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Tooth Loss and Dementia: A Critical Examination
Thomson WM, Barak Y.. Journal of dental research, 2020-09-18
Topic: Brain imaging, connectivity and assessment
Dementia is a major contributor to dependence and disability in older people, with aging societies characterized by growing numbers of people living with the condition. Dementia rates are highest in those with low education early in life, midlife hypertension, midlife hearing loss, depression, obesity, loneliness, a sedentary lifestyle, or sustained exposure to smoking or diabetes. Tooth loss is a putative risk factor for dementia which has received increasing research attention, but systematic review findings are mixed. Three main mechanisms have been proposed, involving 1) tooth loss leading to compromised nutrition and then leading to poorer central nervous system (CNS) function; 2) tooth loss resulting in fewer interocclusal contacts and so less somatosensory feedback to the CNS, leading to impaired cognition; and (3) chronic periodontitis resulting in tooth loss, but not before the inflammation has affected the CNS, impairing cognition. None of these is supported by compelling empirical evidence. Here, we use the life course approach to propose a plausible, empirically supported explanation for the associations between missing teeth and poorer cognitive function in older people. Evidence from longstanding cohort studies demonstrates that the putative association arises from cognitive function much earlier in life, in childhood. People with better childhood cognitive function have better oral health and access to routine dental care as they go through life, losing fewer teeth along the life course. They are also much more likely to have better cognitive function in old age. Their less cognitively able childhood counterparts will experience higher disease rates and poorer access to care, resulting in greater incremental tooth loss. Comparison of the 2 groups at any age from the mid-20s on will show greater numbers of missing teeth in the group who were less cognitively able in childhood. Those differences will be most pronounced in old age.
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APA 7th
Thomson, W. M., & Barak, Y. (2021). Tooth Loss and Dementia: A Critical Examination. Journal of dental research. https://doi.org/10.1177/0022034520957233
Vancouver
Thomson WM, Barak Y. Tooth Loss and Dementia: A Critical Examination. Journal of dental research. 2021. doi:10.1177/0022034520957233. PMID: 32942945.
BibTeX
@article{thomson2021-32942945,
author = {Thomson, W. M. and Barak, Y.},
title = {{Tooth Loss and Dementia: A Critical Examination}},
journal = {Journal of dental research},
year = {2021},
doi = {10.1177/0022034520957233},
pmid = {32942945},
url = {https://doi.org/10.1177/0022034520957233}
}
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Key findings
- People with better childhood cognitive function have better oral health and access to routine dental care as they go through life, losing fewer teeth along the life course.
- They are also much more likely to have better cognitive function in old age.
- Their less cognitively able childhood counterparts will experience higher disease rates and poorer access to care, resulting in greater incremental tooth loss.
- Comparison of the 2 groups at any age from the mid-20s on will show greater numbers of missing teeth in the group who were less cognitively able in childhood.
- Those differences will be most pronounced in old age.
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Study details
- Study designsystematic review
- Evidence strengthHigh
How this study scored 67/100
Published in a peer-reviewed journal, and it is a systematic review of all the studies on the question. Scored zero for sample size, effect reported and studied in people because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 39 of the 58 points we could judge it on, which is 67 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Journal of dental research) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 12 / 12 | A systematic review of all the studies on the question |
| Strength of evidence | 5 / 5 | Rated “high” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | A review of other studies — randomisation is not credited here |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 32942945) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 39 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 39 of the 58 points we could judge it on is 67 out of 100. |
| Total | 67 / 100 | — |
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