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However, the impact of oral microorganisms, such as\n                    <jats:italic>Porphyromonas gingivalis<\/jats:italic>\n                    , on the pathogenesis of Alzheimer disease and the potential causative relationship is still unclear. The present review has critically reviewed the literature by examining the following aspects: (a) the oral microbiome and the immune response in the elderly population, (b) human studies on the association between periodontal and gut microorganisms and Alzheimer disease, (c) animal and in vitro studies on microorganisms and Alzheimer disease, and (d) preventive and therapeutic approaches. Factors contributing to microbial dysbiosis seem to be aging, local inflammation, systemic diseases, wearing of dentures, living in nursing homes and no access to adequate oral hygiene measures.\n                    <jats:italic>Porphyromonas gingivalis<\/jats:italic>\n                    was detectable in post\u2010mortem brain samples. Microbiome analyses of saliva samples or oral biofilms showed a decreased microbial diversity and a different composition in Alzheimer disease compared to cognitively healthy subjects. Many in\u2010vitro and animal studies underline the potential of\n                    <jats:italic>P\u00a0gingivalis<\/jats:italic>\n                    to induce Alzheimer disease\u2010related alterations. In animal models, recurring applications of\n                    <jats:italic>P\u00a0gingivalis<\/jats:italic>\n                    or its components increased pro\u2010inflammatory mediators and \u03b2\u2010amyloid in the brain and deteriorated the animals' cognitive performance. Since periodontitis is the result of a disturbed microbial homoeostasis, an effect of periodontal therapy on the oral microbiome and host response related to cognitive parameters may be suggested and should be elucidated in further clinical trials.\n                  <\/jats:p>","DOI":"10.1111\/prd.12429","type":"journal-article","created":{"date-parts":[[2022,3,4]],"date-time":"2022-03-04T09:08:56Z","timestamp":1646384936000},"page":"59-82","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":162,"title":["Periodontal microorganisms and Alzheimer disease \u2013 A causative relationship?"],"prefix":"10.1111","volume":"89","author":[{"given":"Gert","family":"Jungbauer","sequence":"first","affiliation":[{"name":"Department of Periodontology School of Dental Medicine University of Bern  Bern Switzerland"},{"name":"Private Dental Practice  Straubing 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