A feasibility study to recruit, retain and treat periodontitis in volunteers with mild dementia, whilst monitoring their cognition

Objectives: Dementia patients are challenging to manage dentally. This study determined whether individuals with mild dementia and periodontitis, could be recruited, retained and demonstrate sustained oral health improvements over 2 years following personalised professional periodontitis treatment. The feasibility of same visit cognition measurements was assessed.

Methods: A non-randomised study in individuals with mild dementia, capacity to consent, periodontitis and >6 teeth. Following enrolment and dental/cognitive assessments, personalised periodontal treatment, followed by 3-monthly supportive periodontal care was performed. Cognitive and periodontal assessments were undertaken at 6, 12, 24-months. Participants and project-partners fed back on homecare regimens.

Results: 18 participants were recruited, 15 completed 12- & 8 completed 24-months, 1 participant failed to attend one appointment, and early study termination due to COVID19. From baseline to 12-months mean percentage bleeding sites, Turesky plaque score >2 and periodontal pockets >4mm decreased significantly (34.4 vs 14.75, p<0.01; 78.49 vs 57.5, p<0.01; 18.38 vs 5.14, p<0.001). Significant change from baseline was retained at 24-months for mean percentage periodontal pockets >4mm (14.47 vs 4.29, p<0.05; n=8). Cognition declined significantly to 12-months (mean ACEIII 71.47 vs 65.40, p<0.05), but not between 12- and 24-months (67.5 vs 65.38, n=8). Most reported home-care regimen as easy/OK to follow.

Conclusions: Mild dementia participants with periodontitis can be recruited, retained in a 24-month study and periodontally treated with personalised professional and at-home care regimens. Cognitive assessments can be performed at the same treatment visit. This demonstrates sustained engagement and supports oral health compliance can be successful in challenging cohorts.

Clinical Significance Statement
Faster cognitive decline rates are seen in Alzheimer’s patients with active periodontitis, dental care posing considerable challenges. This study demonstrates dementia cohorts can be successfully periodontally managed over 2 years, alongside cognitive measurement. This result is meaningful to inform public health policy and suggests RCTs for full evaluation are needed.