{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T05:41:42Z","timestamp":1791265302888,"version":"4.1.0"},"reference-count":89,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2023,3,7]],"date-time":"2023-03-07T00:00:00Z","timestamp":1678147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Introduction: Periodontitis is a severe oral infection that can contribute to systemic inflammation. A large body of evidence suggests a role for systemic inflammation in the initiation of neurodegenerative disease. This systematic review synthesized data from observational studies to investigate the association between periodontitis and neuroinflammation in adults. Methods and materials: A systematic literature search of PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed for studies published from the date of inception up to September 2021. Search terms for the exposure \u201coral disease\u201d and outcome \u201cdementia\u201d, \u201cneuroinflammation\u201d and \u201ccognitive decline\u201d were used. Study selection and data extraction were independently undertaken by two reviewers. The final eligible articles were included only if the exposure is periodontitis and the outcome is cognitive impairment or dementia or a topic related to this condition, and if the study was conducted in an adult population. The quality and risk of bias were assessed by Newcastle Ottawa Scale (NOS). Qualitative synthesis was used to narratively synthesize the results. Six cohort studies, three cross-sectional studies, and two case-control studies met the inclusion criteria. These eleven studies were only narratively synthesized. Meta-analysis was not performed due to the methodological heterogeneity of the studies. Results: The results of included studies show that chronic periodontitis patients with at least eight years of exposure are at higher risk of developing cognitive decline and dementia. Oral health measures such as gingival inflammation, attachment loss, probing depth, bleeding on probing, and alveolar bone loss are associated with cognitive impairment. The reduction of epidermal growth factor (EGF), interleukin 8 (IL-8), interferon \u03b3-induced protein 10 (IP-10), and monocyte chemoattractant protein-1 (MCP-1) in addition to over expression of interleukin 1-\u03b2 (IL-1\u03b2) are significant in patients suffering from cognitive decline with pre-existing severe periodontitis. Conclusions: All the included studies show evidence of an association between periodontitis and cognitive impairment or dementia and Alzheimer\u2019s disease pathology. Nonetheless, the mechanisms responsible for the association between periodontitis and dementia are still unclear and warrant further investigation.<\/jats:p>","DOI":"10.3390\/ijerph20064707","type":"journal-article","created":{"date-parts":[[2023,3,8]],"date-time":"2023-03-08T02:30:23Z","timestamp":1678242623000},"page":"4707","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":56,"title":["Association between Periodontal Disease and Cognitive Impairment in Adults"],"prefix":"10.3390","volume":"20","author":[{"given":"Najwane","family":"Said-Sadier","sequence":"first","affiliation":[{"name":"College of Health Sciences, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-6765-7457","authenticated-orcid":false,"given":"Batoul","family":"Sayegh","sequence":"additional","affiliation":[{"name":"Neuroscience Research Center (NRC), Lebanese University, Beirut 1533, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Farah","sequence":"additional","affiliation":[{"name":"Neuroscience Research Center (NRC), Lebanese University, Beirut 1533, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9185-3831","authenticated-orcid":false,"given":"Linda Abou","family":"Abbas","sequence":"additional","affiliation":[{"name":"Neuroscience Research Center (NRC), Lebanese University, Beirut 1533, Lebanon"},{"name":"INSPECT-LB (Institut National de Sant\u00e9 Publique, d\u2019\u00c9pid\u00e9miologie Clinique et de Toxicologie-Liban), Beirut 1103, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rania","family":"Dweik","sequence":"additional","affiliation":[{"name":"College of Health Sciences, Abu Dhabi University, Abu Dhabi 59911, United Arab Emirates"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norina","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Periodontics, University of the Pacific, San Francisco, CA 94103, USA"},{"name":"Department of Laboratory Medicine, Veterans Affairs Medical Center, San Francisco, CA 94121, USA"},{"name":"Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1461-4495","authenticated-orcid":false,"given":"David M.","family":"Ojcius","sequence":"additional","affiliation":[{"name":"Arthur Dugoni School of Dentistry, University of the Pacific, San Francisco, CA 94103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1111\/j.1600-051X.1986.tb01487.x","article-title":"Natural History of Periodontal Disease in Man","volume":"13","author":"Anerud","year":"1986","journal-title":"J. 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