AIM: To evaluate pattern of change in periodontal variables and tooth loss in a twelve-year follow-up study of older adults living in Sweden.

METHODS: In a prospective population study of older adults, a clinical examination and radiographic dental examination were performed at baseline (2001-2003) and after 12 years (2013-2015). In 375 individuals, the number and proportion of sites with a distance ≥4 mm and ≥5 mm from cemento-enamel junction to the bone level, the number and proportion of teeth with pockets ≥5 mm and number of teeth lost were calculated. Dental caries was registered. Periodontitis was defined as having ≥2 sites with ≥5 mm distance from cemento-enamel junction to the marginal bone level and ≥1 tooth with pockets ≥5 mm.

RESULTS: A diagnosis of periodontitis was evident in 39% of the individuals, and 23% of the individuals lost ≥3 teeth over the study period. The proportion of sites with ≥4 mm and ≥5 mm bone loss increased with age, while the proportion of teeth with pockets remained stable. Periodontitis was the strongest predictor for losing ≥3 teeth, OR 2.9 (p < .001) in the final model.

CONCLUSIONS: Periodontitis is a risk factor for future tooth loss among older adults.

As a result of ongoing demographic transitions, populationsthroughout the world are ageing. Cognitive decline is a leadingcontributor to dependence and disability among older adults. Declinein cognitive abilities can also influence lifestyle factors associatedwith oral health. Increasing evidence suggest that more teethare retained throughout life and therefore an increasing number ofteeth are at risk of oral diseases.Periodontitis is an inflammatory disease affecting the supportivetissues of the teeth resulting in alveolar bone loss and eventuallytooth loss. Associations between periodontitis and systemic diseaseswith an inflammatory profile have been reported.The overall aim of the present thesis was to evaluate a potentialassociation between tooth loss, periodontitis, and cognitive declineand to describe changes in oral health-related parameters amongolder adults in a twelve-year follow-up.In Paper I the impact of tooth loss on the risk for lower cognitivetest score was evaluated in 1147 older adults. An examination includingclinical and radiographic registration of number of teethpresent was performed. Cognitive functioning was evaluated usingMini-Mental State Examination (MMSE) (cut-off <25) and Clocktest(CT) (cut-off <8). Number of teeth was categorised into edentulous,1-19 and ≥20 teeth. The risk for low cognitive test scorewas statistically related to number of teeth. Results from the multiplelogistic regression after adjustments for age and educationdemonstrated a statistically significant impact of being edentulous on cognitive functions. In addition, having 1 to 19 teeth had a significantimpact on the risk for Clock-test

Aim: to determine whether having periodontitis is associated with cognitive decline among older adults. Material and Methods: A prospective population study of older adults, Swedish National Study on Ageing and Care, (SNAC) provided repeated registrations of cognitive functions. Cognitive decline was defined as ≥ 3-points deterioration from a predetermined level at baseline, using the Mini-Mental State Examination (MMSE). Between 2001 and 2003, 715 individuals had a medical as well as a clinical and radiographic dental examination. The individuals were re-examined after 6 years. Periodontitis was defined as ≥ 4mm bone loss at ≥ 30 % of tooth sites. Social variables were captured from questionnaires. Results: The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of periodontitis and cognitive decline after adjustments of confounding factors of importance. Conclusions: A history of periodontitis may be of importance for cognitive functions among older adults.

Objective: This study aims to evaluate the potential association between periodontitis, the number of teeth and cognitive functions in a cohort of older adults in Sweden. Material and methods: In total, 775 individuals from 60 to 99 years of age were selected for the study. A clinical and radiographic examination was performed. The number of teeth and prevalence of periodontal pockets and bone loss was calculated and categorised. Cognitive functions were assessed using the Mini-Mental State Examination (MMSE) and clock test. The education level was obtained from a questionnaire. Data were analysed using chi-square tests and multivariate logistic regression. Results: Age and gender were associated with the prevalence of bone loss. Age and education were associated with lower number of teeth. Gender was also associated with the presence of pockets. The multivariate logistic regression analysis demonstrated a statistically significant association between prevalence of bone loss, the number of teeth and the outcome on MMSE test. This association remained even after adjustment for age, education and gender. Tooth loss was also associated with lower outcome on clock test. Presence of periodontal pockets ≥ 5 mm was not associated with cognitive test outcome. Conclusions: A history of periodontitis and tooth loss may be of importance for cognitive functions among older adults. Clinical relevance: Diseases with and inflammatory profile may have an impact on cognitive decline.

OBJECTIVE: To evaluate the association between the number of teeth and cognitive functions adjusted for age and education level in a cohort of older adults living in Sweden. MATERIALS AND METHODS: The study employed a cross-sectional design in which 1147 individuals between 60-96 years underwent a clinical oral examination. The cognitive functions were assessed using Mini-Mental State Examination (MMSE) and Clock-test. The level of education was obtained from a questionnaire. Data were subjected to Chi-square tests and multivariate logistic regression analyses were employed, grouping the different variables into pre-determined categories. RESULTS: The co-variables age and education were significantly associated with the number of teeth (p < 0.05). The multivariate logistic regression analysis revealed that the association between the number of teeth and the cognitive functions persisted even after adjusting for age and level of education. CONCLUSIONS: The findings suggest that the presence of teeth may be of importance for cognitive abilities in older adults.