Episode 12: Oral Health & Healthy Aging with guest Dr. Bei Wu
Oral hygiene is a regular part of most people’s daily lives. But, did you know that oral health (such as brushing your teeth daily and visiting your dentist regularly) is related to many health outcomes, including cardiovascular disease, diabetes, depression, quality of life and even your mental functions? To help us better understand the relationship between oral hygiene and healthy aging, we’re talking with Dr. Bei Wu – a professor at New York University’s (NYU) Rory Meyers College of Nursing and Co-Director of the Aging Incubator at NYU. Her numerous publications cover a variety of issues related to oral health and its relationship to healthy aging.
Meet Dr. Bei Wu
Dr. Bei Wu is a professor at NYU Rory Meyers College of Nursing. She is also a co-director of the newly-funded NYU Aging Incubator. Dr. Wu’s career in gerontology has spanned close to 30 years. Currently, her main research focus is aging, particularly healthy aging, because as we know, people are living longer, and the aging population increases around the globe. Dr. Wu was inspired to deal with this challenge, and she thought of ways on how it is that we can add life to years, instead of just adding years to life. Aging is a lifelong process and so, it is important to promote healthy aging not only to older adults, but also to the younger generations. Over 15 years ago, Dr. Wu became interested in examining the relationship between oral health and healthy aging.
The Research
Oral Health and Overall Well-Being
In recent years, studies have been increasing and evidence suggests that oral health has an impact on an individual’s quality of life. Dr. Wu’s team has done research and established that there is in fact a relationship between an individual’s oral health and their quality of life. Moreover, oral health also has an impact on nutrition, social interaction, as well as mental health - particularly in the area of depressive symptoms. Oral health also affects an individual’s physical health, including cardiovascular diseases and diabetes. One study that was conducted in Europe found that individuals with tooth loss had a higher risk of death. Our team has found that tooth loss is also related to the onset of physical limitations.
Having said that, we also need to be cautious about these findings that look at the relationship between oral health and overall general health status. We need to be cautious because most of these findings have been established using cross-sectional data. So, in fact, we can only establish associations between oral health and overall well-being – we are not able to determine causation. In other words, we cannot say that poor oral health causes lower quality of life. All we are able to say, from the research, is that there is a relationship between poor dental hygiene and quality of life, whereby individuals with poorer oral health also seem to have lower quality of life. More clinical trial research is needed for us to be able to establish causation, and we also need to do more longitudinal research (a study that follows people over time) – this kind of data would be more powerful than looking at how oral health and overall health are related at a single point in time.
Oral Health and Depression
From a prevention perspective, the association between depression and oral hygiene is very related to an individual’s oral hygiene and regular dental visits. Presumably, someone who is ing major depressive symptoms, this will affect their oral hygiene behaviours – including regular dental visits and daily oral hygiene behaviours.
Oral Health and Diabetes
Evidence suggests that adults with diabetes have a two-times greater risk of tooth loss than people without diabetes. Studies have indicated that the relationship between diabetes and periodontitis (gum disease) is bi-directional. Specifically, diabetes can increase the risk of having periodontal disease, which can cause tooth loss and periodontal disease can complicate the control of diabetes in a person. One of the major symptoms of periodontal disease is increased gum inflammation. Research has also linked diabetes to cognitive impairment.
Oral Health and Cognitive Function
Fifteen years ago, there were very few studies conducted about the association between oral health and cognitive function in older adults. In 2008, Dr. Wu published a study looking specifically at the relationship between cognitive function and oral health in community-dwelling older adults who were aged 60 and above. The research found that there is a linear relationship between individuals oral health and their cognitive functioning. Specifically, older adults with higher levels of cognitive functioning have better oral health, lower number of tooth loss and reduced prevalence of periodontitis (regardless of socioeconomic status, income, level of education, or insurance). Dr. Wu and her team conducted another study where they looked at the association between level of cognitive functioning and frequency of dental visits. They found that individuals with higher levels of cognitive functions attend preventative dental visits more frequently.
Oral Health and Mild Cognitive Impairment & Dementia
Dr. Wu is interested in exploring oral health in individuals at different levels of cognitive functioning, including people who are experiencing mild cognitive impairment (MCI) or dementia (e.g., Alzheimer’s). People with mild cognitive impairment (or early stages of dementia) show poorer oral hygiene (e.g., frequency and quality of tooth brushing); so, Dr. Wu and her team are working on developing interventions to help people develop strategies to maintain their oral hygiene. Brushing your teeth is a habitual behaviour and, so, it is related to your procedural memory. Of note, procedural memory is a type of memory that is less affected in MCI and dementia; so, people with MCI and dementia retain the capacity to brush their teeth. The issue is that they may forget to engage in the act of brushing in the first place.
What might be underlying the association between cognitive functions and oral health?
· Inflammation in the gums might be affecting cardiovascular health
· Bacteria build up in the mouth might affect brain function
· Dietary intake might be compromised by tooth pain or tooth loss
· Frequency of dental visits might be reduced for those experiencing cognitive impairment
Beneficial Changes to our Healthcare System
Doctors and researchers, like Dr. Wu, need to generate more evidence to look at and show the relationship between oral health and general health. As a result of this research, it would then not make sense to exclude dental services from universal health coverage. Oral health is an essential component of healthy aging; as such, we need to start considering dental services as part of our medical coverage. So, we need to think about expanding health coverage to include dental care, specifically preventative care (e.g., regular dental check-ups).
Exercising Proper Oral Health Behaviours
A good way to start optimizing your oral health is by brushing your teeth regularly. Follow dentist recommendations like brushing for at least two minutes and covering all parts of your mouth. Also, be sure you visit your dentist regularly (at least every six months).
Final Comments
We need to learn from other countries – e.g., Japan has the longest life expectancy and they also implement universal dental coverage.
To learn more about the work that Dr. Bei Wu is doing on oral health and healthy aging at NYU, you can visit their website (for general information about the NYU Aging Incubator click here and for specific information about Dr. Bei Wu click here).