doi.org/10.1007/s00401-010-0654-5

    Article  PubMed  Google Scholar 

  2. Kim JS, Won CW, Kim BS, Choi HR (2013) Predictability of various serial subtractions on global deterioration scale according to education level. Korean J Fam Med 34:327–333. https://doi.org/10.4082/kjfm.2013.34.5.327

    Article  PubMed  PubMed Central  Google Scholar 

  3. Cummings J (2004) Alzheimer’s disease. N Engl J Med 351:56–67. https://doi.org/10.1056/NEJMra040223

    Article  PubMed  Google Scholar 

  4. Friedlander AH, Norman DC, Mahler ME, Norman KM, Yagiela JA (2006) Alzheimer’s disease: psychopathology, medical management and dental implications. J Am Dent Assoc 137:1240–1251

    Article  Google Scholar 

  5. Ribeiro GR, Costa JLR, Bovi Ambrosano GM, Rodrigues Garcia RCM (2012) Oral health of the elderly with Alzheimer’s disease. Oral Surg Oral Med Oral Pathol Oral Radiol 114:338–343. https://doi.org/10.1016/j.oooo.2012.03.028

    Article  PubMed  Google Scholar 

  6. Ellefsen BS, Morse DE, Waldemar G, Holm-Pedersen P (2012) Indicators for root caries in Danish persons with recently diagnosed Alzheimer’s disease: root caries indicators in Alzheimer’s disease. Gerodontology 29:194–202. https://doi.org/10.1111/j.1741-2358.2011.00560.x

    Article  PubMed  Google Scholar 

  7. Ellefsen B, Holm-Pedersen P, Morse DE, Schroll M, Andersen BB, Waldemar G (2009) Assessing caries increments in elderly patients with and without dementia: a one-year follow-up study. J Am Dent Assoc 140:1392–1400

    Article  Google Scholar 

  8. Hatipoglu MG, Kabay SC, Güven G (2011) The clinical evaluation of the oral status in Alzheimer-type dementia patients: oral health in AD. Gerodontology 28:302–306. https://doi.org/10.1111/j.1741-2358.2010.00401.x

    Article  PubMed  Google Scholar 

  9. Singhrao SK, Harding A, Simmons T, Robinson S, Kesavalu L, Crean S (2014) Oral inflammation, tooth loss, risk factors, and association with progression of Alzheimer’s disease. J Alzheimers Dis 42:723–737. https://doi.org/10.3233/JAD-140387

    Article  PubMed  Google Scholar 

  10. Uppoor AS, Lohi HS, Nayak D (2013) Periodontitis and Alzheimer’s disease: oral systemic link still on the rise? Gerodontology 30:239–242. https://doi.org/10.1111/j.1741-2358.2012.00660.x

    Article  PubMed  Google Scholar 

  11. Abbayya K, Chidambar Y, Naduwinmani S, Puthanakar N (2015) Association between periodontitis and alzheimer’s disease. North Am J Med Sci 7(6):241–246. https://doi.org/10.4103/1947-2714.159325

    Article  Google Scholar 

  12. Ruiz-Medina P, Bravo M, Gil-Montoya JA, Montero J (2005) Discrimination of functional capacity for oral hygiene in elderly Spanish people by the Barthel General Index. Community Dent Oral Epidemiol 33:363–369. https://doi.org/10.1111/j.1600-0528.2005.00222.x

    Article  PubMed  Google Scholar 

  13. McKhann GM, Knopman DS, Chertkow H et al (2011) The diagnosis of dementia due to Alzheimer’s disease: recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimers Dement 7:263–269. https://doi.org/10.1016/j.jalz.2011.03.005

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sano M, Egelko S, Jin S, Cummings J, Clark CM, Pawluczyk S, Thomas RJ, Schittini M, Thal LJ, Alzheimer's Disease Cooperative Study Group (2006) Spanish instrument protocol: new treatment efficacy instruments for Spanish-speaking patients in Alzheimer disease clinical trials. Alzheimer Dis Assoc Disord 20:232–241. https://doi.org/10.1097/01.wad.0000213862.20108.f5

    Article  PubMed  PubMed Central  Google Scholar 

  15. Han H-R, Park S-Y, Song H, Kim M, Kim KB, Lee HB (2013) Feasibility and validity of dementia assessment by trained community health workers based on clinical dementia rating. J Am Geriatr Soc 61:1141–1145. https://doi.org/10.1111/jgs.12309

    Article  PubMed  PubMed Central  Google Scholar 

  16. World Health Organization (1987) Oral health surveys: basic methods, 3rd edn. World Health Organization, Geneva

    Google Scholar 

  17. Domingo A, Marcos J (1989) Proposal of an indicator of “social class” based on the occupation. Gac Sanit 3:320–326

    Article  Google Scholar 

  18. Brennan LJ, Strauss J (2014) Cognitive impairment in older adults and oral health considerations. Dent Clin N Am 58:815–828. https://doi.org/10.1016/j.cden.2014.07.001

    Article  PubMed  Google Scholar 

  19. Henry RG, Smith BJ (2009) Managing older patients who have neurologic disease: Alzheimer disease and cerebrovascular accident. Dent Clin N Am 53:269–294. https://doi.org/10.1016/j.cden.2008.12.011

    Article  PubMed  Google Scholar 

  20. Kocaelli H, Yaltirik M, Yargic LI, Özbas H (2002) Alzheimer’s disease and dental management. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontology 93:521–524. https://doi.org/10.1067/moe.2002.123538

    Article  Google Scholar 

  21. Gitto CA, Moroni MJ, Terezhalmy GT, Sandu S (2001) The patient with Alzheimer’s disease. Quintessence Int 32:221–231

    PubMed  Google Scholar 

  22. Arrivé E, Letenneur L, Matharan F, Laporte C, Helmer C, Barberger-Gateau P, Miquel JL, Dartigues JF (2012) Oral health condition of French elderly and risk of dementia: a longitudinal cohort study: Elderly’s oral health and risk of dementia. Community Dent Oral Epidemiol 40:230–238. https://doi.org/10.1111/j.1600-0528.2011.00650.x

    Article  PubMed  Google Scholar 

  23. Chen X, Shuman SK, Hodges JS, Gatewood LC, Xu J (2010) Patterns of tooth loss in older adults with and without dementia: a retrospective study based on a Minnesota cohort: tooth loss patterns in older adults. J Am Geriatr Soc 58:2300–2307. https://doi.org/10.1111/j.1532-5415.2010.03192.x

    Article  PubMed  Google Scholar 

  24. Syrjälä A-MH, Ylöstalo P, Ruoppi P, Komulainen K, Hartikainen S, Sulkava R, Knuuttila M (2012) Dementia and oral health among subjects aged 75 years or older: dementia and oral health. Gerodontology 29:36–42. https://doi.org/10.1111/j.1741-2358.2010.00396.x

    Article  PubMed  Google Scholar 

  25. Srisilapanan P, Jai-Ua C (2013) Oral health status of dementia patients in Chiang Mai Neurological Hospital. J Med Assoc Thail 96:351–357

    Google Scholar 

  26. Leal SC, Bittar J, Portugal A, Falcão DP, Faber J, Zanotta P (2010) Medication in elderly people: its influence on salivary pattern, signs and symptoms of dry mouth: medication in elderly people. Gerodontology 27:129–133. https://doi.org/10.1111/j.1741-2358.2009.00293.x

    Article  PubMed  Google Scholar 

  27. Turner LN, Balasubramaniam R, Hersh EV, Stoopler ET (2008) Drug therapy in Alzheimer disease: an update for the oral health care provider. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 106:467–476. https://doi.org/10.1016/j.tripleo.2008.06.009

    Article  Google Scholar 

  28. Stein PS, Desrosiers M, Donegan SJ, Yepes JF, Kryscio RJ (2007) Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc 138:1314–1322. https://doi.org/10.14219/jada.archive.2007.0046

    Article  PubMed  Google Scholar 

  29. Tsakos G, Watt RG, Rouxel PL, de Oliveira C, Demakakos P (2015) Tooth loss associated with physical and cognitive decline in older adults. J Am Geriatr Soc 63:91–99. https://doi.org/10.1111/jgs.13190

    Article  PubMed  Google Scholar 

  30. Hugo FN, Hilgert JB, Bertuzzi D, Padilha DM, De Marchi RJ (2007) Oral health behaviour and socio-demographic profile of subjects with Alzheimer’s disease as reported by their family caregivers. Gerodontology 24:36–40. https://doi.org/10.1111/j.1741-2358.2007.00149.x

    Article  PubMed  Google Scholar 

  31. Vergona KD (2005) A self-reported survey of Alzheimer’s centers in Southwestern Pennsylvania. Spec Care Dentist 25:164–170

    Article  Google Scholar 

  32. Ship J, Puckett S (1994) Longitudinal study on oral health in subjects with Alzheimer’s disease. J Am Geriatr Soc 42:57–63. https://doi.org/10.1111/j.1532-5415.1994.tb06074.x

    Article  PubMed  Google Scholar 

  33. Zickert I, Emilson CG, Krasse B (1983) Correlation of level and duration of Streptococcus mutans infection with incidence of dental caries. Infect Immun 39:982–985

    PubMed  PubMed Central  Google Scholar 

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Acknowledgements

The authors would like to thank the Alzheimer Center Reina Sofia Foundation (Madrid, Spain), the Alzheimer and other Dementias State Reference Center (Salamanca, Spain) and their staff, and all of the participants who took part in the study for their collaboration and willingness to help.

Funding

This work was partially supported by the project number BIO/SA72/13 of the Regional Government of Castilla y León (Spain) and the Research Group (Avances en Salud Oral; GIR_USAL_2015) of the University of Salamanca (Spain).

Author information

Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine and Dentistry, University of Salamanca, Campus Miguel de Unamuno, Calle Alfonso X El Sabio s/n, 37007, Salamanca, Spain

    F. Aragón, J. Montero & A. Albaladejo

  2. Alzheimer Disease Research Unit, CIEN Foundation, Alzheimer Center Reina Sofia Foundation, Carlos III Institute of Health, Calle de Valderrebollo, 5, PC 28031, Madrid, Spain

    M. A. Zea-Sevilla & B. Frades-Payo

  3. Department of Microbiology and Genetics, University of Salamanca, Campus Miguel de Unamuno, PC 37007, Salamanca, Spain

    P. Sancho, R. Corral & C. Tejedor

  4. Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Av. de Blasco Ibáñez, 15, PC 46010, Valencia, Spain

    V. Paredes-Gallardo

Authors
  1. F. Aragón
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  2. M. A. Zea-Sevilla
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  3. J. Montero
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  9. A. Albaladejo
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Corresponding author

Correspondence to F. Aragón.

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Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed involving human participants were in accordance with the ethical standards of the Ethical Committee of the Institute of Health Carlos III (Madrid, Spain) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individuals participants included in the study.

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Cite this article

Aragón, F., Zea-Sevilla, M.A., Montero, J. et al. Oral health in Alzheimer’s disease: a multicenter case-control study. Clin Oral Invest 22, 3061–3070 (2018). https://doi.org/10.1007/s00784-018-2396-z

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  • DOI: https://doi.org/10.1007/s00784-018-2396-z

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