Elderly People Who Were Missing 20 Or More Teeth Had A 31% Higher Risk Of Cognitive Impairment

Maybe you are too busy to go to the dentist, even if your gums are bleeding or your breath smells bad. Or maybe you are so afraid of going to the dentist that even though your gums are getting bigger or your roots are getting longer, you put it off as long as you can and don't want to take the initiative.

Such procrastination can be costly, as you may then have to deal with a major headache, namely missing teeth. If it is a front tooth that has been lost,  no matter how busy you are or how scared you are of going to the dentist, just take care of it as soon as possible for the sake of saving face, but if it is a back tooth that is more invisible to others, I guess some people may still resort to delaying.

Worse still, even if only one tooth is missing at first, a domino effect will gradually start to occur, posing a threat to oral and general health. For middle-aged and elderly people in particular, it can also be one of the risk factors for Alzheimer's disease.

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Why does tooth loss affect Alzheimer's disease?

Tooth loss is a risk factor for Alzheimer's disease because it affects the functioning of the brain. We can start by looking at some of the research done in Japan, one of the first countries to move towards an aging society.Ryusei Yamamoto, an assistant professor at Kanagawa Dental University, published a paper in 2012 in the American journal Psychosomatic Medicine: Journal of Biobehavioral Medicine. In the paper, he noted that his research team at the Japanese Ministry of Health, Labour and Welfare had studied 4,425 elderly people aged 65 and above. After four years of follow-up, it was found that those with fewer than 20 teeth and no dentures had a 1.9 times higher risk of dementia than those with more than 20 teeth.

Professor Minoru Ueda of the Nagoya University Institute of Medical Research also conducted a survey of 78 healthy elderly people, 39 elderly people with cerebrovascular cognitive impairment, and 36 elderly people with Alzheimer's disease.

It was found that the number of teeth in the Alzheimer's disease group was 1/3 of the average for the healthy group, and the lower the number of teeth remaining in the Alzheimer's disease group, the more severe the brain shrinkage. In addition, when they started losing their teeth, the Alzheimer's group was found to be 20 years earlier than the healthy group. This means that in general, elderly people with Alzheimer's disease start losing their teeth earlier and suffer more from tooth loss.

If tooth loss starts early and is not treated, the risk of developing Alzheimer's disease is three times higher than the average for all elderly people.

Why are missing teeth and Alzheimer's disease so closely related? A series of suspensory ligaments called periodontal ligaments to connect the teeth to the alveolar bone. When we chew, the roots of our teeth are pressed downwards under pressure, causing the microvasculature within the periodontium to compress and stimulate blood flow back to the brain. In fact, this chewing action not only stimulates blood flow but also affects memory and cognitive areas of the brain, including the hippocampus and grey matter. When tooth loss occurs, chewing power begins to decline, and the more teeth missing, the more severe the decline.

1. Chewing revitalizes the hippocampus for Alzheimer's disease Patients

The hippocampus is located in the limbic system of the brain. Its volume slowly shrinks as people age and the number of blood vessels decreases, but it can be revitalized with proper stimulation. Many elderly people tend to have a poor appetite or a tendency to eat liquid food due to poor or missing teeth. However, if they do not chew for a long time, they lose the opportunity to revitalize the hippocampus.

In 2020, the American medical journal Aging published a report on a 22-year study. which followed 554 subjects over the age of 50, showed a positive correlation between reduced chewing ability and mental decline with age, i.e. the worse the chewing ability, the more pronounced the mental decline.

Professors Minoru Onozuka and Masafumi Fujita of the Gifu University School of Medicine in Japan also conducted a gum-chewing experiment to observe the effect of chewing on the hippocampus, which is responsible for memory in the brain. The subjects were asked to chew gum for 2 minutes and functional magnetic resonance imaging (fMRI) was used to observe the changes before and after chewing.

The results showed that 2 minutes of chewing did stimulate the activation of the hippocampus. More interestingly, this change was not apparent in the young subjects but showed significant results in the older ones. If 2 minutes of chewing gum alone can activate the hippocampus, we should certainly make use of the opportunity to chew as much as possible during our three meals to increase the force of hippocampal stimulation.

2. Chewing thwarts dementia by Grey matter

Grey matter is the concentration of nerve cells in the brain. As we age, we lose grey matter, resulting in cognitive decline.

In 2018, Professor Ming-Lun Hsu of the School of Dentistry at Yang Ming University published a study on the correlation between grey matter and chewing ability in the brain. The results showed that elderly people with better chewing and swallowing ability lost grey matter at a slower rate.

Chewing not only increases blood flow to the brain but also provides direct stimulation to the brain and further activates it.

After 80, aim for 80/20

The Japanese Ministry of Health and Welfare and the Japanese Dental Association jointly introduced the concept of "80/20" in 1989: aim to have at least 20 natural teeth when you reach the age of 80. With 20 natural teeth, your diet and life will not be affected too much, and you will be able to live and enjoy food until you are old.

In 2001, the World Health Organisation (WHO) also followed up on this concept. A survey conducted by the Kagawa Prefectural Dental Association in Japan in 2013 found that elderly people with 0 to 4 teeth were 1.5 times more likely to spend more on health care than those with 20 or more teeth.

While the 80/20 concept was originally intended to allow seniors to have a normal diet, subsequent research has shown that the more teeth one has, the better one's health is, the more one can save on medical expenses and the less one is likely to lose one's mind.

It is not too difficult for modern people to live into their 70s, 80s or even 90s. However, it is not enough to live to a ripe old age, one must also live a healthy and active life to enjoy the dividends of longevity. Many people are aware of this, so when they reach middle age, they actively exercise or take health supplements in order to age healthily and gracefully.

However, when it comes to dementia, most people can only shake their heads and sigh. Not only does it cause great distress and inconvenience to the patient or his or her family. Moreover, it is not yet fully manageable with current medical technology.

It is well known that dementia is a disease of the brain. People with dementia suffer from cognitive deterioration, behavioural changes and mood disorders. According to a survey conducted by the Ministry of Health and Welfare and the Ministry of the Interior's demographic data in 2021, the prevalence of dementia among the elderly aged 65 and above in Taiwan is estimated to be around 7%, which means that there is one person with dementia in every 13 people.

Among the dementias, "degenerative dementia" is the most common, and Alzheimer's disease is one of the most familiar ones, with about 60% to 80% of dementia patients suffering from Alzheimer's disease.

Alzheimer's disease is irreversible, prevention is the best way to deal with it

Perhaps you are close to someone with Alzheimer's disease, or have heard stories of helplessness and hopelessness of those with the disease and their families, and wish that similar regrets would not happen to you and your family. Unfortunately, there is no real effective treatment for Alzheimer's disease. What is even more frightening is that it is an irreversible disease, meaning that once the disease is developed, all that can be done medically is to slow down the progression and improve the symptoms, but it will eventually get worse. This is why 'prevention' is one of the most important strategies in dealing with this disease.

Thanks to experts in the fields of neurology and neurology, the causes of Alzheimer's disease continue to be explored, and there are now some research findings that show concrete ways to reduce the risk of developing the disease. For example, adopting a Mediterranean diet, exercising regularly, socialising, and playing brain games are some of the ways to prevent the disease.

As an oral health care dentist, I would like to look at several risk factors that may be associated with Alzheimer's disease from an oral perspective, from small to large, from fillings, reconstruction, disease, missing teeth, etc. These include silver powder in poor condition, poor quality metal dentures, periodontal disease and missing teeth.

It cannot be said arbitrarily that avoiding these risk factors will keep you completely safe from the threat of Alzheimer's disease. However, if you are aware of the potential risks, you should try to understand them and avoid them as much as possible.