Poor Periodontal Health in Nursing Home Residents With Dementia

Objectives: Poor oral health conditions have frequently been reported for institutionalized older people but literature is lacking research on relationships between dementia and periodontal health in nursing home residents. The purpose of this cohort study therefore was to evaluate whether dementia is associated with poor oral health / denture hygiene and an increased risk of periodontal disease in the institutionalized elderly.

Methods: For 223 participants included in this study cognitive state was assessed using the Mini Mental State Examination (MMSE). According to the MMSE outcome, participants scoring ≤20 were assigned to dementia group (D) and those scoring >20 to the non-dementia group (ND), respectively. For each of the dependent variables Gingival Bleeding Index (GBI) and Denture Hygiene Index (DHI) linear regression models were compiled with the confounders age, gender, dementia, number of comorbidities and number of diseases. Logistic regression analysis was performed to assess the risk factors for severe periodontitis as measured by Community Index of Periodontal Treatment Needs (CPITN).

Results: Oral hygiene, denture hygiene and periodontal health are poor in nursing home residents. Statistical analysis yielded no significant differences of GBI as well of DHI for people with dementia and healthy subjects (p>0.05). The logistic regression showed a 3.3 fold increased risk among demented participants (p<0.05). Severe periodontitis was detected in 66% of participants with dementia compared to 37% in non-demented. The severity of oral problems, primarily periodontitis, was enhanced in subjects with dementia.

Conclusions: As older people with dementia seem to be at risk of suffering from severe periodontitis, it is of importance to monitor their oral conditions continuously and to enable preventive therapies like professional tooth cleaning. Longitudinal studies are needed to clarify the cause-reaction relationship.