How taking care of your teeth and gums could stave off dementia
Experts say that poor oral hygiene could be heightening our risk of more than 50 diseases, including dementia and arthritis.
Experts say that poor oral hygiene could be heightening our risk of more than 50 diseases, including dementia and arthritis.
We can be forgiven for presuming that brushing our teeth morning and night, with an occasional floss and a mouthwash has us covered for clean, healthy teeth and gums.
But some of us are falling short with our oral hygiene routine, and we’re not aware of the whole-body health implications that come with ailing teeth and gums.
Bacteria from infected gums can easily spread around the body and transfer from our bloodstream to our brains – potentially increasing the risk of dementia and cognitive decline.
Data from a collection of in-depth dental studies was presented at a recent conference in Arizona. Entitled “The Mouth as a Gateway to Overall Health”, it saw oral health experts from around the world, including the UK, gathered to present their insights into the links between more than 50 serious diseases that affect our brain, gut and joints.
One expert at the conference cited the need for the UK to address attitudes to oral care, claiming that British people had “third-world” levels of tooth and gum health due to diets that are often rich in processed, sugary food and drinks.
The Adult Oral Health Survey for England says that around 41% of us are experiencing some level of tooth decay and up to 93% show signs of gum disease.
Karen Coates is an educator for the UK’s Oral Health Foundation and agrees that the connection between poor oral health and cognitive decline is plausible.
“This is particularly relevant when we look at gum disease, which is driven by harmful bacteria such as ‘Porphyromonas gingivalis’ (P gingivalis),” she says.
“These bacteria (or their toxins) can enter the bloodstream through inflamed gums. Some studies have found these bacterial components in the brains of people with Alzheimer’s disease.”
Simon Wheeler, senior knowledge officer at the Alzheimer’s Society, agrees that gum disease might play a role in the development of the cognitive condition.
“This comes from the discovery of gum disease bacteria and their toxic products in the brains of people who already had Alzheimer’s,” he explains.
“Gum disease has also been associated with a greater risk of developing Alzheimer’s disease, with faster loss of memory and thinking abilities in people living with the condition.”
Wheeler continues: “Alzheimer’s Society-funded research has shown that gum inflammation, missing teeth and tooth decay are all associated with poorer memory and thinking skills in people over 60.
“This might mean that poor oral health can contribute to memory and thinking decline, but it is also possible that people with cognitive decline take less care of their dental health.”
He believes more research is needed to better understand the connection between gum disease and Alzheimer’s as well as other dementias.
But dental health expert and orthodontist Dr Kami Hoss – and author of If Your Mouth Could Talk – believes that the scientific evidence is clear: “The dementia pathway is no longer theoretical. Research has shown that periodontal pathogens (harmful bacteria in the mouth), particularly P gingivalis, produce enzymes that can compromise the blood-brain barrier.
“They allow bacteria and inflammatory mediators to enter the central nervous system directly, and can also travel to the brain via cranial nerve routes. Because we have found these bacteria in the brain tissue of Alzheimer’s patients, we can’t ignore this.”
Dr Hoss adds: “One study found that periodontitis (chronic inflammatory gum disease and a major cause of adult tooth loss) was associated with a sixfold increase in cognitive decline over just six months in Alzheimer’s patients, accompanied by rising systemic inflammatory markers. And this is preventable, with good oral care.”
Cardiovascular wellbeing is another overlooked component in our all-round oral health, says Coates, with studies showing a potential 15 to 25% higher risk of heart disease.
“Inflamed or bleeding gums can also allow bacteria to travel to the heart, and chronic gum disease causes inflammation in the body. This plays a major role in heart disease.
“Studies have shown that oral bacteria may contribute to arterial plaque, which puts you more at risk of narrowed or blocked arteries (atherosclerosis).”
In 2023, the British Heart Foundation carried out a study of 160 people admitted to Aberdeen Royal Infirmary with a heart attack. About two-thirds of those involved had a severe gum infection.
Researchers found that people with higher levels of P gingivalis in their mouths tended to have more damage to their heart (based on the amount of the protein troponin in their blood) and more fatty build-up in their coronary arteries.
Dr Hoss explains the links between poor oral care and wider health implications. “Bowel and arthritis connections run through what researchers now call the oral-gut axis,” he explains.
“Periodontal bacteria can translocate in large numbers into the gut, disrupting microbial diversity and increasing opportunistic pathogens, with systemic diseases implicated through this pathway including inflammatory bowel disease, colorectal cancer and rheumatoid arthritis (RA).”
Coates adds: “Again, because gum disease can trigger inflammation in the body, this can worsen joint inflammation in arthritis. Harmful oral bacteria can enter the bloodstream and potentially contribute to joint damage.
“In autoimmune conditions like RA and psoriatic arthritis, this can make the symptoms worse. And studies have shown higher rates of gum disease in people with RA.”
Firstly, Dr Hoss points out that it has taken too long to educate the public about the impact of poor oral health on much wider ailments in the body and mind.
“The reason medicine took a long time to acknowledge this is structural, not scientific,” he says. “Dentistry and medicine were separated as disciplines over 150 years ago. The mouth shares a bloodstream, a nervous system, and a microbiome with every organ. We are finally reckoning with what that means.”
Coates says there are several reasons behind the rise of poor oral health rates in the UK. “Diet and sugar consumption are key here,” she says. “But public health campaigns, such as the Sugary Drinks Industry Levy (‘sugar tax’) are helping to improve this.
“Socioeconomic inequalities are also a factor. There are higher rates of tooth decay in more deprived areas. Diet, education and access to dental care all play a role in improving this.”
She believes wider water fluoridation across the country could have a huge impact on improving dental health.
“Unlike in some countries such as Singapore and the bulk of Australia, water fluoridation is not universal across the UK,” Coates says. “But according to the World Health Organisation ‘community water fluoridation is historically considered one of the 20th century’s most effective public health achievements’.
“Children in areas where fluoride is added to their water (around 10% of the UK) have significantly less dental decay than those who do not. Good oral health lasts a lifetime; good oral health in childhood means less problems as we age.”
The NHS dentistry crisis is also taking its toll. “Many people are experiencing issues accessing an NHS dentist,” Coates explains. “This can lead to long waiting lists, and delays in regular check-ups and preventative treatments, which could lead to more oral health problems in the future.
“However, on the bright side, it’s not all bad. In fact, the UK has lower rates of tooth decay than countries like the US and fewer missing teeth in some age groups.”
(Hero image credit: GettyImages)
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