Asociación entre la adherencia a la dieta mediterránea y las manifestaciones orales auto reportadas en adultos mayores / Association between adherence to the Mediterranean diet and self-reported oral manifestations in older adults

Fundamentos: La Dieta mediterránea (DM) es muy abundante en vitaminas que podrían contribuir al equilibrio en el mantenimiento de la salud cavidad oral. Por ello, es necesario determinar la asociación de la adherencia a la dieta mediterránea con las manifestaciones orales autoreportadas en adultos mayores. Métodos: El diseño del estudio realizado fue observacional de tipo analítico y transversal. Se ejecutó mediante una encuesta de forma virtual en adultos mayores durante el año 2022. Se utilizaron instrumentos validados de adherencia de la DM (MEDAS-14) y un autorreporte sobre manifestaciones orales, además se evaluaron diversas covariables. Para las variables cualitativas se obtuvieron frecuencias relativas y absolutas. En el análisis bivariado se utilizó la prueba estadística Chi-cuadrado. Para la asociación de las variables cualitativas y el cálculo de las razones de prevalencia crudas y ajustadas, se empleó la regresión de Poisson con varianza robusta. Resultado: Se halló que el 90,91% de los encuestados que mantenían una adherencia a la DM alta no manifestaban halitosis. Además, se observó que 57,58% que seguían una dieta mediterránea alta no manifestaba dolor dental. Se encontró en el análisis multivariado asociación estadísticamente significativa entre los encuestados que tenían una adherencia a la DM con ciertas manifestaciones orales tales como presencia de caries dental, dolor dental, halitosis, presencia de sangrado y movilidad dental en los análisis crudo y ajustado. Conclusión: La adherencia a la dieta mediterránea se relaciona a un mejor estado de salud en una población de adultos mayores. (AU)

Background: The Mediterranean Diet is very abundant in vitamins that could contribute to the balance in the maintenance of oral cavity health. Therefore, it is necessary to determine the association of adherence to the Mediterranean diet with self-reported oral manifestations in older adults. Methods: The study design was observational, analytical and cross-sectional. It was carried out through a virtual survey in older adults during the year 2022. Validated instruments of adherence to the Mediterranean diet (MEDAS14) and a self-report on oral manifestations were used, in addition various covariates were evaluated. For the qualitative variables, relative and absolute frequencies were obtained. In the bivariate analysis, the Chi-square statistical test was used. For the association of the qualitative variables and the calculation of the raw and adjusted prevalence ratios, Poisson regression with robust variance was used. Result: It was found that 90.91% of the respondents who maintained a high adherence to the MD did not manifest halitosis. In addition, it was observed that 57.58% who followed a high Mediterranean diet did not manifest dental pain. In the multivariate analysis, a statistically significant association was found between those surveyed who adhered to the MD with certain oral manifestations such as the presence of dental caries, dental pain, halitosis, presence of bleeding, and dental mobility in the crude and adjusted analyzes. (AU)

Association between low bone mineral density and periodontitis in generally healthy perimenopausal women.

BACKGROUND: The association between low bone mineral density (BMD) and periodontitis in perimenopausal women is controversial. The purpose of this study was to determine whether osteoporosis or osteopenia is associated with periodontal disease in a population of adult women. METHODS: A sample of over-45-year-old women with or without low BMD underwent lumbar spine and hip bone densitometry and a complete periodontal examination. The extent/severity or absence of periodontal disease was noted using two different case definitions. Data were gathered on socio-economic status, medication history, systemic co-morbidities, alcohol or tobacco use as well as serum levels of calcium and vitamin D. RESULTS: One hundred seventy three women aged between 45 and 72 years old were recruited with a mean age of 57.8 years. One hundred and three had decreased BMD (61 with osteoporosis and 42 with osteopenia) and 70 were healthy. Moderate or severe periodontitis was present in 52.6% of the women. Multivariate analysis showed a clear association between low BMD and periodontitis, but only in women above 58 years old and independent of tobacco consumption or oral hygiene. CONCLUSION: In this sample of generally healthy perimenopausal women, low BMD was associated with clinical attachment level (CAL). Women over 58 years old with decreased BMD presented with a higher mean percentage of sites with CAL ≥ 4 mm as well as CAL ≥ 6 mm when compared to controls, independent of active smoking status or poor oral hygiene.

Oral health and healthy chewing for healthy cognitive ageing: A comprehensive narrative review.

INTRODUCTION: Ageing leads to physiological cognitive decline that it is worsened in people with neurodegenerative diseases such as Alzheimer's disease. Despite the ongoing search for a solution to this cognitive decline, no effective remedies have been established. It has been determined that modifiable external factors, such as oral health and occlusal function, prevent cognitive decline. OBJECTIVE: To analyse the primary interactions between occlusal function and cognitive functions. MAIN FINDINGS: Masticatory function is related to cognitive functions. In particular, current evidence, from both animal and human studies, suggests that the activation of masticatory muscles and proper mastication, with natural teeth or dental prosthesis, induces the release of several mediators and the activation of specific brain areas. Together, they result in higher neuronal activity, neurotrophic support, blood flow and the prevention of amyloid-beta plaque formation. Thus, all the components of the masticatory system must work together in order to preserve cognitive function. CONCLUSIONS: Available evidence suggests that oral and cognitive health are more interconnected than previously thought. Therefore, maintenance and adequate restoration of the whole masticatory system are important for the prevention of cognitive decline. In summary, oral and chewing health lead to healthy cognitive ageing.

Systemic inflammatory impact of periodontitis on cognitive impairment.

OBJECTIVES: The role in dementia of systemic inflammation derived from periodontal disease is not fully elucidated. The objective of our study was to examine the impact of inflammation on the relationship between periodontitis and cognitive impairment. METHODS: We have designed a case (n = 171) and control (n = 131) study to determine the periodontal health status, grade of cognitive impairment/dementia and systemic inflammation level, the last being measured by analysis of 29 inflammatory biomarkers using multiplex techniques. RESULTS: At the time of sampling, 11 of the 29 inflammatory biomarkers were associated with cognitive impairment in patients with more severe periodontitis. However, the inflammatory response to severe periodontitis was more reduced (lower biomarker concentrations) in cases (with cognitive impairment or dementia) than in (cognitively healthy) controls, an unexpected finding. CONCLUSIONS: Based on these results, we cannot confirm that systemic inflammation derived from periodontal disease plays a relevant role in the aetiology of cognitive impairment.

An update of knowledge on PD-L1 in head and neck cancers: Physiologic, prognostic and therapeutic perspectives.

Programmed cell death-ligand 1 (PD-L1) is a transmembrane protein that acts as a co-inhibitory factor in the immune response. Its receptor, programmed cell death protein 1 (PD-1), is found on immune cells, where binding to PD-L1 can reduce the proliferation of PD-1-positive cells, inhibit their cytokine secretion and induce apoptosis. PD-L1 in immune-privileged tissue plays a crucial role in peripheral tolerance. PD-L1 can be overexpressed in various malignancies, including oral squamous cell carcinoma, where it can attenuate the host immune response to tumour cells and has been associated with a worse prognosis. Monoclonal antibody therapies targeting the PD-1:PD-L1 axis have shown initial promise, but further research is needed to identify which patients will benefit. We provide an update of knowledge on PD-L1, including its structure, function and regulation. We also review studies on the overexpression of PD-L1 in cancer, specifically oral squamous cell carcinoma, and explore its potential value as a therapeutic target.

Malignant transformation risk of oral lichen planus: A systematic review and comprehensive meta-analysis.

OBJECTIVES: To evaluate current evidence on the malignant transformation of oral lichen planus (OLP), oral lichenoid lesions (OLLs), and oral lichenoid reactions (LRs) and to determine the variables with greatest influence on cancer development. MATERIAL AND METHODS: We searched PubMed, Embase, Web of Science, and Scopus for studies published before November 2018. We evaluated the quality of studies (QUIPS tool). We carried out meta-analyses to fulfill our objectives. We examined the between-study heterogeneity and small-study effects, and conducted sensitivity studies and subgroup analyses. RESULTS: Inclusion criteria were met by 82 studies (26,742 patients. The combined malignant transformation rate was 1.14% for OLP (95% CI = 0.84-1.49), 1.88% for OLLs (95% CI = 0.15-4.95) and 1.71% for LRs (95% CI = 0.00-5.46). Subgroup analysis revealed a higher malignant transformation rate in studies when the presence of epithelial dysplasia was not an exclusion criterion (p = 0.001), when both clinical and histopathological criteria were used for diagnosis (p < 0.001), when the follow-up was at least 12 months (p = 0.048), and when there was lower risk of potential bias (p = 0.002). Malignant transformation risk factors were: tongue localization (RR = 1.82, 95% CI = 1.21-2.74, p = 0.004), presence of atrophic-erosive lesions (RR = 4.09, 95% CI = 2.40-6.98, p < 0.001), tobacco use (RR = 1.98, 95% CI = 1.28-3.05, p = 0.002), alcohol consumption (RR = 2.28, 95% CI = 1.14-4.56, p = 0.02), and hepatitis C virus infection (RR = 4.46, 95% CI = 0.98-20.22, p = 0.053). CONCLUSIONS: The malignant transformation rates of OLP, OLLs and LRs are underestimated due essentially to restrictive diagnostic criteria, inadequate follow-up periods, and/or low quality of studies.

Predictive value of CCND1/cyclin D1 alterations in the malignant transformation of potentially malignant head and neck disorders: Systematic review and meta-analysis.

BACKGROUND: To evaluate published evidence on the predictive value of CCND1 amplification/cyclin D1 overexpression as malignant transformation risk markers in potentially malignant disorders (PMDs) of the head and neck. MATERIAL AND METHODS: We searched PubMed, Embase, Web of Science, and Scopus for studies published before June 2018. We conducted a meta-analysis to quantify the impact of CCND1/cyclin D1 amplification/overexpression on malignant transformation of head and neck PMDs. RESULTS: Nine studies met inclusion criteria. Quantitative evaluation indicated strong statistically significant association between CCND1/cyclin D1 amplification/overexpression and the progression of head and neck PMD to head and neck squamous cell carcinoma (risk ratio [RR] = 2.04, 95% confidence interval [CI] = 1.37-3.03, P < .001, and RR = 2.27, 95% CI = 1.32-3.91, P = .003, respectively). We observed moderate heterogeneity among studies (I2 = 40.7%), and we cannot rule out small-study effects such as publication bias. The oral cavity subgroup showed the strongest association between CCND1/cyclin D1 amplification/overexpression and progression to cancer. CONCLUSION: CCND1/cyclin D1 amplification/overexpression is important to predict the malignant transformation risk of head and neck PMDs, especially oral PMDs.

The influence of habitual consumption of chewing gums in the outcome of masticatory performance tests using two-coloured chewing gums.

The aim of this study is to assess the influence of regular consumption of chewing-gums on the Masticatory Performance (MP); and to determine if increasing the consumption improves the MP of non-regular consumers. We recorded the chewing-gums consumption rate (CGC) and measured the MP of 265 participants (µ = 47.09, σ = 22.49 years) using the Variance of the Histogram of the Hue (VhH) image processing method. Then, participants were instructed to increase the consumption, and the MP was measured again (SESSION) two and four days after. Normality of MP was verified with Kolmogorov-Smirnov and Shapiro-Wilk tests. The association between the age and the consumption rate was measured with GEE and the eta-squared statistic. Finally, a 3 × 3 mixed ANOVA with SESSION as the within-subject factor and CGC as the between-subjects factor was run. Session-wise and group-wise comparison were performed with post hoc Bonferroni. No systematic error was detected for VhH (p = 1.00). Kolmogorov-Smirnov and Shapiro-Wilk tests confirmed the normality of the distribution of MP (p > 0.05). There was a significant effect of SESSION on MP, F(1.746, 457.328) = 59.075, p < 0.001; furthermore, there were significant differences in MP between SESSIONs. Additionally, there was a significant effect of CGC on MP, with F (2, 356.53) = 564.73, p < 0.001. In conclusion, the chewing-gum consumption habits influence the two-coloured chewing gum mixing test. The apparent MP of non-regular consumers can be improved by prescribing a controlled increase in the consumption of chewing-gums for a few days.

Clinicopathological significance of tumor cyclin D1 expression in oral cancer.

OBJECTIVE: To evaluate the association of cyclin D1 overexpression with clinicopathological parameters classically considered of prognostic value in OSCC (T, N, M, clinical stage, degree of differentiation, invasive morphology and, cellular proliferation index). DESIGN: A retrospective immunohistochemical study was conducted of cyclin D1 and ki-67 expression in 68 OSCCs from 54 patients. Cases were scanned using a digital pathology system. The tumor expression of markers was assessed in four randomly selected fields (40x), and a semi-automatized count was conducted of cyclin D1-positive and -negative cells. RESULTS: Cyclin D1 overexpression was found in 28.7% of the cases of OSCC. It was significantly and positively associated with the following clinicopathological parameters: low tumor differentiation degree (p = 0.030), invasive morphology (p = 0.045), and proliferative phenotype according to tumor cell ki-67 expression (p = 0.018). CONCLUSIONS: Cyclin D1 overexpression is an event of oral carcinogenesis associated with clinicopathological parameters classically associated with a poor prognosis in patients with OSCC.

Quality of life during pregnancy and its influence on oral health: a systematic review / Calidad de vida durante el embarazo y su influencia en la salud bucal: una revisión sistemática

Abstract: Objective: To perform a systematic review of scientific literature on the impact of oral health on the quality of life of pregnant women. Methods: A systematic search following PRISMA guidelines was carried out and 16 specific articles/studies on the subject were selected. Results: Pregnant women's quality of life (QoL) is related to age, number of pregnancies, pain, difficulty eating and presence of dental caries. Quality of life was directly related to oral health. Conclusions: It was found that most studies associating QoL and oral health during pregnancy were cross-sectional and observational; therefore, for a better understanding of these impacts, performing longitudinal studies from the beginning of pregnancy until postpartum is necessary. The need for preventive oral health counseling and dental care assistance during pregnancy is highlighted.

Objetivo: Realizar una revisión sistemática de la literatura científica sobre el impacto de la salud oral en la calidad de vida de las embarazadas. Métodos: Se lleva a cabo una búsqueda sistemática y se seleccionaron 16 artículos específicos sobre el tema, siguiendo las directrices PRISMA. Resultados: La calidad de vida (CdV) en la embarazada está relacionado con la edad, número de embarazos, dolor, dificultad para comer y presencia de caries. La calidad de vida se relacionó directamente con la salud oral. Conclusiones: A través de esta revisión se encontró que la mayoría de los estudios que relacionaban la CdV y la salud oral durante la gestación fueron de corte observacional transversal, por ello para una mejor comprensión de estos impactos, es necesario realizar estudios longitudinales desde el comienzo del embarazo hasta el posparto. Se destaca la necesidad de asesoramiento de salud oral preventiva y una ruta de atención dental durante el embarazo.

Prognostic and clinicopathological significance of CTTN/cortactin alterations in head and neck squamous cell carcinoma: Systematic review and meta-analysis.

BACKGROUND: To evaluate the prognostic significance of CTTN/cortactin alterations in head and neck squamous cell carcinoma (HNSCC). MATERIAL AND METHODS: We searched PubMed, Embase, Web of Science, and Scopus for studies published before May 2018. We conducted a meta-analysis to quantify the impact of CTTN/cortactin alterations on clinicopathological and survival variables. RESULTS: Eighteen studies (1633 patients) met inclusion criteria. Quantitative evaluation revealed a strong association of CTTN/cortactin alterations with N+ status (P < .001), higher T status (P < .001), advanced clinical stage (P < .001), high histological grade (P = .001), and lower overall survival (OS) (P < .001). We found heterogeneity in T status, histological grade, and OS and observed small-study effects on N status and OS. In subgroup analyses, a significant association of CTTN amplification and cortactin overexpression with the above variables was preserved. The strongest association between CTTN/cortactin alterations and a worse outcome was observed in the subgroups of Asian patients and pharyngolaryngeal squamous cell carcinomas. CONCLUSIONS: CTTN/cortactin alterations should be evaluated to predict the HNSCC prognosis.

Associated factors with health-compromising behaviors among patients treated for oral cancer

Background: To improve eradication strategies of health-compromising behaviors between oral cancer survivors, this study aimed to explore the extent of clustering of risk behaviors and to assess possible factors associated. Material and Methods: A cross-sectional study was carried out among oral cancer patients at least 6 months after treatment. They completed a questionnaire about smoking, alcohol consumption, oral hygiene habits and dental visits. Presence of clusters was evaluated through pairwise Pearson correlations and principal component analysis. Factors associated with each identified cluster were analyzed with multivariate models. Results: Among 142 patients, 14.8% smoked, 51.7% consumed alcohol, 52.1% performed oral hygiene less than twice a day, and 74.6% visited to dentist when there was a problem or never. There were two distinct clusters: smoking-alcohol consumption (general risk behaviors cluster) and oral hygiene-dental attendance (oral risk behaviors cluster). Multivariate analysis showed significant associations between males and both clustering patterns of health compromising behaviors, patients with clinical stage I or with longer follow-up and the presence of general risk behaviors cluster and worse social class and the presence of oral risk behaviors cluster. Conclusions: A high proportion of patients treated for oral cancer presented health-compromising behaviors occurring in clusters which reinforce the need for health promotion strategies to target multiple behaviors. Factors analyzed suggest that chances of having detrimental behavioral clustering are higher in male, patients with clinical stage I, with lower social class and those with longer follow-up after treatment

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Asymmetrical proliferative pattern loss linked to cyclin D1 overexpression in adjacent non-tumour epithelium in oral squamous cell carcinoma.

OBJECTIVE: To evaluate cyclin D1 overexpression in oral squamous cell carcinomas and adjacent non-tumour epithelium as a biomarker of premalignant fields and a risk factor for multiple tumour development. DESIGN: We studied cyclin D1 expression in 54 patients with 68 oral squamous cell carcinomas plus adjacent non-tumour epithelia characterized as close (n = 58) or distant (n = 41) from the invasion point. Randomized 40x fields were evaluated (4 in tumour tissue and 1 each in close and distant non-tumour epithelium). Expression in non-tumour epithelium was evaluated in basal, parabasal, middle-third and upper-third compartments. RESULTS: Cyclin D1 overexpression was found in both carcinomas and non-tumour epithelia. Nuclear expression in basal and parabasal layers of distant epithelium was significantly increased in patients with multiple tumours (p < 0.001). A significant association between cyclin D1 overexpression in different epithelial layers was found in both close and distant epithelia. A significant association was found between nuclear expressions of cyclin D1 and Ki-67 in the basal layer of distant epithelium (p = 0.02). CONCLUSIONS: Cyclin D1 overexpression is an early event in oral carcinogenesis linked to loss of the physiological asymmetrical proliferation pattern. Cyclin D1 overexpression in basal and parabasal layers of epithelia distant from the invasion point may act as a potential marker of premalignant fields and multiple tumour development.

An update of knowledge on cortactin as a metastatic driver and potential therapeutic target in oral squamous cell carcinoma.

Cortactin is a protein encoded by the CTTN gene, localized on chromosome band 11q13. As a result of the amplification of this band, an important event in oral carcinogenesis, CTTN is also usually amplified, promoting the frequent overexpression of cortactin. Cortactin enhances cell migration in oral cancer, playing a key role in the regulation of filamentous actin and of protrusive structures (invadopodia and lamellipodia) on the cell membrane that are necessary for the acquisition of a migratory phenotype. We also analyze a series of emerging functions that cortactin may exert in oral cancer (cell proliferation, angiogenesis, regulation of exosomes, and interactions with the tumor microenvironment). We review its molecular structure, its most important interactions (with Src, Arp2/3 complex, and SH3-binding partners), the regulation of its functions, and its specific oncogenic role in oral cancer. We explore the mechanisms of its overexpression in cancer, mainly related to genetic amplification. We analyze the prognostic implications of the oncogenic activation of cortactin in potentially malignant disorders and in head and neck cancer, where it appears to be relevant in the development of lymph node metastasis. Finally, we discuss its usefulness as a therapeutic target and suggest future research lines.

Prognostic and clinicopathological significance of cyclin D1 expression in oral squamous cell carcinoma: A systematic review and meta-analysis.

OBJECTIVES: To evaluate the prognostic significance of cyclin D1 (CD1) overexpression in OSCC. MATERIAL AND METHODS: We searched studies published before August 2017 (Pubmed, Embase, Web of Science, Scopus). We evaluated the quality of the studies included (Quality in Prognosis Studies [QUIPS] tool). The impact of CD1 overexpression on overall survival and disease-free survival, T status, N status, stage, and histological degree was meta-analyzed. We analyzed heterogeneity among studies, conducted sensitivity analyses, analyzed small-study effects, and conducted subgroup analyses. RESULTS: 31 studies (2942 patients) met inclusion criteria. Qualitative evaluation demonstrated that not all studies were performed with the same rigor, finding the greatest risk of bias in the study confounding domain. Quantitative evaluation showed that CD1 overexpression had a strong statistical association with worse overall survival (HR = 2.00, 95% CI = 1.59-2.51, p < 0.001), worse disease-free survival (HR = 1.46, 95% CI = 1.13-1.87, p = 0.003), higher T status (OR = 1.51, 95% CI = 1.07-2.13, p = 0.02), N+ status (OR = 2.16, 95% CI = 1.60-2.92, p < 0.001), advanced stage (OR = 1.44, 95% CI = 1.15-1.81, p = 0.002), and high histological grade (OR = 1.60, 95% CI = 1.12-2.29, p = 0.010). We observed heterogeneity in all parameters except for disease-free survival and clinical stage. We found effect of small studies on T and N status. The tonguel SCC subgroup showed the strongest association between CD1 overexpression and worse development. In addition, application of a cutoff point ≥10% tumor cells with nuclear CD1 expression maintained most of the significant associations reported. CONCLUSIONS: These findings indicate that immunohistochemical assessment of CD1 overexpression may be useful as a prognostic biomarker for OSCC.

A novel expert system for objective masticatory efficiency assessment.

Most of the tools and diagnosis models of Masticatory Efficiency (ME) are not well documented or severely limited to simple image processing approaches. This study presents a novel expert system for ME assessment based on automatic recognition of mixture patterns of masticated two-coloured chewing gums using a combination of computational intelligence and image processing techniques. The hypotheses tested were that the proposed system could accurately relate specimens to the number of chewing cycles, and that it could identify differences between the mixture patterns of edentulous individuals prior and after complete denture treatment. This study enrolled 80 fully-dentate adults (41 females and 39 males, 25 ± 5 years of age) as the reference population; and 40 edentulous adults (21 females and 19 males, 72 ± 8.9 years of age) for the testing group. The system was calibrated using the features extracted from 400 samples covering 0, 10, 15, and 20 chewing cycles. The calibrated system was used to automatically analyse and classify a set of 160 specimens retrieved from individuals in the testing group in two appointments. The ME was then computed as the predicted number of chewing strokes that a healthy reference individual would need to achieve a similar degree of mixture measured against the real number of cycles applied to the specimen. The trained classifier obtained a Mathews Correlation Coefficient score of 0.97. ME measurements showed almost perfect agreement considering pre- and post-treatment appointments separately (κ ≥ 0.95). Wilcoxon signed-rank test showed that a complete denture treatment for edentulous patients elicited a statistically significant increase in the ME measurements (Z = -2.31, p < 0.01). We conclude that the proposed expert system proved able and reliable to accurately identify patterns in mixture and provided useful ME measurements.

Relevance of chromosomal band 11q13 in oral carcinogenesis: An update of current knowledge.

An important event in oral carcinogenesis is the amplification of chromosomal band 11q13, in which numerous oncogenes and some tumor-suppressor genes are localized and frequently co-amplified during the malignant transformation of oral epithelium. The objectives of this study were to review published data on the involvement of 11q13 amplification in oral cancer, to provide an update on novel concepts and terminology related to gene amplification, and to explore the composition of the 11q13 amplicon in OSCC, including its most relevant amplicon cores and potential drivers. We report on the critical oncogenes and tumor-suppressor genes in 11q13 that may play a major role in oral cancer, focusing on their functions, on the characteristics acquired by their amplification, and on their clinicopathological implications. Finally, we discuss the possible usefulness of the 11q13 region as a therapeutic target in oral cancer.

Association Between Periodontitis and Amyloid ß Peptide in Elderly People With and Without Cognitive Impairment.

BACKGROUND: Evidence that periodontal disease is a possible risk factor for cognitive impairment may be explained by the inflammatory hypothesis. The aim of this study is to determine whether periodontitis is related to the amyloid ß (Aß) load in blood and the role of any such relationship in the association between Aß and cognitive impairment. METHODS: A case-control study was performed in elderly people diagnosed with cognitive impairment with or without dementia (cases group) and cognitively healthy elderly people (control group); data were collected on the medical and dental history of participants, and blood samples were drawn to determine Aß levels using enzyme-linked immunosorbent assay. RESULTS: The study included 166 patients and 122 control participants. Higher blood Aß1-42 levels (P = 0.01) and higher Aß42:40 ratio (P = 0.06) were observed in participants with severe attachment loss than in other participants. Periodontitis was a significant interaction variable, given that the association between Aß1-42 and Aß1-40 and cognitive impairment was only observed in patients with severe periodontitis. According to these data, periodontitis may be a modulating variable of the association between Aß and cognitive impairment. CONCLUSIONS: Plasma Aß1-42 levels are higher in individuals who have severe periodontal disease. The presence of periodontitis may modify the association between Aß and cognitive impairment.

Oral Hygiene in the Elderly with Different Degrees of Cognitive Impairment and Dementia.

The control of bacterial dental plaque through daily oral hygiene is essential to prevent oral diseases such as caries or periodontal disease, especially in at-risk populations, including the elderly with mild cognitive impairment and dementia. The aim of this study was to determine the association between different levels of cognitive impairment and dementia in an elderly population and their capacity to maintain adequate oral hygiene. A case-control study (elderly with versus without mild cognitive impairment or dementia) was performed in Granada, Spain. Outcome variables were tooth/prosthesis-brushing frequency/day, bacterial plaque index, and gingival bleeding index. Statistical models were adjusted by age, sex, educational level, and tobacco and alcohol habits. The study included 240 cases and 324 controls. The final model, adjusted by age, sex, educational level, and tobacco and alcohol consumption, showed a significant association between degree of cognitive impairment and daily oral hygiene, accumulation of bacterial plaque, and gingival bleeding. In summary, deficient daily oral hygiene, evidenced by greater bacterial dental plaque accumulation and gingival inflammation, is independently associated with cognitive impairment, even at its earliest stage.

Prevalence of Drug-Induced Xerostomia in Older Adults with Cognitive Impairment or Dementia: An Observational Study.

BACKGROUND: Older adults, especially those with cognitive impairment or dementia, frequently consume drugs with potential xerostomic effects that impair their quality of life and oral health. OBJECTIVES: The objective of this study was to determine the prevalence and analyze the possible pharmacological etiology of xerostomia in older people with or without cognitive impairment. METHODS: Individuals with cognitive impairment were recruited from patients diagnosed using standardized criteria in two neurology departments in Southern Spain. A comparison group was recruited from healthcare centers in the same city after ruling out cognitive impairment. Data on oral health, xerostomia, and drug consumption were recorded in both groups. Dry mouth was evaluated using a 1-item questionnaire and recording clinical signs of oral dryness. All drugs consumed by the participants were recorded, including memantine, anticholinesterases, antipsychotics, antidepressants, and anxiolytics. RESULTS: The final sample comprised 200 individuals with mild cognitive impairment or dementia and 156 without. Xerostomia was present in 70.5 % of participants with cognitive impairment versus 36.5 % of those without, regardless of the drug consumed. Memantine consumption was the only variable significantly related to xerostomia in the multivariate model (OR 3.1; 95 % CI 1.1-8.7), and this relationship persisted after adjusting for possible confounders and forcing the inclusion of drugs with xerostomic potential. CONCLUSIONS: More than 70 % of participants diagnosed with cognitive impairment or dementia had xerostomia. Anticholinesterases and memantine were both associated with the presence of xerostomia. In the case of memantine, this association was independent of the consumption of the other drugs considered.