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Cited by 151Dementia and Cognitive Impairment ResearchDental Health and Care UtilizationOral microbiology and periodontitis research

Dose-Response Meta-Analysis on Tooth Loss With the Risk of Cognitive Impairment and Dementia

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Qi, Xiang, Zhu, Zheng, Plassman, Brenda L., Wu, Bei·2021·Journal of the American Medical Directors Association
DOI 10.1016/j.jamda.2021.05.009PMC PMC8479246
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Abstract

Objectives To quantify the dose-response associations between tooth loss and risk of cognitive impairment and dementia. Design Longitudinal studies that examined the association between tooth loss and cognitive function were systematically searched on 6 databases through March 1, 2020. The study adhered to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Risk estimates were pooled using random-effects models. The dose-response associations were assessed using generalized least squares spline models. Setting and participants Adults from community, institution, outpatient or in-hospital were included in the meta-analysis. Measures Cognitive impairment and dementia were defined by neuropsychological tests, diagnostic criteria, or medical records. Tooth loss was self-reported or assessed by clinical examinations. Results Fourteen studies were entered into the meta-analysis, including 34,074 participants and 4689 cases with diminished cognitive function. Participants with more tooth loss had a 1.48 times higher risk of developing cognitive impairment [95% confidence interval (CI) 1.18-1.87] and 1.28 times higher risk of being diagnosed with dementia (95% CI 1.09-1.49); however, the association was nonsignificant for participants using dentures (relative risk = 1.10, 95% CI 0.90-1.11). Eight studies were included in the dose-response analysis, and data supported the use of linear models. Each additional tooth loss was associated with a 0.014 increased relative risk of cognitive impairment and 0.011 elevated relative risks of dementia. Edentulous participants faced a 1.54 times higher risk of cognitive impairment and a 1.40 times higher risk of being diagnosed with dementia. Conclusions and implications Moderate-quality evidence suggested tooth loss was independently associated with cognitive impairment and dementia; risk of diminished cognitive function increased with incremental numbers of teeth lost. Furthermore, timely prosthodontic treatment with dentures may reduce the progression of cognitive decline related to tooth loss.

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  • There is a strong epidemiologic association between periodontitis and Alzheimer's disease and related dementia.

    “There is a strong epidemiologic association between periodontitis (PD) and ADRD [5,6,7,8,9,10,11,12,13] but how these two diseases intersect and whether it is at the level of causation is unclear.”

    From Oral Microbially-Induced Small Extracellular Vesicles Cross the Blood–Brain Barrier (2024) · cites this paper as [12]

    The Results (page unavailable) report an epidemiologic association between tooth loss and dementia, not between periodontitis and dementia. The Discussion (page unavailable) identifies periodontitis as a cause of tooth loss and discusses a possible inflammatory mechanism, but does not establish the claimed strong epidemiologic association for periodontitis itself. (LLM, conf=0.84)

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Cited by

Sorted by citations

Authors
Qi, X., Zhu, Z., Plassman, B. L., & Wu, B.
Affiliations
  • New York University (US)
  • Fudan University (CN)
  • Duke University (US)
Corresponding author
Wu, Bei
ORCID
Venue
Journal of the American Medical Directors Association
Publisher
Elsevier BV
Published
2021-10
Volume
22
Issue
10
Pages
2039-2045
ISSN
1525-8610 (ISSN-L)
DOI
10.1016/j.jamda.2021.05.009
PMC
PMC8479246
OpenAlex
W3179409016
Cited by
151
References
7
Citations by year
2026: 39 · 2025: 41 · 2024: 29 · 2023: 23 · 2022: 18 · 2021: 1
FWCI
3.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of the American Medical Directors Association (acceptedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institutes of Health (1R56AG067619, U01DE027512)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
  • Health Sciences › Dentistry › Periodontics › Dental Health and Care Utilization
  • Health Sciences › Dentistry › Periodontics › Oral microbiology and periodontitis research
Keywords
tooth loss, cognitive impairment, dementia, dose-response relationship, edentulism, dentures, prosthodontic treatment, cognitive decline
MeSH terms
Adult, Cognition, Dementia, Humans, Tooth Loss, Cognitive Dysfunction

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