Dental Hygienist using an intramural scanner to scan a patients teeth

Alzheimer’s DiseaseWhy A Visit to Your Dental Hygienist Could Reduce Your Risk 

Most of us associate going to the dental hygienist with having a scale and polish – a wee clean up every 6 months to keep things looking shiny! But what if I told you there was mounting evidence that there may be a connection between gum disease and Alzheimer’s Disease? Would you value your time in the hygienist chair just a little bit more? Would you listen a bit more intently to what she has to say? 

Let’s have a little explore of Alzheimer’s disease, gum disease (periodontal disease), the recent research that shows how they may be linked, what you can do about it and how we, at Coatbridge Family Dental Care, can help you. 

The Impact of Alzheimer’s Disease

I don’t know about you, but as I get older the thought of getting dementia concerns me. My grandfather had it in the years before he died and it’s such a heartbreaking condition. The thought of no longer recognising family or friends, the confusion that you must feel as you lose your memory and understanding of the world around you. And it’s not just distressing for the person who has it. Imagine being the husband or wife or child of someone with dementia. For a person you have loved and who has loved you for your whole life to no longer remember you – it’s agonising. 

What is Alzheimer’s Disease? 

Alzheimer’s Disease is a progressive, degenerative disease of the nerves in the brain, affecting memories, thoughts, language and behaviour. The first signs are memory loss. As this progresses, it brings with it an inability to form new memories, confusion and disorientation, problems looking after yourself and difficulty moving around. Alongside this worsening quality of life, people often experience personality and behaviour changes and can suffer from anxiety and depression. 

Older woman looking at younger woman

Alzheimer’s disease was first discovered in 1906, by German scientist, Alois Alzheimer. Despite the fact that we’ve known about the disease for over a century and although we have some drugs which can relieve some of the symptoms, we have yet to find a cure. Once you have Alzheimers disease, unfortunately there is no recovery.  

How common is Alzheimer’s Disease? 

Alzheimers disease is the commonest form of dementia. There are currently 55 million living people with dementia in the world, with 10 million new cases every year. This is predicted to rise to 132 million by 2050, according to the World Health Organisation. 

Causes Of Alzheimer’s Disease 

The NHS website tells us that

“Alzheimer’s disease is thought to be caused by the abnormal build-up of proteins in and around brain cells.” 

The two proteins that are involved are called amyloid and tau.

Amyloid

Amyloid normally plays a good guy role in the brain – repairing leaks in the blood brain barrier and protecting from infection. However in Alzheimer’s, there is too much amyloid and it forms plaques around the outside of brain nerve cells. This is either due to too much being produced or not enough being removed. Amyloid plaques cause damage to nerve cells and damage to the blood brain barrier. 

Tau

Tau proteins form tangles outside of brain nerve cells. These tangles are lesions called Neurofibrillary Tangles. They kill the nerve cells of the brain

Once the nerve cells are damaged or die, there is a reduction in the chemical transmitters which are the substances which pass messages between brain cells.  

Over time, different regions of the brain shrink. The region responsible for memory is usually the first. 

It is still not known what triggers the start of this process, but we do know that it begins a long time before someone might first experience symptoms of Alzheimer’s. This means that it is a difficult disease to treat. 

Medical history with memory loss ticked

Risk Factors for Alzheimer’s Disease 

There is, however, research which has discovered some risk factors for Alzheimer’s Disease. Of these, ageing carries the biggest risk. And there is some research which has shown a relationship between Alzheimer’s and lifestyle-related risk factors, according to WHO. These may increase your risk of developing the condition and are risk factors for many of today’s common chronic diseases. 

  1. Physical inactivity
  2. Obesity 
  3. Unbalanced diet 
  4. Tobacco use 
  5. Harmful use of alcohol 
  6. Diabetes 
  7. Mid-life high blood pressure 

Your family history and the genes you inherit from your parents, may also increase your risk of Alzheimer’s disease. 

Tackling Alzheimer’s Disease 

Because dementia is such a prolific disease, which has a significant societal and financial impacts, in 2017 WHO developed the Global Action Plan on the Public Health Response to Dementia. 

As part of this, Global Target 7 states 

“The output of global research on dementia doubles between 2017 and 2025.”

So, at the moment, scientists all over the world are working hard to investigate all possible causes of dementia and Alzheimer’s. 

In recent years, the dental world has become part of this research. But why? What on earth do our mouths have to do with a disease of the brain?  

Why are mouths important in Alzheimer’s Disease? 

As far back as 1891, Willoughby D Miller, a US dentist, suggested that bacteria could leave the mouth and cause disease in other parts of the body.

Despite this, when I was at dental school (almost 30 years ago!) there was very little taught about this phenomenon – medicine and dentistry were quite separate entities. Indeed the way medicine has developed in the western world, means that we have always treated different body parts very separately. You have a heart problem, you go to a heart specialist, you have a brain problem, you go to a brain specialist, you have a mouth problem, you go to a dentist. It’s taken us a long time to think of the body as one living organism, to really appreciate the fact that all of the organs in our bodies are connected. And that something that is happening in one area of our body may have an effect on a distant part.

Furthermore we have only recently begun to appreciate the role that the microbiome plays in the health of our bodies.  

Periodontal Disease and the Spread of Bacteria 

But there’s an oral microbiome too. Unbelievably, about 700 different species of bacteria live in our mouths. And our mouths are a vulnerable point, a place where these bacteria can enter into our bloodstream and spread around the whole of our body. 

This isn’t an issue when our mouths are healthy and well-looked after, but poor oral hygiene can cause a buildup of bacteria and food in our mouths. This forms a sticky coating on our teeth called plaque. Over time if plaque is not removed by brushing, it hardens into a substance known as tartar or calculus. This tartar cannot be removed by your toothbrush and requires to be professionally removed by your dental hygienist.  

 

 

Smiley face carved into tartar on a tooth
Dental probe in a periodontal pocket<br />

When plaque and tartar are left on our teeth, this causes inflammation of our gums and the beginnings of gum disease. You can see this in your mouth – your gums look puffy and red, and they bleed when you brush even just lightly. At this point gum disease is reversible and is known as gingivitis.  

As inflammation increases, bacteria start to destroy the tissues that surround and support the teeth, the gums start to pull away from the teeth and deep pockets form around the roots of the teeth. This is when gum disease gets more serious and is then called Periodontitis. At this stage it is irreversible but can still be treated and improved by a dental hygienist. 

(Remember the little probe that the dental hygienist pokes around your gums – they’re measuring these pockets). These pockets are lined with ulcers and are essentially open wounds in our mouths. Although we can’t really see them when we look in our mouths, they can range from 5cm2 to 20cm2, which incredibly is about the size of the palm of your hand! These open wounds then make it easy for bacteria and inflammatory substances from the mouth to enter the bloodstream during eating and brushing. This means that bacteria from the mouth can travel to and affect parts of the body far away from the mouth. 

Here’s a great video from the British Society of Periodontology and Implant Dentistry showing just how bacteria can travel around the body.

Symptoms of Periodontal Disease

If you notice any of these things make an appointment with your dental hygienist and have them checked out. You can call our team on 01236 421103.

 

  1. Bleeding gums 
  2. Red, swollen gums
  3. Bad breath
  4. Gaps appearing between teeth
  5. Loose teeth
  6. Teeth moving position
  7. Receding gums
  8.  Sensitivity to hot/cold food and drinks

Find some more information about periodontal disease here.

Periodontitis linked with other systemic diseases

Periodontitis is prolific – it affects 1 in every 2 adults, worldwide! 

Because it is such a widespread disease, in those last 30 years since I was at university, there have been numerous studies on the relationship between gum disease and systemic disease (disease which affects the rest of the body). Studies on its relationship with heart disease, diabetes and rheumatoid arthritis all seem to suggest a link. 

It seems sensible then that scientists have started to look at the potential spread of this bacteria from the mouth to the brain and what it may be doing when it gets there. 

In the dental world researchers are working hard to identify what exactly the association is between periodontal disease and Alzheimer’s Disease. 

So, what have they found so far? 

How Could Periodontal Disease Cause Alzheimer’s?

Several studies have shown that bacteria associated with periodontal disease can enter the bloodstream and have been found in the brain. 

This is backed up by the fact that periodontal bacteria from the mouth has been shown to travel to the brain in live mice studies.

One of these bacteria, P. Gingivalis, releases an enzyme – gingipains – that has been shown to destroy nerve cells, which can lead to memory loss. In this study they examined the brains of 53 deceased people who had alzheimers. Nearly all of them had high levels of gingipain present. 

One of the ways it is thought gingipains may destroy nerve cells is by causing nerve cells to release the protein tau (remember we mentioned that as one of the causes of alzheimers?)

Once outside the cell, the tau changes into filaments and attaches to the outside of the nerve cell. This forms a lesion called a neurofibrillary tangle (remember we mentioned those too?).

These lesions kill the nerve cells of the brain. Once the cell dies the unattached tau can then attach itself to another healthy nerve cell, killing this cell and so the process evolves, the disease spreading throughout the brain. 

You can read more about this study here.

Gingipains may also cause direct injury to the blood vessels in the brain also causing damage to the blood brain barrier. 

As we mentioned earlier, a buildup of amyloid is also thought to cause Alzheimer’s. A further study has shown that oral bacteria may also interfere with the immune cells which normally would digest the amyloid plaque formations. In the presence of oral bacteria, the microglial cells that normally eat amyloid plaques become greedy and eat too much oral bacteria. This means that they don’t have the capacity to digest the amyloid and remove it from the brain. 

Pictures of journals<br />

Further mice studies have also shown that inflammatory substances from the pockets around teeth can cause inflammation of nerve cells and deficiencies in memory and spatial learning.  

Other periodontal bacteria have also been shown to invade the brain and produce amyloid plaques, changes in tau proteins and shrinkage of new nerve cells. 

There is also evidence pointing towards the fact that Alzheimer’s could be an inflammatory disease. And that having periodontitis increases the overall amount of inflammation that your body is having to deal with. This can then trigger or worsen inflammation of nerve cells in your brain, causing Alzheimer’s.

What does this mean?

At this stage studies are very much ongoing, in line with the WHO action plan.

All the current research seems to point to an association between Alzheimer’s and Periodontal Disease. 

However the mechanisms are not quite understood yet and there is no proof of cause and effect – whether the bacteria involved in periodontal disease actually cause Alzheimer’s disease. This review suggests that it is in fact likely that the relationship between periodontal disease and Alzheimer’s goes both ways.

As well as periodontal disease being involved in causing Alzheimer’s, those with dementia may also be more likely to develop periodontal disease. Is this due to the presence of inflammation or more down to the fact that they forget to or are unable to brush their teeth? 

At the moment we have to assume that Alzheimer’s disease is multifactorial – there may be many causes, as the research is still ongoing, But in the meantime  we can definitely act on the information we do have.

What you can do to help yourself

If there is something out there that we can do that might help prevent Alzheimer’s – something that’s easy and inexpensive – then it’s a no-brainer!  It’s something we should all be doing! 

And what is it I hear you ask?

When they tell us to brush our teeth, now we know, it’s not just about keeping our mouths healthy. It’s about keeping our whole body healthy too. It’s about preventing serious diseases that could have profound impacts on our life in the future. 

Watch Laura, one of our hygienist therapists explain why it’s important to come to see her and what to expect.

So here’s a list of things you can do to ensure your gums and your mouth stay as healthy as possible.

 

1.Brush for 2 minutes, twice a day 

2.Use floss or interdental brushes between your teeth 

3.Visit your dental hygienist every 3 or 6 months, depending on what they recommend 

4.If you’re worried about your gums, if they’re bleeding or if you have lots of tartar building up, see your dental hygienist. 

5. If you care for someone with Alzheimer’s disease, help them to keep their mouths as healthy as possible and to access regular dental care when they are able.

Here’s Laura again with some great info on how to brush effectively and use interdental brushes.

And another great one showing how to floss.

How we can help you

Our friendly team are always available to answer your questions. You can contact us  on 01236 421103 or fill in our contact form.

Laura and Ashley, our dental hygiene therapy team, are available 5 days a week in the practice, to offer you dental hygiene coaching and treatment.

One of the great benefits of the Coatbridge Family Dental Care membership plans is 3 or 6 monthly dental hygiene coaching and treatment with Laura or Ashley. Memberships start from as little as 53p per day.