Association Between Oral Hygiene Behaviours and Cognitive Decline in Adults: A Systematic Review and Meta-Analysis.
Zheng Zhu, Zhongfang Yang, Xiang Qi and 3 others
PMID 39373499WHAT IT FOUND
Toothbrushing performed by professionals or caregivers was associated with slightly better global cognitive scores in older adults, particularly those in nursing homes or with moderate to severe dementia.
Self-performed brushing showed no significant association. The evidence quality is very low.
Key findings
01Toothbrushing was associated with a mean difference of 0.65 points on the MMSE for global cognitive function, but the certainty of this evidence is very low.
02Assisted toothbrushing by professionals or caregivers showed significant cognitive benefits, whereas self-performed toothbrushing did not.
03Brushing teeth twice or more daily was associated with a lower risk of dementia in cohort studies, but other oral hygiene behaviors like flossing or mouthwash use showed no significant association.
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What it does not show
The overall certainty of evidence was rated as very low due to serious risk of bias in the included studies. Only eight studies were included, and subgroup analyses relied on one to three studies each, making findings fragile. Most studies were conducted in Japan, limiting the generalizability of the results to other populations. None of the intervention studies blinded participants or staff, which may have influenced outcomes. The effect size for global cognition (0.65 MMSE points) is small and may not be clinically meaningful for individual patients.
Declared interests
The authors declare no competing interests.
The easy way to misread this
Do not interpret the small MMSE improvement as proof that toothbrushing prevents dementia. The evidence is very low certainty, the effect size is minimal, and the benefit was only seen in assisted brushing, not self-care.