The impact of Alzheimer's disease on the loss of dental elements. Systematic review with meta-analysis of case control study
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1
University of Foggia, Italy
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2
Department of Clinical and Experimental Medicine, University of Foggia, Italy
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3
Department of Clinical Sciences and Odontostomatology, Marche Polytechnic University, Italy
Aim.
Diseases related to ageing in Western countries are tending to become increasingly prevalent with a more significant socio-economic impact, due to the increase in average lifespan. The elderly need to be able to face senility under improved conditions, by reducing the most disabling manifestations of neurodegenerative diseases like, for example, dementia associated with Alzheimer's disease. Alzheimer's is one of the neuro-degenerative diseases, which are a heterogeneous group of illnesses characterized by the slow and progressive loss of one or more functions of the nervous system. The best known is Alzheimer's disease, followed by Parkinson's, amylotrophic lateral sclerosis and Huntington's chorea. A recurring sign of these pathologies is dementia, defined as "a significant decrease or total loss of intellectual functions, which gradually and progressively takes place, due to different causes in previously normal subjects. In epidemiological terms, the impact of dementia on the population translates into percentages that can reach up to 50% in older patients: half of such cases are attributable to Alzheimer's disease. The incidence of this disease tends to increase gradually from 65 years of age, up to a prevalence in the population of 4% at the age of 75. Paradoxically, above this age, new cases of Alzheimer's disease tend to progressively decrease. As prospective lifespan has considerably lengthened over the past few decades, it should be recognized that any disease which predominantly affects individuals aged 65 to 75 is a major public health problem. Alongside the classical theory that histopathological alterations caused by senile plaques, with neurofibrillary tangles and neuronal losses, are all secondary to the deposition of β-amyloid substances due to altered metabolism of APP (amyloid precursor protein), an inflammatory theory has also been put forward, in which peripheral inflammatory processes trigger the precipitation of β-amyloid. This β-amyloid precipitation can be combined with both local sub-acute inflammatory (CNS) and peripheral inflammation, sustained mainly by Gram-negative bacteria, such as, for example, those that serve as etiologic agents for periodontal and endodontic lesions. Amongst the various problems, there is a reduction in masticatory capacity due to the loss of dental elements, leading to malnutrition, which is acknowledged to be the main cause of periodontal disease and carious lesions.
Materials and Methods.
After an initial screening phase, publications that were eligible were studied using qualitative analysis, and by searching for possible "outcomes", from which to draw any linking hypotheses and new indications for future research. The works taken into consideration were epidemiological research studies, literature reviews and clinical studies, with greater attention being paid to case control studies, regarding the links between oral health, specifically periodontal and oral diseases, and dementia associated with Alzheimer's disease, conducted within the last 30 years and published in English. The studies were identified through bibliographic searches in electronic databases and by examining the bibliographies in published articles. Bibliographic research was conducted on search engines like "PubMed", "EBSCO", "WEB OF SCIENCE" and "Google Scholar". The research on providers was conducted between 11.02.2018 and 10.03.2018, and the last search for a partial literature update was performed on 4.10.2018. The following search terms or combinations of them were used on PubMed, EBSCO and WEB OF SCIENCE: Alzheimer's disease AND periodontal (109 records) (131records) (117 records), Alzheimer's disease AND periodontitis (86 records) (103 records) (84 records), dementia AND (periodontitis OR periodontal) (163 records) (180 records) (183 records).
Using Google Scholar, the following search terms were identified: Alzheimer's disease AND periodontal (20,000 records).
Results.
The records obtained were screened, and after applying the eligibility and inclusion criteria, 9 articles were obtained, 6 of which were analysed for primary outcome (loss of dental elements) and 6 for secondary outcome (tooth loss). We performed a meta-analysis of both outcomes using Rev Manager 5.3 software, the results were in favour of the controls, as evidenced by the calculated forest plots.
Discussion.
The majority of the revisioned studies in this manuscript agree on the reduction of oral hygiene performed by patients affected by Alzheimer’s disease, with a significant worsening of their oral health status. Analysis of the literature shows there is a greater loss of dental elements in all the studies examined in subjects suffering from Alzheimer's disease. The data on edentulism are more highly contrasted: 2 studies out of 6 report data in favour of the disease, even if the meta-analysis highlights overall data in favour of controls. Ultimately, the authors can state that from the data in the literature, there is an increase in the loss of dental elements in patients with Alzheimer's disease. Greater attention to the oral health of the elderly and Alzheimer's patients should be put in place, so as to establish both a preventative and management regime as regards the loss of dental elements, with the aim of ensuring patients have a more satisfactory quality of life.
References
1. Oral manifestations in chronic uremia patients. Ren Fail. 2016;38(1):1-6.
2. Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc. 2007 Oct;138(10):1314-22; quiz 1381-2.
3. Amyloid in the Brain, Alzheimer's on the Mind Hastings Cent Rep. 2018 Sep;48(5): inside back cover. doi: 10.1002/hast.904.
Keywords:
Tooth Loss,
Alzheime disease,
oral pathology,
Dementia,
Oral Health
Conference:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine., Ancona, Italy, 19 Oct - 20 Oct, 2018.
Presentation Type:
Poster Presentation
Topic:
Oral Diseases
Citation:
Dioguardi
M,
Di Gioia
G,
Mascitti
M,
Santarelli
A,
Procaccini
M and
Lo Russo
L
(2019). The impact of Alzheimer's disease on the loss of dental elements. Systematic review with meta-analysis of case control study.
Front. Physiol.
Conference Abstract:
5th National and 1st International Symposium of Italian Society of Oral Pathology and Medicine..
doi: 10.3389/conf.fphys.2019.27.00045
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Received:
24 Oct 2018;
Published Online:
09 Dec 2019.
*
Correspondence:
Dr. Giovanni Di Gioia, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Apulia, 71121, Italy, digioia-giovanni@outlook.it