Summary: Poor oral health has been linked to cognitive decline and increased symptoms of stress. Stress increases symptoms of dry mouth, which can lead to poor overall oral health. Those with tooth related symptoms, such as toothaches and cavities, are more likely to experience declines in cognition and episodic memory.
Oral health is an essential part of psychological well-being and overall health in older adults. Poor oral health is associated with decreased quality of life, depression, hypertension, and cognitive decline. Two Rutgers studies, co-authored by Darina Petrovsky, Bei Wu, and Weiyu Mao, and published in the Journal of the American Geriatrics Society, explored the relationship between poor oral health and cognitive decline and the effects of perceived stress and social support on dry mouth among older Chinese Americans.
Researchers interviewed more than 2,700 Chinese Americans aged 60 and older and found that nearly 50 percent of study participants reported experiencing tooth symptoms, 25.5 percent reported dry mouth. In the first study, those who reported tooth symptoms experienced declines in cognition and episodic memory, often precursors to dementia. In the second study, the researchers found that stress increased symptoms of dry mouth, leading to poorer overall oral health.
“Racial and ethnic minorities are particularly vulnerable to the negative consequences of poor oral health,” said XinQi Dong, director of Rutgers University’s Institute for Health, Health Care Policy and Aging Research. “Minorities have less access to preventive dental care that is further exacerbated by language barriers and low socioeconomic status. Older Chinese Americans are at particular risk for experiencing oral health symptoms due to lack of dental insurance or not visiting a dental clinic regularly.”
According to Dong, the increasing oral health disease burdens among older Chinese immigrants point to the need for investigations of psychosocial factors due to the current emphasis on physical diseases and health behaviors in oral health.
“Efforts must be made to increase social support to alleviate stress and the resulting dry mouth issues reported by our study participants,” Dong continued. “These efforts can help preserve older adults’ health and well-being and limit cognitive decline.”
47.8 percent of older Chinese Americans reported having teeth symptoms; participants who reported teeth symptoms at baseline experienced their global cognition and episodic memory decline
18.9 percent of older Chinese Americans reported gum symptoms.
15.6 percent of older Chinese Americans reported teeth and gum symptoms.
25.5 percent of older Chinese Americans reported dry mouth.
More perceived stress was associated with higher odds of dry mouth.
“These studies demonstrate the importance of examining immigrant oral health outcomes later in life to understand the specific type of outcomes of different cultural groups,” said Dong. “The studies further serve as a call to action for policymakers to develop programs aimed at improving oral health preventative and dental care services in this high-risk population. Darina Petrovsky, first author, added, “Examining current oral health practices among older Chinese Americans is crucial for developing culturally-tailored interventions to promote oral health and ultimately mitigate cognitive decline.”
“Poor oral health is a top concern among older Chinese Americans. In our study, the prevalence rate of dry mouth is followed by diabetes and heart disease. Our findings demonstrate the importance of studying the linkage between stress and dry mouth in this vulnerable population.” said author Weiyu Mao, Assistant Professor, School of Social Work, University of Nevada, Reno.
“Support from family and friends could be protective against dry mouth symptoms in relation to stress; however, the potential overload of such support could be detrimental to oral health outcomes among older Chinese Americans.” Mao continued. “Intervention strategies need to expand beyond the common risk factors, such as health conditions and health behaviors, and account for the psychosocial determinants, including stress and social support, to better promote oral health and reduce oral health disparities in this population.”
“Our research raises critical awareness for dental and healthcare providers of the role of perceived stress in dry mouth symptoms,” added Dong. “Working collaboratively, dental, and healthcare providers can better identify oral health symptoms as risk factors of cognitive decline in this fast-growing vulnerable population. The primary focus should include promoting optimal oral health and improving the quality of life.”
About this neuroscience research article
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Oral Health Symptoms and Cognitive Function Among US Community‐Dwelling Chinese Older Adults
BACKGROUND/OBJECTIVES Limited research is available on the relationship between oral health symptoms and cognitive function among community‐dwelling US Chinese older adults. The purpose of this study was to examine the associations between tooth/gum symptoms and changes in cognitive function.
DESIGN Two‐wave epidemiological study. SETTING Population Study of Chinese Elderly in Chicago (PINE).
PARTICIPANTS US Chinese older adults (N = 2713; mean age = 72.6 y; 58.4% women).
MEASUREMENTS We selected self‐reported oral (tooth and gum) symptoms as independent variables. To examine changes in cognitive function (wave 2: Baseline), we chose the following three domains: episodic memory (East Boston Memory Test); executive function (Symbol Digit Modalities Test); and working memory (Digit Span Backwards). In addition, we assessed global cognitive function by constructing a composite measure.
RESULTS At baseline, 1297 participants (47.8%) reported having teeth symptoms, and 513 participants (18.9%) reported having gum symptoms. Adjusting for sociodemographic and health‐related characteristics, participants who reported having teeth symptoms at baseline experienced their global cognition decrease by 0.07 units (estimate = −0.07; p = .003) and their episodic memory decrease by 0.07 units (estimate = −0.07; p = .026). Participants who reported having teeth symptoms at baseline experienced a faster rate of decline in global cognition for every additional year (estimate = 0.02; p = .047). However, this effect disappeared once we adjusted for all covariates (estimate = 0.02; p = .069). We found no significant relationship between baseline gum symptoms and change of cognitive function.
CONCLUSION Having teeth symptoms was associated with a decline in cognitive function among US Chinese older adults. Developing policy measures aimed at ameliorating health and improving cognition in this high‐risk fast‐growing population in the United States would need to include oral health preventive and dental care services. J Am Geriatr Soc 67:S532–S537, 2019.