Feb 2, 2018

Caregiver Alert: The Connection Between Gum Disease and Alzheimer's Disease

A recent research study showed that the presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in dementia patients.

A recent research study showed that the presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in dementia patients.
By Rita Jablonski and Bob DeMarco
Alzheimer’s Reading Room

Bottom line: gum disease can hasten memory loss and hasten the progression of Alzheimer's disease.

Most people know that keeping teeth and dentures clean makes the person with dementia feel good, but mouth care goes beyond “feeling” good.

Healthy teeth and gums can keep the rest of the body healthy.

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Inadequate mouth care, often from refusals to brush, can lead to things like gum disease, periodontitis, and pneumonia.

We rarely hear caregivers talking or even thinking about this issue. The two most frequent causes of death in dementia patients are pneumonia (aspiration pneumonia), and infection. It is highly probable that the infections may be coming from the mouth!

An undetected gum infection can cause a dementia patient to be mean, and can contribute to memory loss.

We know of Alzheimer's patients that have died as a result of a mouth infection that spread into the body. This alone should tell you that you have to pay close attention to the gums of a person living with Alzheimer's.

Why should you be concerned about gum disease?

A recent research study showed that the presence of gum disease was associated with a six-fold increase in the rate of cognitive decline in dementia patients. Bottom line: gum disease can hasten memory loss and hasten the progression of Alzheimer's disease.

The study also indicates that patients with Alzheimer's Disease have poorer dental health than others of similar age and that the more severe the dementia the worse the dental health.

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What is the connection between severe gum disease and the faster progression of Alzheimer’s Disease?

The current thinking in the Alzheimer’s research community is that the human body’s response to gum disease leads to the production and accumulation of the plaques and tangles seen in the brains of Alzheimer’s patients. Basically, the brain’s defenses go a little hyper.

Long-term effects of gum disease

  • Tooth and gum pain can lead to a person not eating and losing weight.
  • Periodontitis: Losing or has lost teeth — this signifies that gum swelling has moved onto periodontal disease, meaning the gum has gotten so swollen that “pockets” form around the base of the teeth.These “pockets” allow the vulnerable tooth root to be attacked by bacteria and acids. Like the exposed root of plants, as the root dies off the tooth dies and falls out.
  • Tooth infection (abscess): persons will have behaviors much like a UTI and can get very sick from this infection. People have died from infections that started in the mouth and moved to the entire body.
Did you know? Mouth infections can cause the same kind of behavioral problems as those you see with urinary tract infections.

This is because infections, regardless of where the infections are in the body, can cause a state called “delirium” which is an even more confused state than the “regular” dementia. People with dementia can have delirium ON TOP OF the dementia.

One of the biggest complaints we hear from caregivers is about "patient meanness".

Most caregivers learn that an undetected UTI can make an Alzheimer's patient act mean. However, they are usually unaware that a gum or tooth infection can also cause a patient to be mean; and it can cause an Alzheimer's patient to eat less or even stop eating.

When you go to your primary care provider, does s/he look in your loved one's mouth for infections?

Does he or she look under their dentures for signs of yeast infection (candidiasis), red marks or other signs of gum disease?

The majority of primary care doctors do not do this routinely. So the next time you go you will need to ask him or her to do it.

You can also do it yourself using a flashlight or the light on your cell phone.

Does your loved one have gum disease?

  • One sign of gum disease occurs when you see blood when a person spits out while brushing their teeth (this of course includes when you brush). You may also see blood on the toothbrush.
  • Reddening of the gums or shiny gums along the tooth edges are also signs of gum disease.
  • Loose teeth are also a sign of gum disease.

Strategies to help caregivers prevent gum disease and keep the mouth healthy

  • A good thorough brushing at least once a day.
  • Flossing with perio brushes (they look like little Christmas trees on toothpicks, and are more effective than string floss)
  • Strategies like hand-over-hand, cueing, chaining
  • Removing dentures overnight and soaking them in clean water (dentures can dry out and warp, so that they no longer fit)
  • Cleaning dentures with denture cleaner or liquid dishwashing soap - don't use toothpaste it scratches the dentures and damages the surface.

When the dentures are out, use a penlight or cell phone flashlight to look at cheeks, gums, top of mouth, and under the tongue of your loved one.

While checking the mouth you are looking for:
  • Reddening of the gums, sores, scraped/bleeding areas
  • White patches which could indicate a yeast infection
  • Sores under the tongue.
All of these are indications of the need for a dental examination.

Please note: Consistent brushing should cause gum bleeding to stop over time. If it continues, you need to see a dentist for evaluation.

Research indicates that gum disease is under diagnosed in persons with Alzheimer's disease and related dementia

Alzheimer's patients are less likely to go to the dentist because:
  • They lack dental coverage
  • There is a shortage of dentists, especially in rural, low-income urban areas;
  • There is also a shortage of dentists willing and able to work with Alzheimer's patients;
  • And because, Alzheimer's patients are less likely to cooperate with dental examinations or procedures.

Gum disease and the importance of mouth care are often overlooked as factors that contribute to memory loss; and, cause infections in Alzheimer’s patients and the elderly.

Caregivers who are stressed often feel that they don’t have the time, or even energy, to deal with this problem on a daily basis.

The downside is a trip to the hospital emergency room when an infection from the gums causes a spike in temperature, and the need for aggressive antibiotic treatment in the hospital.

Sadly, infections are the second largest cause of death in patients living with Alzheimer’s; and, these types of infections can start in the gums.

Dr. Rita Jablonski, PhD CRNP is an internationally recognized expert in dementia behaviors. She is tenured professor at the University of Alabama at Birmingham and a funded researcher, with over 50 publications and book chapters to her credit. She is a nurse practitioner in a Memory Disorders Clinic, where she helps people with dementia and their care partners. She shares her wisdom on her blog, Make Dementia Your B*tch.

Bob DeMarco is the Founder of the Alzheimer's Reading Room (ARR). Bob is a recognized expert, writer, speaker, and influencer in the Alzheimer's and Dementia Community worldwide.

Related Articles and Citations

Dental Health Linked to Dementia Risk

8 Great Strategies to Get a Dementia Patient to Brush Their Teeth

15 Strategies to get dementia patients to brush their teeth

Dementia patients' oral hygiene benefits from researched techniques

5 Reasons Why Every Caregiver Should Participate in a Clinical Trial

Search our Award Winning Alzheimer's Reading Room Knowledge Base for Answers to Your Questions, and Solutions to Problems


Rita A. Jablonski, Ann M. Kolanowski, Andres Azuero, Viki Winstead, Cortes Jones-Townsend, Maria L. Geisinger
Randomised clinical trial: Efficacy of strategies to provide oral hygiene activities to nursing home residents with dementia who resist mouth care. Gerodontology, 2018, DOI 10.111/ger.12357

Jablonski RA, Kolanowski AM, Winstead V, Jones-Townsend C, Azuero A. Maturation of the MOUTh Intervention: From Reducing Threat to Relationship-Centered Care. J Gerontol Nurs. 2016;42(3):15-23; quiz 24-15.

Jablonski RA, Therrien B, Mahoney EK, Kolanowski A, Gabello M, Brock A. An intervention to reduce care-resistant behavior in persons with dementia during oral hygiene: a pilot study. Special care in dentistry : official publication of the American Association of Hospital Dentists, the Academy of Dentistry for the Handicapped, and the American Society for Geriatric Dentistry. 2011;31(3):77-87.

Mark Ide, Marina Harris, Annette Stevens, Rebecca Sussams, Viv Hopkins, David Culliford, James Fuller, Paul Ibbett, Rachel Raybould, Rhodri Thomas, Ursula Puenter, Jessica Teeling, V. Hugh Perry, Clive Holmes. Periodontitis and Cognitive Decline in Alzheimer’s Disease. PLOS ONE, 2016; 11 (3): e0151081
DOI: 10.1371/journal.pone.0151081

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