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Emerging evidence suggests that oral health is associated with cognitive function. This review aims to systematically assess this association in adult populations via prospective cohort study designs. Eligible study reports were identified by searching the MEDLINE (via Ovoid), EMBASE, PsycoINFO, and Cochrane Library databases. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated with a random effects model. From 1,251 identified articles, 10 were included in the systematic review and 8 in the meta-analysis. Random effects analysis showed, with statistically low heterogeneity, that individuals with suboptimal dentition (<20 teeth) were at a 20% higher risk for developing cognitive decline (HR = 1.26, 95% CI = 1.14 to 1.40) and dementia (HR = 1.22, 95% CI = 1.04 to 1.43) than those with optimal dentition (≥20 teeth). Studies on the association between periodontal disease and cognitive status showed conflicting results. Within the limits of the quality of published evidence, this meta-analysis lends further support to the hypothesis that tooth loss is associated with an increased risk of cognitive impairment and dementia. Knowledge Transfer Statement: Based on the published literature, the results of this study show that the risk for cognitive impairment and dementia increases with loss of teeth. This information adds to the evidence showing links between oral and general health and suggests that oral health strategies aimed to preserve teeth may be important in reducing risk of systemic disease.

Aim To evaluate whether the presence of apical periodontitis (AP), root canal treatment (RCT) and endodontic burden (EB) – as the sum of AP and RCT sites – were associated with long-term risk of incident cardiovascular events (CVE), including cardiovascular-related mortality, using data on participants in the Baltimore Longitudinal Study of Aging (BLSA). Methodology This retrospective cohort included 278 dentate participants in the BLSA with complete medical and dental examinations. Periodontal disease (PD) and missing teeth were recorded. Total number of AP and RCT sites was determined from panoramic radiographs. EB was calculated as the sum of AP and RCT sites. Oral inflammatory burden (OIB) was calculated combining PD and EB. The main outcome was, incident CVE including angina, myocardial infarction and cardiovascular-related death. Participants were monitored for up to 44 years (mean=17.4±11.1 years) following dental examination. Relative Risks (RR) were calculated through Poisson regression models, estimating the relationship between AP, RCT, EB, PD, OIB and incident CVE. Results Mean age at baseline was 55.0±16.8 years and 51.4% were men. Sixty two participants (22.3%) developed CVE. Bivariate analysis showed that PD, EB, number of teeth and OIB were associated with incident CVE. Multivariate models, adjusted for socio-demographic and medical variables, showed that age≥60 years (RR=3.07, 95%CI=1.68-5.62), hypertension (RR=2.0, 95%CI=1.16-3.46) and EB≥3 (RR=1.77, 95%CI=1.04-3.02) were independently associated with incident CVE. The association between OIB and incident CVE was reduced to non-significance after adjustments (RR=1.97, 95%CI=0.83-4.70). Conclusions EB in mid-life was an independent predictor of CVE among community-dwelling participants in the BLSA. Prospective studies are required to evaluate cardiovascular risk reduction with the treatment of AP.

Background Findings from several studies suggested an association between oral health and several health outcomes including cardiovascular disease, aspiration pneumonia, malnutrition, poor quality of life, and mortality. Using data from the Baltimore Longitudinal Study of Aging (BLSA), we tested the hypothesis that number of teeth is indicative of mortality risk independent of other confounders. Methods Dentists conducted a standardized oral examination that included tooth count, tooth with coronal and cervical caries count, and gingival and periodontal index. Blood tests used in the analysis included fasting glucose, oral glucose tolerance test, serum low-density lipoprotein (LDL), high-density lipoprotein (HDL) cholesterol, triglycerides, and white blood cell counts. Physical activity, skin fold thickness, body mass index and chronic diseases were also evaluated. Results Of the 500 BLSA participants evaluated, 198 died an average of 130 (±75) months postdental evaluation, and 302 survivors were followed for a mean of 185 (±90) months. Based on multivariate Cox regression models, being edentulous or having than 20 teeth was independently associated with mortality. Conclusion The results of this study support the notion that number of teeth is a significant and independent risk indicator for early mortality. These findings suggest that the improvement of oral health may have a positive impact on general health and may delay mortality.

Using a hierarchical approach, positive self-perceived oral health was found to be associated with several variables included in the conceptual framework of oral health outcomes, such as resilience. Resilience may act as a potentiating agent in the positive adaptation to tooth loss.