Alzheimer's and Gum Disease

As our population ages, more and more diseases are affecting the elderly. 

Alzheimer’s and gum disease is a relatively new pairing of terms. A research study published in 2019 linked the two diseases.7 This is how this pairing came to be.

Scientists are consistently seeking more information about gum disease, its cause, and potential treatments and cures.

The link between Alzheimer’s Disease and gum disease is a result of this ongoing research.

What Is Alzheimer's Disease?

Alzheimer’s Disease is a progressive decline of the nervous system. This decline mainly occurs in the brain.

The disease causes sufferers to experience reduced cognitive function.

Patients experience a slow decline in their ability to function with normal behavioral and social skills.

As the disease progresses, the symptoms worsen. They may develop from memory loss to the inability to care for themselves.

Scientists suspect that the early-onset variety of Alzheimer’s is genetic in nature. The majority of Alzheimer’s patients suffer from the late-onset variety. Its incidence increases with age.

At this time, there is no cure for Alzheimer’s Disease. Approximately 5.8 million Americans have Alzheimer's Disease.8

Alzheimer’s Disease takes a severe toll on caretakers.

They must watch their loved one drift away into:

  • Memory loss
  • Unpredictable behaviors
  • An inability to perform simple tasks

The cost of caring for someone with Alzheimer’s is high both financially and emotionally.

What Is Gum Disease? When Should I Worry?

Gum disease is an umbrella term for any inflammatory disease of the supporting tissues of the teeth.

In a healthy mouth, the teeth are surrounded by a:

  • Periodontal ligament
  • Alveolar jawbone
  • Gum tissue (also called gingiva)

The cause of inflammation in all gum diseases is dental plaque.

The bacteria living in dental plaque produce toxins that penetrate the gum tissue. This results in an inflammatory response.

Gingivitis

In its earliest stages, this inflammation is acute and limited to the edge of the gum tissue. This is where it meets the teeth.

Acute inflammation produces:

• Redness
• Swelling
• Tenderness
• A tendency to bleed.

When addressed early by dental care, gingivitis is reversible.

teeth with plaque and red gums from gingivitis

Periodontitis (Periodontal Disease)

Gum disease can worsen from gingivitis to periodontitis. This occurs when the inflammatory response begins destroying the ligaments and bones surrounding the teeth.

It is often accompanied by a transition from acute inflammation. This causes visible signs of chronic inflammation. In gingivitis, chronic inflammation is usually difficult to detect.

periodonal disease

Dentists often refer to periodontal disease as a “silent” disease. Many people miss the signs of chronic inflammation in the gum tissues.

Left untreated, periodontitis continues to destroy the attachment between the bone and teeth. This leads to deep pockets or crevices.

These deep pockets are perfect hiding places for bacteria to collect. As the pockets deepen, they also attract different strains of bacteria.

Researchers believe some people are genetically prone to gingivitis and periodontal disease.9

The primary cause of the inflammation is a bacterial buildup in dental plaque.

Even high-risk individuals can prevent the disease by committing to excellent dental care. This includes both professional and at-home care.

Link Between Gum Disease and Alzheimer's

Health professionals have studied the link between gum disease and other systemic health problems for decades.

We know that bacteria in the mouth can enter the bloodstream through the gum tissues.

Bacteria specific to periodontal disease have been found in plaque buildup in arteriosclerosis. This condition is when arteries grow thick and stiff. They restrict blood flow to organs and tissues in the body.

A scientific study published in Science Advances in January 2019 found a specific periodontal pathogen in the brains of Alzheimer’s patients. Researchers investigated plaques in brain samples of deceased people with Alzheimer’s disease. They found within those plaques the bacteria Porphyromonas gingivalis.

This type of bacteria commonly resides in the deep pockets of mouths with chronic adult periodontitis. Researchers also found the bacteria in the cerebrospinal fluid of living Alzheimer’s patients. This is a clear fluid that surrounds the brain and spinal cord.

This study suggests a link between this particular bacteria and the damage in the brain of those with Alzheimer’s.

More research is necessary to confirm this link and use this information to work toward prevention and/or cures.

How Do I Know If I Have Gingivitus or Periodontitis?

The early stages of gum disease are difficult to notice at first. This is because people often do not feel any pain during gingivitis.

However, there are a few warning signs to be aware of.

The most common symptoms of advanced gum disease (periodontitis) include:

  • Red, swollen, or tender gums
  • Bleeding gums, typically while brushing
  • Inflammation around the teeth. This can extend under the gums
  • Loose or sensitive teeth when consuming hot or cold substances
  • Gum recession. This is when the gums pull away from the teeth
  • Pus between the gums and teeth
  • Sudden teeth misalignment
  • Partial dentures that do not fit properly anymore
  • Lingering bad breath. This may not disappear after brushing

Gum Disease and Overall Health

A chronically unhealthy mouth affects the rest of the body.

Many people assume that what happens in the mouth doesn’t affect your overall health. This may be due to the separation between dentistry and traditional medicine. 

We currently continue to learn more about the role of chronic inflammation in diseases like:

  • Diabetes
  • Heart disease
  • Cancer
  • Alzheimer’s

From more research on these diseases, we see that chronic gum disease can have a disastrous effect on the body.

The mouth is the gateway to the rest of the body. It is impossible to have a healthy body with an unhealthy mouth.

Bacteria from gum disease can spread throughout the body, potentially worsening major health problems. To keep your whole body healthy, see your dentist regularly and take great care of your teeth at home.

How to Prevent Gum Disease

The best way to prevent periodontal disease is to visit a dentist every six months for: 

The beginning stages of gum disease often go unnoticed. Only minor symptoms may appear.

Fortunately, dentists can catch gingivitis early with routine check-ups. This results in a lower chance of periodontal disease formation.

Gum Disease Treatment

Gum disease treatment may be performed by a:

  • Periodontist
  • Dentist
  • Dental hygienist

The goal of gum disease treatment is to clean the pockets surrounding the teeth thoroughly. It is also to prevent damage to the surrounding bone.

Nonsurgical Treatment

If gum disease has not advanced, treatment may involve less invasive procedures.

For example:10

  • Scaling and root planing
  • Antibiotics

Surgical Treatment

If you have advanced periodontitis, treatment may require surgery.

For example:10

  • Flap surgery (pocket reduction surgery)
  • Soft tissue grafts
  • Bone grafts
  • Guided tissue regeneration
  • Tissue-simulating proteins

You have the best opportunity for effective treatment when you also:10

  • Follow a daily routine of good oral care
  • Manage health conditions that may affect dental health
  • Stop tobacco use

Resources

(1) Batty, G.-D., 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: European Psychiatry.” Cambridge Core, Cambridge University Press, 2 Oct. 2011

(2) Eke, P.i., et al. “Prevalence of Periodontitis in Adults in the United States: 2009 and 2010.” Journal of Dental Research, vol. 91, no. 10, 2012, pp. 914–920

(3) National Institutes of Health (NIH). Periodontal (Gum) Disease: Causes, Symptoms, and Treatments. NIH Publication, 2013

(4) Periodontal Disease in Adults (Age 20 to 64).” National Institute of Dental and Craniofacial Research, U.S. Department of Health and Human Services

(5) Shoemark, Deborah K. and Allen, Shelley J. ‘The Microbiome and Disease: Reviewing the Links Between the Oral Microbiome, Aging, and Alzheimer’s Disease’. 1 Jan. 2015 : 725 – 738

(6) Watts, Amber, et al. “Inflammation as a Potential Mediator for the Association between Periodontal Disease and Alzheimer's Disease.” Neuropsychiatric Disease and Treatment, Dove Medical Press, Oct. 2008

(7) Dominy, Stephen S et al. “Porphyromonas gingivalis in Alzheimer's disease brains: Evidence for disease causation and treatment with small-molecule inhibitors.” Science advances vol. 5,1 eaau3333. 23 Jan. 2019 (8) Alzheimer's Disease and Related Dementias, Centers for Disease Control and Prevention (CDC), October 2020

(9) Tettamanti, L et al. “Genetic susceptibility and periodontal disease: a retrospective study on a large italian sample.” ORAL & implantology vol. 10,1 20-27. 10 Apr. 2017

(10) Periodontitis, Mayo Clinic, February 2020
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