Are you at increased risk for dementia? Poor oral health may contribute to the risk

By Ellen Allen

My grandmother Goldie died in 1984. Among other things, she had developed dementia and lived with us for several years when she could no longer take care of herself. It was hard seeing the effects of dementia ravaging her mind. Her peace. Her independence. Her very identity. I was  23 years old and it unsettled me.

Grandma Goldie also had dentures. She lost all of her teeth early in life. She grew up and existed in abject poverty most of her life in rural Southern West Virginia. Goldie had five children before she was 33. When her husband died unexpectedly leaving her with five young children, including an 18 month old infant — my mother — she went to work in a commercial laundry working over 12 hours a day, six days a week.  This was before any social safety nets existed.  Franklin Delano Roosevelet was early on in his historic presidency.

She was an adult in her senior years before she ever saw a dentist.

Is there a link between oral health and dementia?

Because September is World Alzheimer’s Awareness Month, we want to share interesting information that may be relevant to your life and those who you care about.

Recent research from the CareQuest Institute for Oral Health suggests that there may be a link between oral health and dementia.

It is estimated that by 2040, the number of individuals with Alzheimer’s disease and related dementias (ADRD) in the U.S. could reach 12 million, making it critical to determine whether improvements in oral health may prevent or reduce the symptoms of this disease.

Highlighted research findings include:

• Adults aged 50-80 with Alzheimer’s disease have worse periodontal (gum) health than their peers without Alzheimer’s, including more plaque, more bone loss around the teeth, and more gingival bleeding.
• Tooth loss from gum disease or tooth decay is linked with a higher risk of being diagnosed with ADRD.
• Individuals with ADRD — including those living in long-term care facilities — are at increased risk of poor oral health, due to challenges with maintaining oral hygiene and accessing professional oral health care.

The state of our oral health

Oral health data from the recent Oral Health Report Cards published by the West Virginia Oral Health Coalition last year compared the state’s dental care performance with that of the nation on 15 indicators that include preventive dental care, tooth decay and loss, among other indicators that we will talk about in future commentaries.

West Virginia earned a D+ overall.

According to the report, about 40% of West Virginians aged 45 and above have lost more than six teeth to tooth decay, a number that’s more than twice the national average.

A quarter of West Virginians over 65 have lost all of their natural teeth, compared with 12% nationally.

The state also earned a D for the number of adults who had visited a dentist in the last year — 56.6% compared to the national average of 65.9%.

Are West Virginians at greater risk for Alzheimer’s disease and related dementias?

Let’s take the current oral health data and the most current Alzheimer’s and age related dementia and draw some insights.

In 2023, the Alzheimer’s Association estimated that 38,000 people aged 65 and older in West Virginia were living with Alzheimer’s disease. Additionally, 13.6% of people aged 45 and older in West Virginia were experiencing subjective cognitive decline.

Age is a significant risk factor in itself. West Virginia has one of the oldest populations in the country. West Virginia also has the distinction of higher rates of risk factors for Alzheimer’s disease, such as high blood pressure, diabetes, high cholesterol, smoking and heart disease.

As we know by studying social determinants of health, West Virginia’s dementia mortality rate varies depending on the cause of death and the county.

Surprisingly, one’s zip code makes a difference. For instance, dementia mortality rates in West Virginia counties range from 5.2 deaths per 100,000 in Webster County to 63.6 deaths per 100,000 in Boone County.

A May 2011 study under the Gov. Earl Ray Tomblin administration, An Overview of Dementia: The Growing Crisis in West Virginia, produced some interesting results:

• The rate of hospital discharges with a principal or secondary diagnosis of AD was 29% higher in West Virginia than in the nation as a whole (24.4 per 10,000 discharges vs. 18.9).
• Dementia was the fifth leading cause of death in West Virginia in 2007. Approximately 5% of all deaths in the state in that year were due to AD or other dementia.
• When 2006 multiple-cause-of-death data were examined, the results showed the state rate for mortality from dementia as an any-listed cause of death was 11% higher than the national rate (99.4 deaths per 100,000 population vs. 89.9).
• From 1988 through 2007, the mortality rate for dementia increased from 8.2 deaths per 100,000 population to 49.9 deaths. The increase was seen for both AD and other dementias and in 51 of the 55 counties in the state.

Even though West Virginia needs more current data curated relating to dementia mortality, it is not unreasonable to draw connections between West Virginia’s low life expectancy, abysmal oral health outcomes, and increasing dementia crisis.

There is some good news, however. The Oral Health Report Card did show progress in oral health among West Virginia children, but there’s still more to be done.

Can oral health public policy initiatives move the needle on the dementia crisis in West Virginia? Probably, but it will be slow progress; perhaps the upcoming generation of our youth will turn the tide. All progress is incremental, and West Virginians for Affordable Healthcare is poised to support the West Virginia Oral Health Association and others to advance such policies.

 

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Are you at increased risk for dementia? Poor oral health may contribute to the risk