Influence of periodontal disease on risk of dementia: a systematic literature review and a meta-analysis
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META-ANALYSIS
Influence of periodontal disease on risk of dementia: a systematic literature review and a meta‑analysis Rizwan Nadim1 · Jie Tang1,2 · Amena Dilmohamed1 · Siyang Yuan1,3 · Changhao Wu4 · Aishat T. Bakre1 · Martin Partridge1 · Jindong Ni5 · John R. Copeland6 · Kaarin J. Anstey7,8 · Ruoling Chen1 Received: 29 August 2019 / Accepted: 8 May 2020 © Springer Nature B.V. 2020
Abstract Periodontal disease (PD) is common and increases cardiovascular diseases. However, it is unclear whether PD is associated with increased risk of dementia. We carried out a systematic review and meta-analysis to investigate the influence of PD on dementia. We projected the number of dementia cases to be saved by reducing PD prevalence in the world. We searched cohort and case–control studies reporting the association of PD with all dementia (or any specific type of dementia) through PubMed, MEDLINE, PsycINFO, SocINDEX, CINHAL, and CNKI until 7th November 2018. Five cohorts and seven case– control studies were identified for review. We pooled eligible data to calculate relative risk (RR) of dementia in relation to PD and computed the number of dementia cases saved through reducing PD prevalence. Of 12 studies, six were undertaken in Asia, four in Europe and two in America. Eleven studies showed a positive association between PD and the risk of dementia, of which 10 were significant, and one reported a non-significant inverse association. Overall their quality was good. Pooled RR of dementia in relation to PD from all high quality studies was 1.38 (95%CI 1.01–1.90); in the five cohorts was 1.18 (1.06–1.31) and in the two case–control studies 2.25 (1.48–3.42). A 50% reduction in the current prevalence of 20% of PD in the population could save 850,000 (630,000–1,420,000) patients with dementia in the world. PD could increase the risk of incident dementia. Preventing and treating PD could contribute to controlling the global epidemic of dementia. Keywords Oral health · Periodontitis · Periodontal disease · Dementia · Alzheimer’s disease · Meta-analysis
Introduction Periodontal disease (PD) is a chronic inflammatory disease, affecting the gums by infection of oral bacteria resulting in alveolar bone loss and eventually tooth loss [1]. PD includes both gingivitis and periodontitis, while periodontitis alone has been reported to be the sixth most prevalent condition worldwide, affecting around 20–50% of the global population [2]. PD can start from early life and then progress to chronic periodontitis in the 40–50 year age range [3]. Dental plaque Rizwan Nadim and Jie Tang joint first author. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10654-020-00648-x) contains supplementary material, which is available to authorized users. * Ruoling Chen [email protected]
(bacterial biofilm) forms on teeth and calcifies to become dental calculus, on which additional plaque can form. Subgingival biofilm and calculus cause PD [4]. As a source of chronic inflammation and bacterial infection, PD m
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