09 March 2023

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Poor oral health may contribute to declines in brain health

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Taking care of your teeth and gums may offer benefits beyond oral health such as improving brain health, according to preliminary research presented last month at the American Stroke Association’s International Stroke Conference. According to a news release, the global meeting is for researchers and clinicians dedicated to the science of stroke and brain health.

Studies have shown that gum disease, missing teeth and other signs of poor oral health, as well as poor brushing habits and lack of plaque removal, increase stroke risk. According to the American Stroke Association, stroke is the number five cause of death and a leading cause of disability in the U.S. 

Previous research has also found that gum disease and other oral health concerns are linked to heart disease risk factors and other conditions like high blood pressure.

Study author Dr. Cyprien Rivier, MD, a postdoctoral fellow in neurology at the Yale School of Medicine, said in the news release that what hasn’t been clear is whether poor oral health affected brain health, meaning the functional status of a person’s brain. He said scientists are now able to better understand these issues using neuroimaging tools such as magnetic resonance imaging or MRI. 

“Studying oral health is especially important because poor oral health happens frequently and is an easily modifiable risk factor – everyone can effectively improve their oral health with minimal time and financial investment,” he said. 

Just as healthy lifestyle choices impact the risk of heart disease and stroke, they also affect brain health, which includes one’s ability to remember things, think clearly and function in life. Three in five people in the U.S. will develop brain disease in their lifetime, according to estimates from the American Stroke Association, a division of the American Heart Association.

Between 2014 and 2021, researchers analyzed the potential link between oral health and brain health among about 40,000 adults (46% men, average age 57 years) without a history of stroke enrolled in the U.K. Biobank. Participants were screened for 105 genetic variants known to predispose people to have cavities, dentures and missing teeth later in life, and the relationship between the burden of these genetic risk factors for poor oral health and brain health was evaluated. Signs of poor brain health were screened via MRI images of the participants’ brains.

The analysis found:

• People who were genetically prone to cavities, missing teeth or needing dentures had a higher burden of silent cerebrovascular disease, as represented by a 24% increase in the amount of white matter hyperintensities visible on the MRI images.
• Those with overall genetically poor oral health had increased damage to the fine architecture of the brain, as represented by a 43% change in microstructural damage scores visible on the MRI scans. Microstructural damage scores are whole-brain summaries of the damage sustained by the fine architecture of each brain region.

“Poor oral health may cause declines in brain health, so we need to be extra careful with our oral hygiene because it has implications far beyond the mouth,” Rivier said. “However, this study is preliminary, and more evidence needs to be gathered – ideally through clinical trials – to confirm improving oral health in the population will lead to brain health benefits.”

The analysis was limited by the fact that the UK Biobank includes only people who reside in the U.K., predominantly of European ancestry (94% of the U.K. Biobank participants reported their race as white vs. 6% reported as mixed, Black British, Asian British or other). More research must be conducted among people from diverse racial and ethnic backgrounds.

Stroke Council member Dr. Joseph Broderick, MD, a professor at the University of Cincinnati Department of Neurology and Rehabilitation Medicine said that while the study results don’t demonstrate that dental hygiene improves brain health, the findings are “intriguing” and should prompt more research. He is also the director of the University of Cincinnati Gardner Neuroscience Institute and was not involved in this study.

“Environmental factors such as smoking and health conditions such as diabetes are much stronger risk factors for poor oral health than any genetic marker – except for rare genetic conditions associated with poor oral health, such as defective or missing enamel,” Broderick said. “It is still good advice to pay attention to oral hygiene and health. However, since people with poor brain health are likely to be less attentive to good oral health compared to those with normal brain health, it is impossible to prove cause and effect. Also, genetic profiles for increased risk of oral health may overlap with genetic risk factors for other chronic health conditions like diabetes, hypertension, stroke, infections, etc. that are known to be related to brain imaging markers.“ 

Co-authors are Drs. Daniela Renedo, Adam H. de Havenon, Sam Pyabvash, Kevin N. Sheth and Guido J. Falcone. 

The study was funded by the American Heart Association through the Bugher Center for Hemorrhagic Stroke Research Network (AHA grant #817874). U.K. Biobank data were accessed using project application 58743.

A summary of this news release was posted on Odontologia33.