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Article

Association of Periodontal Disease with Dementia in Older Adults from Lima, Peru

by
Leonardo Ariza-Cabello
1,
Ximena Lucar-Dueñas
1,
Jorge Noriega-Castañeda
2,
Jose Antonio Gil-Montoya
3,4 and
Ximena Alejandra León-Ríos
1,*
1
School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru
2
Second Specialty in Periodontics and Implantology, School of Dentistry, Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas, Lima 15067, Peru
3
School of Dentistry, Universidad de Granada, Paseo de Cartuja s/n, 18071 Granada, Spain
4
Instituto de Investigación Biosanitaria de Granada, Avda. de Madrid 15, 18012 Granada, Spain
*
Author to whom correspondence should be addressed.
Oral 2025, 5(4), 94; https://doi.org/10.3390/oral5040094
Submission received: 8 September 2025 / Revised: 11 October 2025 / Accepted: 4 November 2025 / Published: 20 November 2025
(This article belongs to the Special Issue Editorial Board Members' Collection Series: Oral Health Management for Special Care Patients)
Versions Notes

Abstract

Objective: This study aimed to determine the association between periodontal disease and dementia in older adults in Lima Centro. Materials and methods: A cross-sectional analytical study was conducted in 112 institutionalized older adults, who were clinically evaluated using the Periodontal Screening and Recording (PSR) system. Bivariate analyses were performed using the chi-square test, Mann–Whitney U test, and Student’s t-test. Logistic regression was used to estimate the crude and adjusted odds ratios with 95% confidence intervals, with p < 0.05 considered statistically significant. Results: The results showed that 49.11% of the participants scored a code 3 in the PSR system, indicating periodontal pockets of 3 to 5 mm, bleeding, and bacterial plaque, while 79.46% exhibited the presence of bacterial plaque. Likewise, older adults with dementia were observed to have clinical plaque upon probing, whereas 40.35% of older adults without a dementia diagnosis did not have plaque; this association was statistically significant. In the multivariate analysis, an association between periodontal disease and dementia was observed in the crude analysis (OR = 4.43; 95% CI: 2.20–8.93; p = 0.000) and the adjusted analysis (OR = 4.69; 95% CI: 2.32–9.48; p = 0.000). Conclusions: In conclusion, a significant relationship was identified between periodontal disease (assessed using the PSR system), the presence of bacterial plaque, and gingival bleeding with dementia in the evaluated older adults. This finding highlights the importance of periodontal health not only for oral well-being but also as a potentially modifiable risk factor for dementia prevention. Integrating oral health interventions into broader geriatric care may contribute to delaying or reducing the risk of neurodegenerative diseases, underscoring the need for interdisciplinary approaches in public health strategies.

1. Introduction

Periodontal disease is one of the most prevalent chronic conditions globally, affecting approximately 45–50% of adults over 30 years old [1]. In the Peruvian context, it is estimated that more than 70% of adults suffer from some form of periodontal disease, with rural communities and those with limited access to healthcare being the most affected, reflecting significant disparities in care [2]. This condition presents chronic inflammation that compromises the supporting tissues of the teeth, including the gum, periodontal ligament, and alveolar bone, often induced by the accumulation of bacterial biofilms [3]. Without proper intervention, it can lead to irreversible tooth loss, causing significant functional, aesthetic, and psychological impacts [4]. Additionally, its impact extends beyond the oral cavity, as inflammatory mediators derived from periodontitis have systemic repercussions [5]. Various studies have shown its association with cardiovascular diseases, diabetes mellitus, and even gestational complications, underscoring the interrelationship between oral health and overall systemic well-being [6].
In a study involving 20,070 individuals aged ≥65 years, the prevalence of dementia and mild cognitive impairment (MCI) was approximately 5.4% (95% confidence interval [CI], 5.1–5.7) and 7.7% (95% CI, 7.4–8.1), respectively. The findings also indicated that dementia and MCI share similar risk factors, including older age, female sex, hypertension, and diabetes mellitus [7]. In Peru, it is estimated that between 6 and 10% of older adults suffer from some type of dementia, with limited access to early diagnosis being a common challenge, particularly in rural and low-resource communities [8]. Alzheimer’s disease, which accounts for 60–80% of cases, is the most common form of dementia [9]. This neurodegenerative condition is characterized by a progressive decline in cognitive functions—including memory, judgment, orientation, and language—severely interfering with individuals’ ability to perform daily activities [10]. This cognitive decline not only affects the patients, but also places substantial emotional, social, and economic burdens on their families and caregivers [11].
Neuroinflammation plays a central role in the pathogenesis of dementia. Persistent activation of microglia and the release of pro-inflammatory cytokines promote the deposition of beta-amyloid and tau proteins, which are characteristic markers of the disease [12,13]. Importantly, periodontal disease has been linked to similar inflammatory pathways. Approximately 40% of patients with advanced periodontitis present elevated levels of inflammatory mediators, which have been associated with a higher risk of cognitive decline [14]. Pathogens such as Porphyromonas gingivalis and their products (e.g., lipopolysaccharides) may cross the blood–brain barrier, directly contributing to neuroinflammation and neuronal damage [15,16]. These mechanisms suggest that periodontal health may represent a modifiable risk factor for dementia in aging populations [17]. Although numerous studies support an association between periodontal disease and dementia, methodological limitations persist. Variability in study designs, the absence of longitudinal clinical trials, and confounding factors such as age, socioeconomic status, and comorbidities complicate interpretation [18,19,20]. Moreover, most of the existing evidence comes from high-income countries, with little to no data from Latin American populations. Cultural, socioeconomic, and healthcare access differences may influence both periodontal and cognitive health, meaning that international findings cannot be directly generalized to the Peruvian context. Addressing this gap is essential to developing context-specific strategies for prevention and early intervention.
Given the potential role of periodontal disease in systemic and cognitive health, further research is needed to clarify this association. Expanding our knowledge of the shared pathophysiological mechanisms could support preventive strategies that integrate oral health into dementia risk reduction. Thus, the present study contributes novel evidence by exploring this relationship in a Peruvian urban population, which has not been systematically examined in this region. Since limited evidence exists in the Peruvian context, this study aimed to determine the association between periodontal disease and dementia in older adults in Central Lima during 2023.

2. Materials and Methods

This observational, analytical, cross-sectional study was designed and reported in accordance with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines. Ethical approval was granted by the Ethics and Research Subcommittee of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC), under code FCS-CTA/002-01-24. The participants’ willingness to participate and confidentiality were safeguarded with authorization from the care home director in compliance with Law No. 28803 on the rights of older adults [21].
The study sample consisted of older adults residing in nursing homes in Central Lima, Peru, in 2023. To calculate the minimum representative sample size, the formula for comparing proportions was applied using pilot data, with a statistical power of 80%, a precision level of 5%, and a 95% confidence level. As a result, the final sample included 112 participants. The sampling technique was non-probabilistic convenience sampling, with each older adult who met the established inclusion criteria considered a unit of analysis. The data were processed and analyzed using EPIDAT software, version 4.2.
The inclusion criteria were as follows:
  • Patients with/without a cognitive degenerative disease, evaluated through informed consent granted by their relatives, and determined by the director of the residential care center. Dementia was identified through existing medical records (when available) that indicated the use of standardized neuropsychological tests, such as the Fototest, following the criteria described by Petersen et al. [22] and the International Working Group on Mild Cognitive Impairment [22].
  • Older adults with at least 30% of their teeth present and with identifiable cemento-enamel junctions (CEJs).
  • Older adults in stable general health during the study period, meaning they had not experienced recent hospitalizations or significant changes in their physical or mental health.
The exclusion criteria included older adults unable to participate due to medical restrictions; the presence of a depressive disorder, schizophrenia, or a personality disorder; acute or chronic illness not under medical treatment; periodontal treatment within the previous 6 months; uncooperative older adults; and those with acute infections during the study period.

2.1. Clinical Examination—Training and Calibration

Training was conducted in collaboration with a periodontics expert to improve operator performance. The main goal of this training was to ensure accurate interpretation of the WHO probe readings related to the Periodontal Screening and Recording (PSR) method [23] and to evaluate the patients accordingly.
Before the clinical evaluation, intra-examiner calibration was carried out using a Nissin periodontal model. Prior to evaluation, the gingiva was removed, and each tooth was subjected to millimeter measurements, with some teeth presenting pockets and others not. This data was recorded in a database in collaboration with the periodontics expert in order to calculate Cohen’s kappa coefficient and evaluate the consistency of the results between the trained examiner and the expert over 6 sessions held on different weeks and sextants. A kappa value of 0.93 was obtained, indicating almost perfect agreement [24] in the measurements between the examiner and the expert. In addition, inter-examiner calibration was performed on 10 elderly participants, which allowed for further assessment of the consistency across evaluators.
Once training was completed, an informative session was held for residents and caregivers of the nursing homes in Central Lima. The objectives of the evaluations were presented, and after the session, the care home director granted the necessary permissions, with the approval of legal guardians, to review the patients’ clinical histories. This review included medical certificates of dementia, medication records, and records of recent surgeries and other relevant health variables.
Then, the recruitment process began, applying the inclusion and exclusion criteria to ensure appropriate patient selection.
Clinical evaluations were carried out in appropriate spaces within the nursing home facilities, which were equipped with portable artificial lighting and a workstation with all necessary dental materials, including examination trays, tweezers, intraoral mirrors, bioactive explorers, gauze, disposable containers, and WHO probes (Hu Friedy, Chicago, IL, USA). Protective equipment such as gloves and masks was used, and strict biosafety measures were followed for both the patients and the trained dentists involved in the study.
Each clinical examination began with a thorough inspection of the oral cavity, followed by PSR [25] coding. The established codes are as follows: 0 (no gingival signs and a probing depth of less than 0.5 mm), 1 (bleeding on probing with a depth less than 3.5 mm), 2 (bleeding on probing, presence of plaque, and a depth of less than 3.5 mm), 3 (bleeding on probing, presence of plaque, and a depth between 3.5 mm and 5.5 mm), and 4 (bleeding on probing, presence of plaque, and a depth greater than 5.5 mm). Periodontal Screening and Recording (PSR) scores were recategorized as codes 0, 1, and 2 (indicating healthy or only mild gingival conditions without deep pockets), suggesting no periodontal disease. Those with code 3 or 4 (indicating periodontal pockets and attachment loss) were considered to have periodontal disease. A total of 25 probings were performed in six specific locations around each tooth: mesiobuccal, midbuccal, distobuccal, mesiopalatal/lingual, midpalatal/lingual, and distopalatal/lingual. The examination started in the first quadrant (upper right side) and ended in the fourth quadrant (lower right side).
The presence of plaque was verified using the PSI [26] technique, which did not require additional staining of the patients’ teeth. Specific data from each patient was recorded on a data collection form and compiled into an Excel database for further analysis. Finally, a closing session was held to thank the participants, during which general oral health instructions were provided along with the distribution of dental hygiene materials, such as toothbrushes, toothpaste, and mouthwash, to both patients and caregivers. The goal was to promote and maintain proper oral hygiene, ensuring that each older adult received the care and attention they needed [27].

2.2. Statistical Methods

In the univariate analysis, measures of central tendency (mean and median) and dispersion (standard deviation and interquartile range) were calculated for numerical variables. For categorical variables, absolute and relative frequencies were calculated.
In the bivariate analysis, statistical tests such as the chi-square test, Mann–Whitney U test, and Student’s t-test were used to assess the relationship between periodontal disease, cognitive impairment, and covariates where appropriate.
Additionally, logistic regression analysis was performed and odds ratios are reported. For the crude analysis, the association between dementia and periodontal disease was determined. For the adjusted model, intervening variables such as sex, age, health insurance, medication status, body mass index (BMI) [28], and education level were considered. The analysis was conducted with a 95% confidence interval, and a p-value less than 0.05 was considered statistically significant. The data were analyzed using Stata software, version 16.0 (StataCorp, College Station, TX, USA).

3. Results

The main objective of this study was to determine the association between periodontal disease and dementia in older adults who were evaluated in 2023. The study included 112 elderly subjects after screening using the inclusion and exclusion criteria. A statistically significant association between the presence of periodontal disease and cognitive impairment was identified in both the crude and adjusted analyses.
Table 1 presents the general characteristics and oral health habits of the participants. The study population consisted of 62 (55.36%) men and 50 (44.64%) women, with an average age of 76 (81.5–71) years. Regarding the prevalence of dementia or a major cognitive disorder, 44 (39.29%) participants did not have either of these conditions, while 68 (60.71%) had been diagnosed in their clinical histories. All participants had a history of previous dental treatment. Based on the PSR assessment, 9.82% of subjects scored code 0, 10.71% code 1, 30.36% code 2, and 49.11% code 3. Moreover, bacterial plaque was detected in 79.46% of participants, and 90.18% exhibited gingival bleeding during toothbrushing.
Table 2 The association between patients’ general characteristics, dental parameters, and cognitive status was analyzed. All individuals with dementia (major cognitive disorder) had a PSR score of 3. Among cognitively healthy participants, 21.05% scored code 1 and 59.65% scored code 2 (p < 0.001). All dementia patients exhibited bleeding during brushing and the presence of plaque, whereas 19.30% and 40.35% of non-dementia participants, respectively, did not (both p < 0.001).
Table 3 presents the logistic regression analysis of the association between the presence of periodontal disease and cognitive status, reporting the odds ratios (ORs). A statistically significant association was observed between periodontal disease and dementia in both the crude analysis (OR = 4.43; 95% CI: 2.20–8.93; p < 0.001) and the adjusted analysis, which controlled for sex, age, health insurance, medication status, BMI, and education level (OR = 4.69; 95% CI: 2.32–9.48; p < 0.001). These results indicate that patients with dementia are approximately 4.7 times more likely to have periodontal disease compared to those without dementia.

4. Discussion

The purpose of this study was to determine if there is a relationship between periodontal disease and dementia in older adults in Central Lima. The results revealed a statistically significant relationship between periodontal disease and dementia in both the crude and adjusted analyses.
This research employed the PSR (Periodontal Screening and Recording) clinical assessment scale [29], which is used by dental professionals to evaluate the condition of the gums and periodontal tissues. Its primary goal is to provide early detection of conditions such as gingivitis and periodontitis to allow for timely treatment. The PSR system is considered a reliable diagnostic tool and has demonstrated high specificity for periodontal diagnoses [30] and allows for a comprehensive evaluation of gingival health [31].
In this study, 49.11% of the older adults scored a PSR code 3, indicating periodontal pockets, bleeding, and plaque. Moreover, 79.46% had bacterial plaque. These findings are consistent with those of previous studies, including one conducted in Santiago, Chile, in 2016 [32] where 66.7% of those over 60 years old had periodontal disease. Similarly, a previous study reported that Mexican older adults exhibited poor oral hygiene and a high prevalence of plaque accumulation. These findings highlight that, among Latin American elderly populations, inadequate oral hygiene and limited preventive care are common, which could increase their vulnerability to cognitive impairment [33]. Poor oral hygiene habits in older adults may be linked to cognitive decline, motor coordination loss, and lack of supervision, especially in those with dementia.
All the participants reported brushing only once daily. In a 2019 study, most caregivers indicated the need for training in oral care, with only 18 (36.7%) having received such instruction [33]. The same study also demonstrated that educational interventions directed at caregivers significantly improved the oral hygiene status of institutionalized older adults. Implementing targeted educational interventions for caregivers could increase awareness and improve oral care practices [34], thereby promoting better oral health for elderly individuals. In nursing homes, preventive oral health measures such as supervised toothbrushing, professional cleanings, and caregiver training should be prioritized to mitigate the risk of both oral and cognitive decline.
In this study, sociodemographic and clinical parameters were analyzed. Among those with dementia, 100% scored a PSR code 3 with a 4.5 mm probing depth, while none of the non-dementia group scored this code. This aligns with the findings of Detwel S [35], who found that 30 out of 60 dementia patients had periodontal disease with a 6 mm probing depth. However, a 2016 study reported that both dementia and non-dementia patients scored a PSR code 3 with a 5 mm depth.
Dementia is associated with systemic inflammation, which can affect the oral microbiota and immune responses. Chronic inflammation, often linked to periodontal bacteria, may trigger biological processes that are detrimental to oral health [36]. Evidence suggests that periodontal pathogens such as Aggregatibacter actinomycetemcomitans, Tannerella forsythia, Porphyromonas gingivalis, and Treponema denticola can enter the bloodstream and reach the brain [37,38], potentially contributing to neurodegenerative changes. Moreover, maintaining masticatory function may have cognitive benefits, as shown by De Cicco et al. [39] who reported an association between mastication and brain activity. This underscores the potential role of oral rehabilitation (e.g., prostheses and implants) in preserving cognitive function.
The results indicated that patients with dementia or a major neurocognitive disorder were 4.69 times more likely to have periodontal disease (95% CI). Consistently, Ide et al. [40] reported that periodontal inflammation was associated with accelerated cognitive decline in Alzheimer’s patients, with bleeding linked to an increased dementia risk (OR = 1.16). In contrast, Holmer J. [41] found no significant association between DPPD and dementia incidence after adjusting for confounders. These divergent findings underscore the complex interplay between oral health and dementia, highlighting the need for further longitudinal research.
The methodology of this study used previously validated approaches and aligned with the existing literature [42]. The detailed presentation of variables and methodological choices supports analysis of the link between periodontal disease and dementia. While research in this field is ongoing and discrepancies exist in the literature, the cited studies support the chosen methodology and enhance our understanding of this relationship [40,43,44,45]. These investigations have helped in recognizing that periodontal health is vital to overall well-being [43,44]. Nevertheless, some limitations should be highlighted. The use of convenience sampling reduces the external validity, and the cross-sectional design prevents the establishment of temporality or causality, making it impossible to determine whether periodontal disease precedes dementia or vice versa. Variability in diagnostic criteria across studies also limits comparability. Future longitudinal studies are essential in order to clarify whether periodontal disease increases the risk of dementia or if cognitive decline predisposes individuals to poor oral health. Beyond noting the cross-sectional design, additional limitations should also be acknowledged, including potential recall bias in caregiver reports of oral hygiene practices and possible residual confounding due to unmeasured factors such as smoking, nutritional status, and socioeconomic variables. Future longitudinal research should also employ more rigorous sampling methods, which could improve the representativeness and strengthen the external validity of the findings. With respect to the statistical analysis, caution should be exercised when interpreting these estimates given the modest sample size. Nevertheless, logistic regression was considered an appropriate and widely accepted analytical approach for cross-sectional epidemiological studies as it allows for the examination of associations between binary outcomes and multiple predictors, thereby providing meaningful insights into the relationship between periodontal disease and dementia.
Regarding the periodontal assessment, it should be noted that the PSR tool does not provide a definitive diagnosis; however, it can identify the clinical signs and symptoms of periodontal disease. The PSR system remains a practical, validated, and widely used instrument for large-scale screening, particularly in elderly populations where rapid assessments are often required. In addition, the use of radiographs is not feasible in institutionalized older adults living in nursing homes due to ethical and logistical constraints, making PSR a particularly suitable tool in this setting.
These findings underscore the importance of providing comprehensive and personalized dental care to patients with dementia and support the notion that oral health is fundamental in the care of elderly individuals, particularly those suffering from dementia. Preventive measures, integration of oral health into geriatric care, and caregiver education should be central strategies to improve the quality of life of this population.

5. Conclusions

This study found a statistically significant relationship between PSR scores, the presence of bacterial plaque, gingival bleeding during brushing, and the incidence of major neurocognitive disorders in older adults. In the adjusted analysis, participants with dementia had a significantly higher likelihood of periodontal disease compared to those without dementia (PR = 4.69; 95% CI: 2.32–9.48; p < 0.001). Ultimately, this research contributes to a deeper understanding of the connection between oral health and dementia, opening up new avenues for future research and clinical practices aimed at improving patients’ overall health.

Author Contributions

Conceptualization, L.A.-C. and X.L.-D.; methodology, X.A.L.-R., L.A.-C., and X.L.-D.; validation, J.N.-C. and X.A.L.-R.; formal analysis, X.A.L.-R.; investigation, J.N.-C.; data curation, L.A.-C. and X.L.-D.; writing—original draft preparation, J.A.G.-M.; writing—review and editing, X.A.L.-R. and J.N.-C.; supervision, X.A.L.-R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received funding for its publication from the Annual Research Incentive Competition (2024), organized by the Vice-Rectorate for Academic Affairs and Research and the Research Directorate of the Universidad Peruana de Ciencias Aplicadas (UPC), Lima, Peru.

Institutional Review Board Statement

This study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics and Research Subcommittee of the Faculty of Health Sciences, Universidad Peruana de Ciencias Aplicadas (UPC), under code FCS-CTA/002-01-24, 28 April 2023.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available from the corresponding author upon request.

Acknowledgments

The authors thank the Research Direction of Universidad Peruana de Ciencias Aplicadas EXPOST-UPC-2024 for the support.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Germen, M.; Baser, U.; Lacin, C.C.; Fıratlı, E.; İşsever, H.; Yalcin, F. Periodontitis prevalence, severity, and risk factors: A comparison of the AAP/CDC case definition and the EFP/AAP classification. Int. J. Environ. Res. Public Health 2021, 18, 3459. [Google Scholar] [CrossRef]
  2. Kassebaum, N.J.; Bernabé, E.; Dahiya, M.; Bhandari, B.; Murray, C.J.L.; Marcenes, W. Global burden of severe periodontitis in 1990–2010: A systematic review and meta-regression. J. Dent. Res. 2014, 93, 1045–1053. [Google Scholar] [CrossRef]
  3. Etta, I.; Kambham, S.; Girigosavi, K.B.; Panjiyar, B.K. Mouth-heart connection: A systematic review on the impact of periodontal disease on cardiovascular health. Cureus 2023, 15, e46585. [Google Scholar] [CrossRef] [PubMed]
  4. Stanbouly, D.; Zeng, Q.; Jou, Y.-T.; Chuang, S.-K. Edentulism (missing teeth) and brain central nervous system (CNS) deafferentation: A narrative review. Front. Oral Maxillofac. Med. 2022, 6, 8. [Google Scholar] [CrossRef]
  5. Jain, P.; Hassan, N.; Khatoon, K.; Mirza, M.A.; Naseef, P.P.; Kuruniyan, M.S.; Iqbal, Z. Periodontitis and systemic disorder—An overview of relation and novel treatment modalities. Pharmaceutics 2021, 13, 1175. [Google Scholar] [CrossRef]
  6. Kapila, Y.L. Oral health’s inextricable connection to systemic health: Special populations bring to bear multimodal relationships and factors connecting periodontal disease to systemic diseases and conditions. Periodontol 2000 2021, 87, 11–16. [Google Scholar] [CrossRef]
  7. Jiang, B.; Liu, Q.; Li, J.-P.; Lin, S.-N.; Wan, H.-J.; Yu, Z.-W.; Wang, J.; Zhuang, W.; Tang, J.-H.; Chen, C.-H.; et al. Prevalence and risk factors for dementia and mild cognitive impairment among older people in Southeast China: A community-based study. BMC Geriatr. 2024, 24, 466. [Google Scholar] [CrossRef]
  8. Leiva-Socualaya, S.J.; Guerra-Ramirez, L.N.; Yhuri-Carreazo, N. Asociación entre sobrecarga del cuidador y presencia de alteraciones neurológicas en una población geriátrica peruana. Gerokomos 2023, 34, 30–37. Available online: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-928X2023000100007&lng=es (accessed on 10 November 2024).
  9. Scheltens, P.; De Strooper, B.; Kivipelto, M.; Holstege, H.; Chételat, G.; Teunissen, C.E.; Cummings, J.; van der Flier, W.M. Alzheimer’s disease. Lancet 2021, 397, 1577–1590. [Google Scholar] [CrossRef] [PubMed]
  10. Bosia, M.; Cuoco, F.; Bigai, G.; Martini, F.; Fregna, L.; Congedo, C.; Cavallaro, R. Organic mental disorders and psychiatric issues in the elderly. In Fundamentals of Psychiatry for Health Care Professionals; Springer: Cham, Switzerland, 2022; pp. 297–331. [Google Scholar] [CrossRef]
  11. Tahami Monfared, A.A.; Byrnes, M.J.; White, L.A.; Zhang, Q. The humanistic and economic burden of Alzheimer’s disease. Neurol. Ther. 2022, 11, 525–551. [Google Scholar] [CrossRef] [PubMed]
  12. Leyane, T.S.; Jere, S.W.; Houreld, N.N. Oxidative stress in ageing and chronic degenerative pathologies: Molecular mechanisms involved in counteracting oxidative stress and chronic inflammation. Int. J. Mol. Sci. 2022, 23, 7273. [Google Scholar] [CrossRef]
  13. Kumari, S.; Dhapola, R.; Sharma, P.; Singh, S.K.; Reddy, D.H. Implicative role of cytokines in neuroinflammation mediated AD and associated signaling pathways: Current progress in molecular signaling and therapeutics. Ageing Res. Rev. 2023, 92, 102098. [Google Scholar] [CrossRef]
  14. Zenthoefer, A.; Meyer-Kühling, I.; Hufeland, A.-L.; Schröder, J.; Cabrera, T.; Baumgart, D.; Rammelsberg, P.; Hassel, A.J. Carers’ education improves oral health of older people suffering from dementia: Results of an intervention study. Clin. Interv. Aging 2016, 11, 1755–1762. [Google Scholar] [CrossRef]
  15. Liu, S.; Butler, C.A.; Ayton, S.; Reynolds, E.C.; Dashper, S.G. Porphyromonas gingivalis and the pathogenesis of Alzheimer’s disease. Crit. Rev. Microbiol. 2023, 50, 127–137. [Google Scholar] [CrossRef]
  16. Rauf, A.; Badoni, H.; Abu-Izneid, T.; Olatunde, A.; Rahman, M.M.; Painuli, S.; Semwal, P.; Wilairatana, P.; Mubarak, M.S. Neuroinflammatory markers: Key indicators in the pathology of neurodegenerative diseases. Molecules 2022, 27, 3194. [Google Scholar] [CrossRef] [PubMed]
  17. Asher, S.; Stephen, R.; Mäntylä, P.; Suominen, A.L.; Solomon, A. Periodontal health, cognitive decline, and dementia: A systematic review and meta-analysis of longitudinal studies. J. Am. Geriatr. Soc. 2022, 70, 2695–2709. [Google Scholar] [CrossRef]
  18. Pazos, P.; Leira, Y.; Domínguez, C.; Pías-Peleteiro, J.M.; Blanco, J.; Aldrey, J.M. Asociación entre enfermedad periodontal y demencia: Una revisión de la literatura. Neurología 2018, 33, 602–613. [Google Scholar] [CrossRef]
  19. Larvin, H.; Gao, C.; Kang, J.; Aggarwal, V.R.; Pavitt, S.; Wu, J. The impact of study factors in the association of periodontal disease and cognitive disorders: Systematic review and meta-analysis. Age Ageing 2023, 52, afad015. [Google Scholar] [CrossRef]
  20. Nascimento, G.G.; Leite, F.R.M.; Mesquita, C.M.; Vidigal, M.T.C.; Borges, G.H.; Paranhos, L.R. Confounding in observational studies evaluating the association between Alzheimer’s disease and periodontal disease: A systematic review. Heliyon 2023, 9, e15402. [Google Scholar] [CrossRef] [PubMed]
  21. Perú. Ley N° 28803, Ley de las Personas Adultas Mayores. Diario Oficial el Peruano, 22 July 2006. [Google Scholar]
  22. Winblad, B.; Palmer, K.; Kivipelto, M.; Jelic, V.; Fratiglioni, L.; Wahlund, L.O.; Nordberg, A.; Bäckman, L.; Albert, M.; Almkvist, O.; et al. Mild cognitive impairment—Beyond controversies, towards a consensus: Report of the International Working Group on Mild Cognitive Impairment. J. Intern. Med. 2004, 256, 240–246. [Google Scholar] [CrossRef] [PubMed]
  23. Tan, A.E.S. Periodontal maintenance. Aust. Dent. J. 2009, 54 (Suppl. S1), S110–S117. [Google Scholar] [CrossRef]
  24. Cerda, L.J.; Villarroel, P.L. Evaluación de la concordancia inter-observador en investigación pediátrica: Coeficiente de Kappa. Rev. Chil. Pediatr. 2008, 79, 54–58. [Google Scholar] [CrossRef]
  25. Primal, K.S.; Esther, S.R.; Boehm, T.K. Periodontal Screening and Recording (PSR) Index Scores Predict Periodontal Diagnosis. J. Dent. App. 2014, 1, 8–12. [Google Scholar]
  26. Ziebolz, D.; Szabadi, I.; Rinke, S.; Hornecker, E.; Mausberg, R.F. Initial periodontal screening and radiographic findings—A comparison of two methods to evaluate the periodontal situation. BMC Oral Health 2011, 11, 3. Available online: http://www.biomedcentral.com/1472-6831/11/3 (accessed on 25 March 2025). [CrossRef]
  27. Saez Carriera, R.; Velasco Cornejo, K.; Vintimilla Burgos, N.P. Técnicas de promoción de salud bucal en el adulto mayor. Univ. Soc. 2018, 10, 333–338. Available online: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S2218-36202018000500333 (accessed on 25 March 2025).
  28. Organización Mundial de la Salud. Obesidad y Sobrepeso [Internet]. Ginebra: OMS. 2024. Available online: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight (accessed on 12 March 2025).
  29. Ball, J.; Darby, I. Mental health and periodontal and peri-implant diseases. Periodontol 2000 2022, 90, 106–124. [Google Scholar] [CrossRef] [PubMed]
  30. Paola, C. Enfermedades periodontales como un problema de salud pública: El desafío del nivel primario de atención en salud. Rev. Clin. Periodoncia Implantol. Rehabil. Oral 2016, 9, 177–183. [Google Scholar] [CrossRef]
  31. Becerra Ávila, S.V.; Seminario, O.J.; Rivera Antepara, P.M.; Sarmiento Pérez, M. Influencia mutua entre la diabetes y la salud periodontal del paciente. Univ. Soc. 2025, 8, 454–470. Available online: https://publicacionescd.uleam.edu.ec/index.php/sapientiae/article/view/1165 (accessed on 30 March 2025). [CrossRef]
  32. Juan, G.; Elizabeth, R.; Constanza, G.-U. Creencias relacionadas al cuidado de la salud oral en cuidadores de adultos mayores institucionalizados de la ciudad de Antofagasta, Chile, 2019. Odontoestomatología 2021, 23, e214. [Google Scholar] [CrossRef]
  33. Islas-Granillo, H.; Casanova-Rosado, J.F.; De La Rosa-Santillana, R.; Casanova-Rosado, A.J.; Islas-Zarazúa, R.; Márquez-Corona, M.D.L.; Rueda-Ibarra, V.; Jiménez-Gayosso, S.I.; Navarrete-Hernández, J.D.J.; Medina-Solís, C.E. Self-reported oral hygiene practices with emphasis on frequency of tooth brushing: A cross-sectional study of Mexican older adults aged 60 years or above. Medicine 2020, 99, e21622. [Google Scholar] [CrossRef] [PubMed]
  34. Ptasiewicz, M.; Grywalska, E.; Mertowska, P.; Korona-Głowniak, I.; Poniewierska-Baran, A.; Niedźwiedzka-Rystwej, P.; Chałas, R. Armed to the Teeth—The Oral Mucosa Immunity System and Microbiota. Int. J. Mol. Sci. 2022, 23, 882. [Google Scholar] [CrossRef]
  35. Delwel, S.; Binnekade, T.T.; Perez, R.S.G.M.; Hertogh, C.M.P.M.; Scherder, E.J.A.; Lobbezoo, F. Oral hygiene and oral health in older people with dementia: A comprehensive review with focus on oral soft tissues. Clin. Oral Investig. 2018, 22, 93–108. [Google Scholar] [CrossRef]
  36. Hernández-Santos, D.M.; Díaz-García, I.F. Educational intervention in caregivers and its impact on elderly oral hygiene: Educational intervention and oral hygiene. Rev. Estomatol. 2020, 28, 3–10. Available online: https://estomatologia.univalle.edu.co/index.php/revista_estomatologia/article/view/10463 (accessed on 30 March 2025). [CrossRef]
  37. Worthington, H.V.; MacDonald, L.; Poklepovic Pericic, T.; Sambunjak, D.; Johnson, T.M.; Imai, P.; Clarkson, J.E. Home use of interdental cleaning devices, in addition to toothbrushing, for preventing and controlling periodontal diseases and dental caries. Cochrane Database Syst. Rev. 2019, 4, CD012018. [Google Scholar] [CrossRef]
  38. De Cicco, V.; Barresi, M.; Tramonti Fantozzi, M.P.; Cataldo, E.; Parisi, V.; Manzoni, D. Oral Implant-Prostheses: New Teeth for a Brighter Brain. PLoS ONE 2016, 11, e0148715. [Google Scholar] [CrossRef] [PubMed]
  39. Leira, Y.; Vivancos, J.; Diz, P.; Martín, Á.; Carasol, M.; Frank, A. Asociación entre periodontitis, enfermedad cerebrovascular y demencia. Informe científico del Grupo de Trabajo de la Sociedad Española de Periodoncia y la Sociedad Española de Neurología. Neurología 2024, 39, 302–311. [Google Scholar] [CrossRef] [PubMed]
  40. Ide, M.; Harris, M.; Stevens, A.; Sussams, R.; Hopkins, V.; Culliford, D.; Fuller, J.; Ibbett, P.; Raybould, R.; Thomas, R.; et al. Periodontitis and cognitive decline in Alzheimer’s disease. PLoS ONE 2016, 11, e0151081. [Google Scholar] [CrossRef] [PubMed]
  41. Holmer, J.; Eriksdotter, M.; Häbel, H.; Myrberg, I.H.; Jonsson, A.; Pussinen, P.J.; Garcia-Ptacek, S.; Jansson, L.; Sandborgh-Englund, G.; Buhlin, K. Periodontal conditions and incident dementia: A nationwide Swedish cohort study. J. Periodontol. 2022, 93, 1378–1386. [Google Scholar] [CrossRef]
  42. Hernández, R.; Fernández, C.; Baptista, P. Metodología de la Investigación, 6th ed.; McGraw-Hill: Ciudad de México, Mexico, 2014. [Google Scholar]
  43. Bouziane, A.; Lattaf, S.; Abdallaoui Maan, L. Effect of periodontal disease on Alzheimer’s disease: A systematic review. Cureus 2023, 15, e46311. [Google Scholar] [CrossRef]
  44. Lavigne, S. Evolving evidence for relationships between periodontitis and systemic diseases: Position paper from the Canadian Dental Hygienists Association. Can. J. Dent. Hyg. 2022, 56, 155–171. [Google Scholar]
  45. Liu, Y.C.G.; Lan, S.-J.; Hirano, H.; Lin, L.-M.; Hori, K.; Lin, C.-S.; Zwetchkenbaum, S.; Minakuchi, S.; Teng, A.Y.-T. Update and review of the gerodontology prospective for 2020’s: Linking the interactions of oral (hypo)-functions to health vs. systemic diseases. J. Dent. Sci. 2021, 16, 757–773. [Google Scholar] [CrossRef] [PubMed]
Table 1. General characteristics, clinical parameters, and oral health habits in older adults from Lima, Peru (n = 112).
Table 1. General characteristics, clinical parameters, and oral health habits in older adults from Lima, Peru (n = 112).
Variablen%95% CI †
Age *76(81.5–71)
Sex
Male62(55.36)46.12–64.23
Female50(44.64)35.77–53.88
Dementia
Absence44(39.29)30.74–48.54
Presence68(60.71)51.46–69.26
Health insurance
EsSalud35(31.25)23.41–40.34
Private77(68.75)59.66–76.59
Last visit to the dentist
>1 year1(0.89)0.16–4.88
<1 year111(99.11)95.12–99.84
Patient receiving medical treatment
No24(21.43)14.84–29.91
Yes88(74.57)70.09–85.16
BMI
Thin (<19–21)3430.422.6–39.4
Normal (>23)3127.720.2–36.6
Excess weight (≥28, includes overweight + obesity)4741.933.0–51.6
Condition
None13(11.6)6.9–18.9
Metabolic (diabetes + hypertension)42(37.5)28.9–47.0
Respiratory (asthma)30(26.8)19.4–35.9
Psychological (depression)16(14.3)8.9–22.0
Functional (bruxism)11(9.8)5.6–16.7
Level of education
Basic (primary or high school)82(73.2)64.4–80.4
Higher (university or technical)30(26.8)19.6–35.6
PSR
Code 0 (healthy gingiva)11(9.82)5.57–16.73
Code 1 (bleeding)12(10.71)6.24–17.80
Code 2 (bleeding with presence of calculus)34(30.36)22.61–39.41
Code 3 (presence of periodontal
pocket, bleeding, and calculus)		55(49.11)40.03–58.24
Presence of plaque
No23(20.54)14.09–28.93
Yes89(79.46)71.07–85.91
Bleeding when brushing
No11(9.82)5.57–16.73
Yes101(90.18)83.27–94.43
Number of teeth **13.89(1.37)13.63–14.15
* Medium (RIC). † 95% CI calculated using the Wilson method for proportions; 95% CI of the mean (number of teeth) calculated using the t-interval. ** Media(DS)
Table 2. Association between general characteristics, dental clinical parameters, and cognitive status (n = 112).
Table 2. Association between general characteristics, dental clinical parameters, and cognitive status (n = 112).
Patients with Dementia (n = 54)Patients
Without Dementia (n = 58)		p * Value
Variable
Age **75 (81–69)76 (82–72)0.628 ª
Sex 0.865 *
Male30 (54.55)32 (56.14)
Female25 (45.45)25 (43.86)
PSR <0.01 *
Code 00 (0.00)11 (19.30)
Code 10 (0.00)12 (21.05)
Code 20 (0.00)34 (59.65)
Code 355 (100)0 (0.00)
Last visit to the dentist 0.324 *
>1 year0 (0.00)1 (1.75)
<1 year55 (100)56 (98.25)
Presence of plaque <0.01 *
No0 (0.00)23 (40.35)
Yes55 (100)34 (59.65)
Bleeding when brushing <0.01 *
No0 (0.00)11 (19.30)
Yes55 (100)46 (80.70)
Previous dental treatment >0.05 *
Yes55 (100)57 (100)
BMI 0.275 *
Thin (<19 to ≥21).20 (36.36)14 (24.56)
Normal (>23)11 (20.00)20 (35.09)
Overweight (≥28)21 (38.18)19 (33.33)
Obese (≥32)3 (5.45)4 (7.02)
Number of teeth **13.82 (1.45)13.96 (1.29)0.573 °
** Medium (RIC). * Chi-square test, ª Mann–Whitney U-test, ° Student’s t-test. Statistical significance set at p < 0.05.
Table 3. Logistic regression of the presence of periodontal disease and cognitive status (n = 112).
Table 3. Logistic regression of the presence of periodontal disease and cognitive status (n = 112).
VariablesPresence of Periodontal Disease
Crude Analysis *Adjusted Analysis **
OR[95% CI]pOR[95% CI]p
Dementia
YES4.43[2.20–8.93]<0.0014.69[2.32–9.48]<0.001
NORef. Ref.
Logistic regression results are presented as odds ratios (ORs) with 95% confidence intervals (CIs). * Crude analysis of association between dementia status and periodontal disease without adjustments. ** Adjusted analysis included dementia status, sex, age, health insurance, medication, presence of diabetes, presence of hypertension, body mass index (BMI), and level of education. Ref. = reference category. Statistical significance set at p < 0.05.
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Ariza-Cabello, L.; Lucar-Dueñas, X.; Noriega-Castañeda, J.; Gil-Montoya, J.A.; León-Ríos, X.A. Association of Periodontal Disease with Dementia in Older Adults from Lima, Peru. Oral 2025, 5, 94. https://doi.org/10.3390/oral5040094

AMA Style

Ariza-Cabello L, Lucar-Dueñas X, Noriega-Castañeda J, Gil-Montoya JA, León-Ríos XA. Association of Periodontal Disease with Dementia in Older Adults from Lima, Peru. Oral. 2025; 5(4):94. https://doi.org/10.3390/oral5040094

Chicago/Turabian Style

Ariza-Cabello, Leonardo, Ximena Lucar-Dueñas, Jorge Noriega-Castañeda, Jose Antonio Gil-Montoya, and Ximena Alejandra León-Ríos. 2025. "Association of Periodontal Disease with Dementia in Older Adults from Lima, Peru" Oral 5, no. 4: 94. https://doi.org/10.3390/oral5040094

APA Style

Ariza-Cabello, L., Lucar-Dueñas, X., Noriega-Castañeda, J., Gil-Montoya, J. A., & León-Ríos, X. A. (2025). Association of Periodontal Disease with Dementia in Older Adults from Lima, Peru. Oral, 5(4), 94. https://doi.org/10.3390/oral5040094

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