Mind, Body, Mouth, it’s all connected. Dental Health Week 2023 – Mind

The evidence is still emerging but sufficient to indicate that monitoring and management of oral health diseases is a modifiable risk factor in patients with neurodegenerative diseases.

The consequences of not managing oral health diseases can lead to

1. Translocation of oral pathogen (transport of mouth organisms into other parts of the body such as plaques in the brain).
2. Systemic inflammation (wide spread irritation of the body).
3. Platelet aggregation protein (causes micro clots and plaque formation).

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Dental management of the aging population can come with some challenges including reduced dexterity of the patient, immunosenescence (the progressive decline in immune function with increasing age, and is associated with poor response to vaccinations and increasing levels of infection, as well as diseases including cardiovascular disease and cancer, and reduced cognitive function.

These factors do increase the risk of developing dental diseases and influence not only the incidence but severity.

There is emerging evidence indicating that periodontal pathogens, host responses and genetics are linked to the initiation and progression of neurodegenerative diseases.

Many periodontal pathogens have been implicated in the progression of cognitive decline; however, the pathogen Porphymonas gingivalis (P. gingivalis) is a key one. Studies have found that patients with higher antibody tiers to P. gingivalis were more likely to have Alzheimer disease and scored poorer in cognitive decline tests. Higher antibody tiers were also found with higher levels of amyloid beta in cerebrospinal fluid. It was also found that the level of amyloid beta deposits increased with severity of periodontal disease.

Studies have shown that both bacteria and viruses from the oral cavity are implicated in neuro-inflammatory responses. P. gingivalis has a preferential invasion into regions of the brain responsible for memory. P. gingivalis is capable of the suppression of the immune system is also thought to contribute to an inhibition in removal of amyloid plaque.

The presence of P. gingivalis in the brain may also trigger inflammation that can damage and occlude the microvasculature of the brain contributing to micro strokes and cognitive decline. Viruses from the herpes family may also enter the brain after remaining dormant in the trigeminal nerve.

Also other bacteria including Streptococcus sanguis and P. gingivalis, may cause thrombi and atheroma that increase the risk of cognitive decline through vascular dementia.

The contribution of periodontitis to systemic inflammation suggests that periodontal treatment has a role in reducing the progression and severity of neurodegenerative diseases.