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Evidence summary: the relationship between oral health and dementia

Key Points

  • Suggests that the evidence with regard to an association between oral health and dementia is weak because of the lack of well-designed cohort and case-control studies and variation in how dementia and oral health are defined and measured.

  • Highlights that dementia and cognitive decline are risk factors for poor oral health.

  • Suggests that patients with suboptimal oral health appear to have an associated increased risk of cognitive impairment, but more evidence from different settings is required.


This is the fourth and final paper of a series of reviews undertaken to explore the relationships between oral health and general medical conditions, in order to support teams within Public Health England, health practitioners and policy makers. This review aimed to explore the most contemporary evidence on whether poor oral health and dementia occurs in the same individuals or populations, to outline the nature of the relationship between these two health outcomes and to discuss the implication of any findings for health services and future research. The review was undertaken by a working group comprising consultant clinicians from medicine and dentistry, trainees, public health and academic staff. Whilst other rapid reviews in the current series limited their search to systematic reviews, this review focused on primary research involving cohort and case-control studies because of the lack of high level evidence in this new and important field. The results suggest that poor oral hygiene is associated with dementia, and more so amongst people in advanced stages of the disease. Suboptimal oral health (gingivitis, dental caries, tooth loss, edentulousness) appears to be associated with increased risk of developing cognitive impairment and dementia. The findings are discussed in relation to patient care and future research.

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  1. 1

    Department of Health. Prime Minister's challenge on dementia 2020. 2015. Available at (accessed October 2017).

  2. 2

    World Health Organization. International Classification of Diseases – 10. Geneva: WHO, 2016.

  3. 3

    Alzheimer's Society. Alzheimer's Society. What is Alzheimers Disease? 2015. Available at (accessed October 2017).

  4. 4

    Prince M, Knapp M, Guerchet M et al. Dementia UK: Update 2014. 2015. Available at (accessed November 2017).

  5. 5

    Hughes T F, Ganguli M . Modifiable midlife risk factors for late-life cognitive impairment and dementia. Curr Psychiatry Rev 2009; 5: 73–92.

    Article  Google Scholar 

  6. 6

    Marcenes W, Kassebaum N, Bernabé E et al. Global burden of oral conditions in 1990–2010 A systematic analysis. J Dent Res 2013; 92: 592–597.

    Article  Google Scholar 

  7. 7

    Steele J, O'Sullivan I . Adult Dental Health Survey 2009. 2011. Available at (accessed November 2017)

  8. 8

    Sheiham A, Watt R . The common risk factor approach: a rational basis for promoting oral health. Community Dent Oral Epidemiol 2000; 28: 399–406.

    Article  Google Scholar 

  9. 9

    de Souza Rolim T, Fabri G M, Nitrini R et al. Oral infections and orofacial pain in Alzheimer's disease: a case-control study. J Alzheimers Dis 2014; 38: 823–829.

    Article  Google Scholar 

  10. 10

    Paganini-Hill A, White S C, Atchison K A . Dentition, dental health habits, and dementia: the Leisure World Cohort Study. J Am Geriatr Soc 2012; 60: 1556–1563.

    Article  Google Scholar 

  11. 11

    Noble J M, Scarmeas N, Celenti R S et al. Serum IgG antibody levels to periodontal microbiota are associated with incident Alzheimer disease. PLoS One 2014; 9: e114959.

    Article  Google Scholar 

  12. 12

    Sparks Stein P, Steffen M J, Smith C et al. Serum antibodies to periodontal pathogens are a risk factor for Alzheimer's disease. Alzheimers Dement 2012; 8: 196–203.

    Article  Google Scholar 

  13. 13

    Khangura S, Konnyu K, Cushman R, Grimshaw J, Moher D . Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012; 1: 10.

    Article  Google Scholar 

  14. 14

    Wells G, Shea B, O'Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. 2000. Available at (accessed October 2017).

  15. 15

    Chu C H, Ng A, Chau A M, Lo E C . Oral health status of elderly chinese with dementia in Hong Kong. Oral Health Prev Dent 2015; 13: 51–57.

    PubMed  Google Scholar 

  16. 16

    Gil-Montoya J A, Sanchez-Lara I, Carnero-Pardo C et al. Is periodontitis a risk factor for cognitive impairment and dementia? A case-control study. J Periodontol 2015; 86: 244–253.

    Article  Google Scholar 

  17. 17

    Hatipoglu M G, Kabay S C, Güven G . The clinical evaluation of the oral status in Alzheimer-type dementia patients. Gerodontology 2011; 28: 302–306.

    Article  Google Scholar 

  18. 18

    Adam H, Preston A J . The oral health of individuals with dementia in nursing homes. Gerodontology 2006; 23: 99–105.

    Article  Google Scholar 

  19. 19

    Ellefsen B, Holm-Paedersen P, Morse D E, Schroll M, Andersen B B, Waldemar G . Assessing caries increments in elderly patients with and without dementia: a one-year follow-up study. J Am Dent Assoc 2009; 140: 1392–1400.

    Article  Google Scholar 

  20. 20

    Chen X, Clark J J J, Naorungroj S . Oral health in older adults with dementia living in different environments: a propensity analysis. Spec Care Dentist 2013; 33: 239–247.

    Article  Google Scholar 

  21. 21

    Chen X, Shuman S K, Hodges J S, Gatewood L C, Xu J . Patterns of tooth loss in older adults with and without dementia: a retrospective study based on a Minnesota cohort. J Am Geriatr Soc 2010; 58: 2300–2307.

    Article  Google Scholar 

  22. 22

    Stewart R, Weyant R J, Garcia M E et al. Adverse oral health and cognitive decline: the health, aging and body composition study. J Am Geriatr Soc 2013; 61: 177–184.

    Article  Google Scholar 

  23. 23

    Batty G D, Li Q, Huxley R et al. Oral disease in relation to future risk of dementia and cognitive decline: prospective cohort study based on the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified-Release Controlled Evaluation (ADVANCE) trial. Eur Psychiatry 2013; 28: 49–52.

    Article  Google Scholar 

  24. 24

    Yamamoto T, Kondo K, Hirai H, Nakade M, Aida J, Hirata Y . Association between self-reported dental health status and onset of dementia: a 4-year prospective cohort study of older Japanese adults from the Aichi Gerontological Evaluation Study (AGES) Project. Psychosom Med 2012; 74: 241–248.

    Article  Google Scholar 

  25. 25

    Okamoto N, Morikawa M, Tomioka K, Yanagi M, Amano N, Kurumatani N . Association between tooth loss and the development of mild memory impairment in the elderly: the Fujiwara-kyo Study. J Alzheimers Dis 2015; 44: 777–786.

    Article  Google Scholar 

  26. 26

    Kaye E K, Valencia A, Baba N, Spiro A, 3rd, Dietrich T, Garcia R I . Tooth loss and periodontal disease predict poor cognitive function in older men. J Am Geriatr Soc 2010; 58: 713–718.

    Article  Google Scholar 

  27. 27

    Arrive E, Letenneur L, Matharan F et al. Oral health condition of French elderly and risk of dementia: a longitudinal cohort study. Community Dent Oral Epidemiol 2012; 40: 230–238.

    Article  Google Scholar 

  28. 28

    Stewart R, Stenman U, Hakeberg M, Hagglin C, Gustafson D, Skoog I . Associations between oral health and risk of dementia in a 37-year follow-up study: the prospective population study of women in Gothenburg. J Am Geriatr Soc 2015; 63: 100–105.

    Article  Google Scholar 

  29. 29

    Tsakos G, Watt R G, Rouxel PL, de Oliveira C, Demakakos P . Tooth loss associated with physical and cognitive decline in older adults. J Am Geriatr Soc 2015; 63: 91–99.

    Article  Google Scholar 

  30. 30

    Cerutti-Kopplin D, Feine J, Padilha D et al. Tooth Loss Increases the Risk of Diminished Cognitive Function A Systematic Review and Meta-analysis. JDR Clin Transl Res 2016; 1: 10–19.

    Article  Google Scholar 

  31. 31

    Wu B, Fillenbaum G G, Plassman B L, Guo L . Association Between Oral Health and Cognitive Status: A Systematic Review. J Am Geriatr Soc 2016; 64: 739–751.

    Article  Google Scholar 

  32. 32

    Public Health England. Delivering better oral health: an evidence-based toolkit for prevention (third edition). London: PHE, 2014. Available at (accessed November 2017).

  33. 33

    American Academy of Periodontology Task Force. American Academy of Periodontology Task Force Report on the Update to the 1999 Classification of Periodontal Diseases and Conditions. J Periodontol 2015; 86: 835–838.

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We would like to acknowledge the support of Carly Tutti of Public Health England during a workshop in preparation for this paper. We further acknowledge the overall support of Public Health England, the Faculty of Dental Surgery of The Royal College of Surgeons of England and The British Dental Association.

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Corresponding author

Correspondence to J. E. Gallagher.

Additional information

Refereed Paper

Supplementary information

Supplementary Table 1

Cohort and case-control studies: Is dementia (including cognitive decline) a risk factor for poor oral health? (PDF 174 kb)

Supplementary Table 2

Cohort and case-control studies: Is poor oral health a risk factor for developing dementia (including cognitive decline)? (PDF 216 kb)

Supplementary Table 3

Systematic review on tooth loss and periodontal disease and cognitive impairment (PDF 92 kb)

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Daly, B., Thompsell, A., Sharpling, J. et al. Evidence summary: the relationship between oral health and dementia. Br Dent J 223, 846–853 (2017).

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