Periodontal status in patients with Alzheimer’s disease: a scoping review

Kartika Indah Sari(1*), Restu Amelia Fauziah(2), Erli Sarilita(3), Paulus Anam Ong(4), Ambrosius Purba(5), Sunardhi Widyaputra(6)

(1) Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java
(2) Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java
(3) Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java
(4) Department of Neurology, Hasan Sadikin Hospital Bandung, Bandung, West Java
(5) Department of Physiology, Faculty of Medicine, Universitas Padjadjaran, Bandung, West Java
(6) Department of Oral Biology, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java
(*) Corresponding Author


Periodontitis is the most common condition of chronic periodontal infection and inflammation in the elderly population. Periodontal disease can cause local inflammation that contributes to higher risk of systemic inflammatory disease. Current research suggests a possible link between periodontal disease and neurodegenerative disease, such as Alzheimer’s disease. The aim of the study is to provide a profile of the periodontal tissue status in people with Alzheimer’s disease. This scoping review followed Joanna Briggs Institute (JBI) guideline, and the searching was conducted using PubMed, Cochrane, and EBSCOHost databases during February 6th – February 7th, 2021 with keywords of periodontal disease, periodontitis, periodontal inflammation, Alzheimer’s disease and dementia. It also included MeSH terms of “periodontal disease” and “Alzheimer’s disease” if available. Additionally, snowballing technique was used to include more articles. The identification and writing process for this article followed the PRISMA-ScR framework. There were 60 articles included in this study. This scoping review shows a profile of general characteristics including decreased oral hygiene and periodontal tissue status showed by high score of plaque and calculus, gingival inflammation, high percentage of Clinical Attachment Loss (CAL), Bleeding on Probing (BOP) along with deterioration of cognitive function. There was a decreasing level of periodontal health along with the decline in cognitive function experienced by AD participants. However, further research is needed to see the mechanism of this relationship.


Alzheimer’s disease; dementia; periodontitis; periodontal disease

Full Text:



1. Abbayya K, Puthanakar NY, Naduwinmani S, Chidambar YS. Association between
Periodontitis and Alzheimer’s Disease. N Am J Med Sci, 2015; 7(6): 241–246.
doi: 10.4103/1947-2714.159325

2. Marchetti E, Monaco A, Procaccini L, Mummolo S, Gatto R, Tetè S, et al. Periodontal
disease: the influence of metabolic syndrome. Nutr Metab (Lond). 2012; 9(1): 88.
doi: 10.1186/1743-7075-9-88

3. Wang RP, Ho YS, Leung WK, Goto T, Chang RC. Systemic inflammation linking chronic
periodontitis to cognitive decline. Brain Behav Immun. 2019; 81: 63-73. doi: 10.1016/j.bbi.2019.07.002

4. Nascimento PC, Castro MML, Magno MB, Almeida APCPSC, Fagundes NCF, Maia LC, et al. Association between periodontitis and cognitive impairment in adults: a systematic
review. Front Neurol. 2019; 10: 323. doi: 10.3389/fneur.2019.00323

5. Kim D hyung, Jeong SN, Lee JH. Severe periodontitis with tooth loss as a modifiable
risk factor for the development of Alzheimer, vascular, and mixed dementia: National
Health Insurance Service-National Health Screening Retrospective Cohort 2002-2015. J
Periodontal Implant Sci 2020; 50(5): 303-312. doi: 10.5051/jpis.2000600030

6. Holmes C, Cunningham C, Zotova E, Woolford J, Dean C, Kerr S, et al. Systemic inflammation
and disease progression in Alzheimer disease. Neurology. 2009; 73(10): 768–74.
doi: 10.1212/WNL.0b013e3181b6bb95

7. Korolev IO. Alzheimer’s disease: a clinical and basic science review. Med Student Res J. 2014; 04: 24–33.

8. Khoury R, Ghossoub E. Diagnostic biomarkers of Alzheimer’s disease: A state-of-the-art
review. Biomark Neuropsychiatry. 2019; 1: 100005. doi: 10.1016/j.bionps.2019.100005

9. Mayeux R, Stern Y. Epidemiology of Alzheimer Disease. Cold Spring Harb Perspect Med.
2012; 2(8): a006239–a006239. doi: 10.1101/cshperspect.a006239

10. Domingues C, da Cruz e Silva OAB, Henriques AG. Impact of Cytokines and Chemokines on Alzheimer’s Disease Neuropathological Hallmarks. Curr Alzheimer Res. 2017; 14(8): 870.
doi: 10.2174/1567205014666170317113606

11. Turana Y, Tengkawan J, Suswanti I, Suharya D, Riyadina W, Pradono J. Primary Prevention
of Alzheimer’s Disease in Indonesia. Int J Aging Res. 2019; 2: 1–8. doi: 10.28933/IJOAR-2019-06-2506

12. Peters M, Godfrey C, McInerney P, Munn Z, Trico A, Khalil H. Chapter 11:
Scoping Reviews. In: JBI Manual for Evidence Synthesis. JBI; 2020. Available at

13. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA
extension for scoping reviews (PRISMAScR): Checklist and explanation. Ann Intern Med. 2018; 169(7): 467–473. doi: 10.7326/M18-0850.

14. Lockwood C, dos Santos KB, Pap R. Practical guidance for knowledge synthesis: scoping
review methods. Asian Nurs Res (Korean Soc Nurs Sci). 2019; 13(5): 287-294.
doi: 10.1016/j.anr.2019.11.002

15. UNSD — Methodology. Available at:

16. Chalmers JM, Carter KD, Spencer AJ. Oral diseases and conditions in community-living
older adults with and without dementia. Spec Care Dent. 2003; 23(1): 7–17.
doi: 10.1111/J.1754-4505.2003.TB00283.X

17. Rejnefelt I, Andersson P, Renvert S. Oral health status in individuals with dementia
living in special facilities. Int J Dent Hyg. 2006; 4(2): 67–71.
doi: 10.1111/j.1601-5037.2006.00157.x

18. Noble JM, Borrell LN, Papapanou PN, Elkind MSV, Scarmeas N, Wright CB. Periodontitis
is associated with cognitive impairment among older adults: Analysis of NHANESIII.
J Neurol Neurosurg Psychiatry. 2009; 80(11): 1206–1211. doi: 10.1136/jnnp.2009.174029

19. Hopcraft MS, Morgan MV, Satur JG, Wright FAC, Darby IB. Oral hygiene and periodontal
disease in Victorian nursing homes. Gerodontology. 2012; 29(2): e220–228.
doi: 10.1111/j.1741-2358.2010.00448.x

20. Philip P, Rogers C, Kruger E, Tennant M. Oral hygiene care status of elderly with dementia
and in residential aged care facilities. Gerodontology. 2012; 29(2): e306–11.
doi: 10.1111/j.1741-2358.2011.00472.x

21. Rai B, Kaur J, Anand SC. Possible relationship between periodontitis and dementia in a
North Indian old age population: a pilot study. Gerodontology. 2012; 29(2): e200–5. doi:

22. Syrjälä A-MH, Ylöstalo P, Ruoppi P, Komulainen K, Hartikainen S, Sulkava R, et
al. Dementia and oral health among subjects aged 75 years or older. Gerodontology. 2012;
29(1): 36–42. doi: 10.1111/j.1741-2358.2010.00396.x

23. Chen X, Clark JJJ, Naorungroj S. Oral health in nursing home residents with different cognitive statuses. Gerodontology. 2013; 30(1): 49–60. doi: 10.1111/j.1741-2358.2012.00644.x

24. Poole S, Singhrao SK, Kesavalu L, Curtis MA, Crean S. Determining the Presence of
Periodontopathic Virulence Factors in Short- Term Postmortem Alzheimer’s Disease Brain Tissue. J Alzheimer’s Dis. 2013; 36(4): 665–77. doi: 10.3233/JAD-121918.

25. Farhad SZ, Amini S, Khalilian A, Barekatain M, Mafi M, Barekatain M, et al. The effect
of chronic periodontitis on serum levels of tumor necrosis factor-alpha in Alzheimer
disease. Dent Res J (Isfahan). 2014; 11(5): 549-552.

26. Martande SS, Pradeep AR, Singh SP, Kumari M, Suke DK, Raju AP, et al. Periodontal
Health Condition in Patients With Alzheimer’s Disease. Am J Alzheimers Dis Other Demen.
2014; 29(6): 498-502. doi: 10.1177/1533317514549650

27. Zenthöfer A, Schröder J, Cabrera T, Rammelsberg P, Hassel AJ. Comparison of oral health among older people with and without dementia. Community Dent Health. 2014; 31(1): 27–31.

28. Gil-Montoya JA, Sanchez-Lara I, Carnero-Pardo C, Fornieles F, Montes J, Vilchez R, et al. Is Periodontitis a Risk Factor for Cognitive Impairment and Dementia? A Case-Control Study. J Periodontol. 2015; 86(2): 244–253. doi: 10.1902/jop.2014.140340

29. Chu CH, Ng A, Chau AMH, Lo ECM. Oral health status of elderly chinese with dementia in Hong Kong. Oral Health Prev Dent. 2015; 13(1): 51–57. doi: 10.3290/j.ohpd.a32343

30. Cestari JAF, Fabri GMC, Kalil J, Nitrini R, Jacob-Filho W, De Siqueira JTT, et al. Oral Infections and Cytokine Levels in Patients with Alzheimer’s Disease and Mild Cognitive Impairment Compared with Controls. J Alzheimer’s Dis. 2016; 52(4): 1479–1485. doi: 10.3233/JAD-160212

31. Gusman DJR, Mello-Neto JM, Alves BES, Matheus HR, Ervolino E, Theodoro LH, et al.
Periodontal disease severity in subjects with dementia: A systematic review and metaanalysis.
Arch Gerontol Geriatr. 2018; 76: 147-159. doi: 10.1016/j.archger.2018.02.016

32. Ide M, Harris M, Stevens A, Sussams R, Hopkins V, Culliford D, et al. Periodontitis and
Cognitive Decline in Alzheimer’s Disease. PLoS One. 2016; 11(3): e0151081.
doi: 10.1371/journal.pone.0151081

33. Wu B, Fillenbaum GG, Plassman BL, Guo L. Association between oral health and cognitive
status: a systematic review. J Am Geriatr Soc. 2016; 64(4): 739–751. doi: 10.1111/jgs.14036

34. Chen C-K, Wu Y-T, Chang Y-C. Association between chronic periodontitis and the risk
of Alzheimer’s disease: a retrospective, population-based, matched-cohort study.
Alzheimers Res Ther. 2017; 9(1): 56. doi: 10.1186/s13195-017-0282-6

35. Delwel S, Binnekade TT, Perez RSGM, Hertogh CMPM, Scherder EJA, Lobbezoo F.
Oral health and orofacial pain in older people with dementia: a systematic review with focus
on dental hard tissues. Clin Oral Investig. 2017; 21(1): 17–32. doi: 10.1007/s00784-016-1934-9

36. Gil-Montoya JA, Sánchez-Lara I, Carnero-Pardo C, Fornieles-Rubio F, Montes J, Barrios
R, et al. Oral Hygiene in the Elderly with Different Degrees of Cognitive Impairment and Dementia. J Am Geriatr Soc. 2017; 65(3): 642–647. doi: 10.1111/jgs.14697

37. Gil-Montoya JA, Barrios R, Santana S, Sanchez-Lara I, Pardo CC, Fornieles-Rubio
F, et al. Association between periodontitis and amyloid β peptide in elderly people with and
without cognitive impairment. J Periodontol. 2017;88(10):1051–8. doi: 10.1902/jop.2017.170071

38. Lee Y-L, Hu H-Y, Huang L-Y, Chou P, Chu D. Periodontal disease associated with higher
risk of dementia: population-based cohort study in Taiwan. J Am Geriatr Soc. 2017;
65(9): 1975–1980. doi: 10.1111/jgs.14944

39. Lee Y-T, Lee H-C, Hu C-J, Huang L-K, Chao S-P, Lin C-P, et al. Periodontitis as a modifiable risk factor for dementia: a nationwide population-based cohort study. J Am Geriatr Soc. 2017; 65(2): 301–305. doi: 10.1111/jgs.14449

40. Leira Y, Domínguez C, Seoane J, Seoane-Romero J, Pías-Peleteiro JM, Takkouche B, et al. Is periodontal disease associated with alzheimer’s disease? a systematic review with meta-analysis. Neuroepidemiology. 2017; 48(1–2): 21–31. doi: 10.1159/000458411

41. Tonsekar PP, Jiang SS, Yue G. Periodontal disease, tooth loss and dementia: Is there a
link? A systematic review. Gerodontology. 2017; 34(2): 151-163.

42. Holmer J, Eriksdotter M, Schultzberg M, Pussinen PJ, Buhlin K. Association between
periodontitis and risk of Alzheimer′s disease, mild cognitive impairment and subjective
cognitive decline: A case-control study. J Clin Periodontol. 2018; 45(11): 1287–1298.
doi: 10.1111/jcpe.13016

43. Laugisch O, Johnen A, Maldonado A, Ehmke B, Bürgin W, Olsen I, et al. Periodontal
Pathogens and Associated Intrathecal Antibodies in Early Stages of Alzheimer’s
Disease. J Alzheimers Dis. 2018; 66(1): 105–114. doi: 10.3233/JAD-180620

44. Maldonado A, Laugisch O, Bürgin W, Sculean A, Eick S. Clinical periodontal variables in patients with and without dementia—a systematic review and meta-analysis. Clin Oral Investig. 2018; 22(7): 2463-2474. doi: 10.1007/s00784-018-2523-x

45. Choi S, Kim K, Chang J, Kim SM, Kim SJ, Cho H, et al. Association of Chronic Periodontitis on
Alzheimer’s Disease or Vascular Dementia. J Am Geriatr Soc. 2019; 67(6): 1234-1239.
doi: 10.1111/jgs.15828

46. Iwasaki M, Kimura Y, Ogawa H, Yamaga T, Ansai T, Wada T, et al. Periodontitis, periodontal inflammation, and mild cognitive impairment: A 5-year cohort study. J Periodontal Res. 2019; 54(3): 233–240. doi: 10.1111/jre.12623

47. Lauritano D, Moreo G, Carinci F, Borgia R, Lucchese A, Contaldo M, et al. Aging and oral
care: an observational study of characteristics and prevalence of oral diseases in an Italian
Cohort. Int J Environ Res Public Health. 2019; 16(19): 3763. doi: 10.3390/ijerph16193763

48. Sung C, Huang R, Cheng W, Kao T, Chen W. Association between periodontitis and
cognitive impairment: Analysis of national health and nutrition examination survey
(NHANES) III. J Clin Periodontol. 2019; 46(8): 790–798. doi: 10.1111/jcpe.13155

49. Tiisanoja A, Syrjälä A-M, Tertsonen M, Komulainen K, Pesonen P, Knuuttila M, et al.
Oral diseases and inflammatory burden and Alzheimer’s disease among subjects aged 75
years or older. Spec Care Dent. 2019; 39(2): 158–165. doi: 10.1111/scd.12357

50. Beydoun MA, Beydoun HA, Weiss J, Hossain S, El-Hajj ZW, Zonderman AB. Helicobacter
pylori, periodontal pathogens, and their interactive association with incident all-cause
and Alzheimer’s disease dementia in a large national survey. Mol Psychiatry. 2020; 26:
6038-6053. doi: 10.1038/s41380-020-0736-2

51. Beydoun MA, Beydoun HA, Hossain S, El- Hajj ZW, Weiss J, Zonderman AB. Clinical and Bacterial Markers of Periodontitis and Their Association with Incident All-Cause and Alzheimer’s Disease Dementia in a Large National Survey. J Alzheimer’s Dis. 2020; 75(1): 157–172. doi: 10.3233/JAD-200064

52. Demmer RT, Norby FL, Lakshminarayan K, Walker KA, Pankow JS, Folsom AR, et al. Periodontal disease and incident dementia. Neurology. 2020; 95(12): e1660–1671.
doi: 10.1212/WNL.0000000000010312

53. Gil Montoya JA, Barrios R, Sanchez‐Lara I, Ramos P, Carnero C, Fornieles F, et al. Systemic inflammatory impact of periodontitis on cognitive impairment. Gerodontology.
2020; 37(1): 11–18. doi: 10.1111/ger.12431

54. Kamer AR, Craig RG, Niederman R, Fortea J, de Leon MJ. Periodontal disease as a possible
cause for Alzheimer’s disease. Periodontol 2000. 2020; 83(1): 242–271. doi: 10.1111/prd.12327

55. Lee C, Chang C, Lin C, Yeh C, Hu C, Wu C, et al. Risk of dementia in patients with periodontitis and related protective factors: A nationwide retrospective cohort study. J Clin
Periodontol. 2020; 47(12): 1428–1436. doi: 10.1111/jcpe.13372

56. Nadim R, Tang J, Dilmohamed A, Yuan S, Wu C, Bakre AT, et al. Influence of periodontal
disease on risk of dementia: a systematic literature review and a meta-analysis. Eur J
Epidemiol. 2020; 35(9): 821–833. doi: 10.1007/s10654-020-00648-x

57. Sansores-España D, Carrillo-Avila A, Melgar-Rodriguez S, Díaz-Zuñiga J, Martínez-Aguilar
V. Periodontitis and Alzheimers disease. Med Oral Patol Oral y Cir Bucal. 2021; 26(1): e43–
48. doi: 10.4317/medoral.23940

58. Varma AR, Snowden JS, Lloyd JJ, Talbot PR, Mann DMA, Neary D. Evaluation of the NINCDS-ADRDA criteria in the differentiation of Alzheimer’s disease and frontotemporal dementia. J Neurol Neurosurg Psychiatry.1999; 66(2): 184–188. doi: 10.1136/jnnp.66.2.184.

59. McKhann GM, Knopman DS, Chertkow H, Hyman BT, Jack CR, Kawas CH, et al. The
diagnosis of dementia due to Alzheimer’s disease: Recommendations from the National
Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease. Alzheimer’s Dement. 2011; 7(3): 263–269. doi: 10.1016/j.jalz.2011.03.005

60. Ercoli LM, Siddarth P, Dunkin JJ, Bramen J, Small GW. The Mini-Mental State Examination
(MMSE) MMSE Items Predict Cognitive Decline in Persons With Genetic Risk for Alzheimer’s Disease. J Geriatr Psychiatry Neurol. 2003; 16(2): 67–73. doi: 10.1177/0891988703016002001

61. Creavin ST, Wisniewski S, Noel-Storr AH, Trevelyan CM, Hampton T, Rayment D, et al.
Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated
people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev. 2016; (1): CD011145. doi: 10.1002/14651858.CD011145.pub2

62. Arevalo-Rodriguez I, Smailagic N, Roqué I Figuls M, Ciapponi A, Sanchez-Perez E, Giannakou A, Pedraza OL, Bonfill Cosp X, Cullum S. Mini-Mental State Examination (MMSE) for the detection of Alzheimer’s disease and other dementias in people with mild cognitive impairment (MCI). Cochrane Database Syst Rev. 2015; (3): CD010783. doi: 10.1002/14651858.CD010783.pub2

63. Coen RF, McCarroll K, Casey M, McNulty H, Laird E, Molloy AM, et al. The Frontal Assessment Battery: Normative Performance in a Large Sample of Older Community-Dwelling Hospital Outpatient or General Practitioner Attenders. J Geriatr Psychiatry Neurol. 2016; 29(6): 338–343.
doi: 10.1111/j.1532-5415.2005.53221.x

64. Leroy R, Eaton KA, Savage A. Methodological issues in epidemiological studies of periodontitis - how can it be improved? BMC Oral Health. 2010; 10(1): 1–7.
doi: 10.1186/1472-6831-10-8

65. Khursheed DA, Zardawi FM, Karim SA. Validity of CPITN Index Applied by Undergraduate
Dental Students. Sulaimani Dent J. 2019; 6(2): 67–73. doi:10.17656/sdj.10099

66. Siukosaari P, Ajwani S, Ainamo A, Wolf J, Närhi T. Periodontal health status in the elderly with different levels of education: A 5-year follow-up study. Gerodontology. 2012; 29(2): e170–178. doi: 10.1111/j.1741-2358.2010.00437.x

67. Beltrán-Aguilar ED, Eke PI, Thornton-Evans G, Petersen PE. Recording and surveillance
systems for periodontal diseases. Periodontol 2000; 60(1): 40–53. doi: 10.1111/j.1600-0757.2012.00446.x

68. Bhushan I, Access O, Kour M, Kour G, Gupta S, Sharma S, et al. Alzheimer’s disease:
Causes & treatment-A review 1 MedDocs Publishers Annals of Biotechnology. 2018.
doi: 10.33582/2637-4927/1002

69. Xu W, Ferrari C, Wang H-X. Epidemiology of Alzheimer’s Disease. In: Understanding
Alzheimer’s Disease. InTech; 2013; 229–358. Available at

70. Hou Y, Dan X, Babbar M, Wei Y, Hasselbalch SG, Croteau DL, et al. Ageing as a risk factor
for neurodegenerative disease. Nat Rev Neurol. 2019; 15(10): 565–81. doi: 10.1038/s41582-019-0244-7

71. Sá F, Pinto P, Cunha C, Lemos R, Letra L, Simões M, et al. Differences between early and late-onset Alzheimer’s disease in neuropsychological tests. Front Neurol. 2012: 81. doi: 10.3389/fneur.2012.00081

72. Ganesh PR, Karthikeyan R, Muthukumaraswamy A, Anand J. A potential role of periodontal inflammation in Alzheimer’s disease: A review. Oral Health Prev Dent. 2017;15(1): 7–12. doi: 10.3290/j.ohpd.a37708

73. Tsugane, S. Why has Japan become the world’s most long-lived country: insights from a food and nutrition perspective. Eur J Clin Nutr. 2021; 75; 921–928.
doi: 10.1038/s41430-020-0677-55


Article Metrics

Abstract views : 734 | views : 814


  • There are currently no refbacks.

Copyright (c) 2022 Majalah Kedokteran Gigi Indonesia

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Currently, Majalah Kedokteran Gigi Indonesia indexed by:







 View My Stats

time web analytics