Objectives To determine if rates of tooth loss, periodontal disease progression and caries incidence predict cognitive decline in men. Design Prospective study. Setting Community-dwelling men enrolled in the VA Dental Longitudinal Study. Participants Five hundred ninety-seven dentate men, aged 28–70 years at the study baseline, who have been followed up to 32 years. Measurements Oral examinations were conducted approximately every 3 years. Periodontal disease measures included probing pocket depth and radiographic alveolar bone height. Participants underwent cognitive testing beginning in 1993. Low cognitive statuses were defined as <25 points or <90% of the age and education-specific median on the MiniMental State Examination, and < 10 points on a Spatial Copying Task. Results Each tooth lost per decade since the baseline dental examination increased the risks of low MiniMental score (HR= 1.09, 95% CI=1.01, 1.18) and low spatial copying score (HR=1.12, CI= 1.05, 1.18). Risks were elevated per additional tooth with progression of alveolar bone loss (spatial copying: HR=1.03, CI= 1.01, 1.06), probing pocket depth (MiniMental: HR=1.04, CI= 1.01, 1.09; spatial copying: HR=1.04, CI= 1.01, 1.06) and caries (spatial copying: HR=1.05, CI= 1.01, 1.08). Risks were consistently higher among men who were older than 45.5 years at baseline than in younger men. Conclusion Risk of cognitive decline in older men increases as more teeth are lost. Periodontal disease and caries, major reasons for tooth loss, are also related to cognitive decline.

Background-Several epidemiological studies have suggested periodontitis as a risk factor for coronary heart disease (CHD), but results have been inconsistent. Methods and Results-We evaluated the association between clinical and radiographic measures of periodontitis, edentulism, and incident CHD (angina, myocardial infarction, or fatal CHD) among 1203 men in the VA Normative Aging and Dental Longitudinal Studies who were followed up with triennial comprehensive medical and dental examinations up to 35 years (median 24 years). Cox proportional hazards models with time-varying effects of exposure and potential confounders were fit. We found a significant dose-dependent association between periodontitis and CHD incidence among men Ͻ60 years of age (hazard ratio 2.12, 95% confidence interval 1.26 to 3.60 comparing highest versus lowest category of radiographic bone loss, P for trendϭ0.02), independent of age, body mass index, smoking, alcohol intake, diabetes mellitus, fasting glucose, total cholesterol, high-density lipoprotein cholesterol, triglycerides, hypertension, systolic and diastolic blood pressure, education, marital status, income, and occupation. No association was found among men Ͼ60 years of age. Similar results were found when the sum of probing pocket depths was used as a measure of periodontitis. Among men Ն60 years of age, edentulous men tended to have a higher risk of CHD than dentate men in the lowest bone loss (hazard ratio 1.61, 95% confidence interval 0.95 to 2.73) and lowest pocket depth (hazard ratio 1.72, 95% confidence interval 1.03 to 2.85) categories, independent of confounders. Conclusions-Chronic periodontitis is associated with incidence of CHD among younger men, independent of established cardiovascular risk factors. (Circulation. 2008;117:1668-1674.)

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