title: Tooth loss is associated with severe cognitive impairment among older people: findings from a population-based study in Brazil.
abstract: BACKGROUND
  A consistent and low-to-moderate association between markers of oral infection and loss of cognitive function has been demonstrated in the literature. However, such evidence comes from population studies carried out mainly in the USA.
  
  
  OBJECTIVE
  To assess the association between tooth loss and loss of cognitive function in older people from Southern Brazil, with particular interest on how age may modify such association. In addition, we also test the association between loss of cognition (exposure) and tooth loss (outcome).
  
  
  METHODS
  Data from a baseline population-based cohort study were cross-sectionally analyzed, including tooth loss, cognitive impairment, sex, income, educational attainment, color/race, smoking status and a range of self-reported chronic diseases. Participants (n = 1705) were 60 years of age and over, from a midsized Southern Brazilian city. Odds ratios (OR) and 95% confidence intervals (95%CI) were estimated using multivariable logistic and partial ordinal logistic analyses.
  
  
  RESULTS
  Edentate status was associated (OR 3.3; 95%CI 1.2-9.3) with severe cognitive impairment in the fully adjusted model. Moreover, there was an interaction between number of teeth and age on severe cognitive impairment. A weak association between severe cognitive impairment (exposure) and tooth loss (outcome) was identified after the adjustment for potential covariates.
  
  
  CONCLUSIONS
  This study lends support to hypothesized association between tooth loss and severe cognitive impairment. Older adults seem to be particularly vulnerable to such effects. However, the bidirectional association between tooth loss and severe cognitive impairment cannot be ruled out.
authors.affiliation: a Australian Research Centre for Population Oral Health, School of Dentistry , The University of Adelaide , Adelaide , Australia.
authors.forename: Marco A
authors.initials: MA
authors.lastname: Peres
authors.forename: João L
authors.initials: JL
authors.lastname: Bastos
authors.forename: Richard G
authors.initials: RG
authors.lastname: Watt
authors.forename: André J
authors.initials: AJ
authors.lastname: Xavier
authors.forename: Paulo R
authors.initials: PR
authors.lastname: Barbato
authors.forename: Eleonora
authors.initials: E
authors.lastname: D'Orsi
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D001938:Brazil / Q000453:epidemiology; D003071:Cognition / Q000502:physiology; D003072:Cognition Disorders / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003753:Dental Health Surveys; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D008875:Middle Aged; D009909:Oral Health; D011159:Population Surveillance; D012307:Risk Factors; D057566:Self Report; D012720:Severity of Illness Index; D012907:Smoking / Q000453:epidemiology; D012923:Social Class; D012959:Socioeconomic Factors; D016388:Tooth Loss / Q000453:epidemiology*
keywords: Brazil; cognition disorders; cross-sectional studies; tooth loss