Assessment of Periodontal Health in Patients with Alzheimer's disease in Karachi, Pakistan: Periodontal Health in Alzheimer's Patients

Ujala Mushtaque; Muhammad Ibtahaj Khan; Rohan Tariq; Syeda Rijah; Hibba Batool Zaidi; Abdullah Aslam

doi:10.54393/pjhs.v6i3.2709

Authors

Ujala Mushtaque Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan
Muhammad Ibtahaj Khan Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan
Rohan Tariq Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan
Syeda Rijah Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan
Hibba Batool Zaidi Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan
Abdullah Aslam Department of Periodontology, Jinnah Medical and Dental College, Karachi, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i3.2709

Keywords:

Alzheimer's disease, Periodontal Health, Cognitive Impairment, Plaque and Gingival Index

Abstract

Alzheimer's disease (AD), causes permanent loss of neurons and neural connections. Objective: To assess the periodontal health status of Alzheimer's disease (AD) patients by assessing plaque index, gingival condition, probing pocket depth, attachment levels, and bleeding on probing, and to correlate these findings with cognitive impairment levels as determined by Mini-Mental State Examination (MMSE) scores. Methods: A cross-sectional study, was conducted at Medicare Hospital between July and October 2024. Total 60 patients were recruited in the study. Hence plaque index, gingival condition, probing depth, attachment levels, and bleeding on probing were used to assess periodontal health, whereas MMSE scores were used to classify cognitive impairment. For statistical analysis, ANOVA and unpaired t-test analyses are carried out using SPSS version 24.0. All of the findings were deemed statistically significant if P was less than 0.05. Results: The study results revealed that the demographic and neurological parameters such as age, the distribution of genders, and the number of teeth of those patients suffering from Alzheimer’s disease. Hence, MMSE scores were significantly lower, indicating substantial cognitive impairment (P < 0.001). As the severity of AD increases, there is a trend for all recorded variables to get worse (p < 0.01). PPD and CAL reveal more periodontal tissue loss in patients with severe AD, while PI and GI show more plaque accumulation and gingival inflammation. Conclusions: This study highlighted a strong link between worsening periodontal health and Alzheimer's severity, emphasizing the need for proactive dental care to improve patient well-being.

References

Kumar A, Sidhu J, Goyal A, Tsao JW, Doerr C. Alzheimer disease (nursing). 2025 Jan.

DeTure MA and Dickson DW. The neuropathological diagnosis of Alzheimer's disease. Molecular Neurodegeneration. 2019 Aug; 14(1): 32. doi: 10.1186/s13024-019-0333-5. DOI: https://doi.org/10.1186/s13024-019-0333-5

Breijyeh Z and Karaman R. Comprehensive review on Alzheimer's disease: causes and treatment. Molecules. 2020 Dec; 25(24): 5789. doi: 10.3390/molecules25245789. DOI: https://doi.org/10.3390/molecules25245789

Clemmensen TH, Busted LM, Søborg J, Bruun P. The family's experience and perception of phases and roles in the progression of dementia: An explorative, interview-based study. Dementia. 2019 Feb; 18(2): 490-513. doi: 10.1177/1471301216682602. DOI: https://doi.org/10.1177/1471301216682602

Martínez-García M and Hernández-Lemus E. Periodontal inflammation and systemic diseases: an overview. Frontiers in Physiology. 2021 Oct; 12: 709438. doi: 10.3389/fphys.2021.709438. DOI: https://doi.org/10.3389/fphys.2021.709438

Kinane DF, Stathopoulou PG, Papapanou PN. Periodontal diseases. Nature reviews Disease primers. 2017 Jun; 3(1): 1-4. doi: 10.1038/nrdp.2017.38. DOI: https://doi.org/10.1038/nrdp.2017.38

Kamer AR, Craig

RG, Niederman R, Fortea J, de Leon MJ. Periodontal disease as a possible cause for Alzheimer's disease. Periodontology 2000. 2020 Jun; 83(1): 242-71. doi: 10.1111/prd.12327. DOI: https://doi.org/10.1111/prd.12327

Bui FQ, Almeida-da-Silva CL, Huynh B, Trinh A, Liu J, Woodward J et al. Association between periodontal pathogens and systemic disease. Biomedical Journal. 2019 Feb; 42(1): 27-35. doi: 10.1016/j.bj.2018.12.001. DOI: https://doi.org/10.1016/j.bj.2018.12.001

Singhrao SK, Harding A, Simmons T, Robinson S, Kesavalu L, Crean S. Oral inflammation, tooth loss, risk factors, and association with progression of Alzheimer's disease. Journal of Alzheimer's disease. 2014 Sep; 42(3): 723-37. doi: 10.3233/JAD-140387. DOI: https://doi.org/10.3233/JAD-140387

Sheppard O and Coleman M. Alzheimer's disease: etiology, neuropathology and pathogenesis. Exon Publications. 2020 Dec: 1-21. doi: 10.36255/exonpublications.alzheimersdisease.2020.ch1. DOI: https://doi.org/10.36255/exonpublications.alzheimersdisease.2020.ch1

Scheltens P, De Strooper B, Kivipelto M, Holstege H, Chételat G, Teunissen CE et al. Alzheimer's disease. The Lancet. 2021 Apr; 397(10284): 1577-90. doi: 10.1016/S0140-6736(20)32205-4. DOI: https://doi.org/10.1016/S0140-6736(20)32205-4

Dahlen G, Basic A, Bylund J. Importance of virulence factors for the persistence of oral bacteria in the inflamed gingival crevice and in the pathogenesis of periodontal disease. Journal of Clinical Medicine. 2019 Aug; 8(9): 1339. doi: 10.3390/jcm8091339. DOI: https://doi.org/10.3390/jcm8091339

Harding A and Singhrao SK. Periodontitis and dementia: a bidirectional relationship?. Journal of Dental Research. 2022 Mar; 101(3): 245-6. doi: 10.1177/00220345211043461. DOI: https://doi.org/10.1177/00220345211043461

Pisani F, Pisani V, Arcangeli F, Harding A, Singhrao SK. The mechanistic pathways of periodontal pathogens entering the brain: The potential role of treponema denticola in tracing Alzheimer's disease pathology. International Journal of Environmental Research and Public Health. 2022 Jul; 19(15): 9386. doi: 10.3390/ijerph19159386. DOI: https://doi.org/10.3390/ijerph19159386

Beydoun MA, Beydoun HA, Hossain S, El-Hajj ZW, Weiss J, Zonderman AB. Clinical and bacterial markers of periodontitis and their association with incident all-cause and Alzheimer's disease dementia in a large national survey. Journal of Alzheimer's disease. 2020 May; 75(1): 157-72. doi: 10.3233/JAD-200064. DOI: https://doi.org/10.3233/JAD-200064

Caserta MT, Caccioppo D, Lapin GD, Ragin A, Groothuis DR. Blood-brain barrier integrity in Alzheimer's disease patients and elderly control subjects. The Journal of Neuropsychiatry and Clinical Neurosciences. 1998 Feb; 10(1): 78-84. doi: 10.1176/jnp.10.1.78. DOI: https://doi.org/10.1176/jnp.10.1.78

Thomson WM and Barak Y. Tooth loss and dementia: a critical examination. Journal of Dental Research. 2021 Mar; 100(3): 226-31. doi: 10.1177/0022034520957233. DOI: https://doi.org/10.1177/0022034520957233

Said-Sadier N, Sayegh B, Farah R, Abbas LA, Dweik R, Tang N et al. Association between periodontal disease and cognitive impairment in adults. International Journal of Environmental Research and Public Health. 2023 Mar; 20(6): 4707. doi: 10.3390/ijerph20064707. DOI: https://doi.org/10.3390/ijerph20064707

Nadim R, Tang J, Dilmohamed A, Yuan S, Wu C, Bakre AT et al. Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis. European journal of epidemiology. 2020 Sep; 35: 821-33. doi: 10.1007/s10654-020-00648-x. DOI: https://doi.org/10.1007/s10654-020-00648-x

Ming Y, Hsu SW, Yen YY, Lan SJ. Association of oral health-related quality of life and Alzheimer disease: A systematic review. The Journal of Prosthetic Dentistry. 2020 Aug; 124(2): 168-75. doi: 10.1016/j.prosdent.2019.08.015. DOI: https://doi.org/10.1016/j.prosdent.2019.08.015

Alam MS, Maity MK, Nazmi AS, Alam MS, Ansari MS. Oral health issues and preventive measures in geriatric populations. Journal of Pharmaceutical Negative Results. 2022 Dec; 13(10): 2647-55. doi: 10.47750/pnr.2022.13.S10.316.

Laugisch O, Johnen A, Buergin W, Eick S, Ehmke B, Duning T et al. Oral and periodontal health in patients with Alzheimer's disease and other forms of dementia-a cross-sectional pilot study. Oral Health & Preventive Dentistry. 2021 Apr; 19: 255-261. doi: 10.3290/j.ohpd.b1248937.

Dioguardi M, Crincoli V, Laino L, Alovisi M, Sovereto D, Mastrangelo F et al. The role of periodontitis and periodontal bacteria in the onset and progression of Alzheimer's disease: a systematic review. Journal of Clinical Medicine. 2020 Feb; 9(2): 495. doi: 10.3390/jcm9020495. DOI: https://doi.org/10.3390/jcm9020495

de Oliveira Araújo R, Villoria GE, Luiz RR, Esteves JC, Leão AT, Feres-Filho EJ. Association between periodontitis and Alzheimer's disease and its impact on the self-perceived oral health status: a case-control study. Clinical Oral Investigations. 2021 Feb; 25: 555-62. doi: 10.1007/s00784-020-03489-w. DOI: https://doi.org/10.1007/s00784-020-03489-w

Marchini L, Ettinger R, Caprio T, Jucan A. Oral health care for patients with Alzheimer's disease: An update. Special Care in Dentistry. 2019 May; 39(3): 262-73. doi: 10.1111/scd.12375. DOI: https://doi.org/10.1111/scd.12375