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Experts say it’s not certain whether tooth loss or cognitive decline comes first, but there does seem to be a connection between the two conditions. Morsa Images/Getty Images
  • Researchers say that cognitive decline and tooth loss appear to be linked, although they’re uncertain which condition might come first.
  • They say poor oral health can be linked to nutritional deficiency as well as bacteria buildup, both of which can be a factor in cognitive impairment.
  • Researchers recommend older adults, especially those dealing with stages of cognitive decline, continue to practice good oral hygiene and get regular dental checkups.

Which comes first, tooth loss or cognitive decline?

A new analysis published today in JAMDA: The Journal of Post-Acute and Long-Term Care Medicine reports that tooth loss is a risk factor for cognitive impairment and dementia.

The analysis found that each additional missing tooth a person had was associated with a 1.4 percent increased risk of cognitive impairment and 1.1 percent increased risk of a dementia diagnosis.

However, Bei Wu, PhD, the study’s senior author and a professor in global health at New York University’s Rory Meyers College of Nursing and the co-director of the NYU Aging Incubator, told Healthline that researchers aren’t yet sure which comes first: cognitive decline or tooth loss.

“It’s a chicken/egg thing,” Wu said. “It can go both ways.”

The main message, she said, is that there’s a link between the two conditions and that prevention may be a key to managing both.

Megan Sullivan, DMD, an oral and maxillofacial surgery resident at the University of Texas Health Science Center at San Antonio, told Healthline that the analysis points to the need to stay focused on dental care as well as the ability of dentists to see — and help guide their patients on — many health issues beyond teeth.

Wu hypothesized that families who are caring for a loved one with cognitive decline “may have many other competing demands ahead of (dental concerns).”

That can lead to missed dental appointments, putting off regular cleanings, and not helping the loved one with their daily oral health routine.

“People (in decline) may forget (their routine) and from that can come oral decline,” Wu said. “Oral health care can take a back seat.”

Wu said that with tooth loss, a person’s nutritional intake may be compromised, leading to a multitude of health challenges, including cognitive decline.

People with lost teeth and poor oral care habits are also more susceptible to bacteria, she said, which can lead to certain illnesses and diseases.

“There are many pathways” from the teeth, she said.

Sullivan said this study drives home the importance of staying on top of oral care for all.

“Taking care of your teeth isn’t just for the sake of your teeth,” she said. “It’s for your whole body — and your mind.”

Sullivan said dentists are trained not to just treat your teeth, but also to assess your overall health and share any concerns they may see from your oral health with you.

“Dentists are not just looking at your teeth,” she said. “A lot of things can present orally. We need to get down to why we are seeing tooth loss. Is it financial? Medical? It is important to let your dentist treat you so they can help guide you this way.”

Here are some tips if you or a loved are experiencing cognitive decline — or even, Sullivan said, just tips in general:

  • Do not skip annual dental checkups and cleanings. Prioritize them throughout life and particularly as you age.
  • Help someone who may be in early stages of cognitive decline with their oral care: provide them with a quality toothbrush, make sure they have good products to use, and, if you can, oversee their care and give them brushing and flossing tips.
  • Consider dentures. Wu said the analysis did find that study participants with dentures in place of damaged teeth fared better cognitively.

Sullivan hopes this study brings home these messages.

“Let’s hope this starts to get people thinking more about their oral health,” she said.