Can our teeth affect the way we think? The idea may have sounded slightly absurd at one time. Cognitive function and an upper molar seemed to have little in common.
However, research in recent years has linked the dentition and brain activity closer together. There is even a case to be made that dental implants should be considered more holistically as a solution that restores dental function and aesthetics, but could also provide benefits for our brain health later in life.
Chew on the idea
Cognitive functioning encompasses a range of mental abilities, from thinking and learning, to reasoning, problem solving, attention and memory.[i] It is key to our functional independence, but often declines with age.[ii] Impairment of some everyday abilities is commonly an early sign of a disease that will eventually cause dementia, but it can also be linked to sleep disorders or side effects of medication.[iii]
A decline in cognitive ability is due to cerebral neurophysiological changes such as cortical atrophy, and the loss of neurons, reduced cell groups, and synaptic damage.[iv] However, mastication has been seen to improve cognitive function by activating cerebral cortical activity and increasing cortical blood flow, whilst also uplifting neuronal activities for improved learning and memory.iv
Herein lies the relevance to dentistry. Whilst tooth loss is not inherent to aging – periodontal disease is the primary culprit[v] – it often occurs in tandem with our expectations of cognitive decline. When we consider that masticatory dysfunction is sometimes triggered by a structural factor such as tooth loss,[vi] it becomes clearer that today’s clinicians can support a wide variety of patients, especially those in their later years.
A return to the norm
When patients lose teeth, a dental implant can often be an appealing solution thanks to its fixed nature, aiding in both function and aesthetics. When speaking and chewing, it more closely mimics the natural dentition compared to traditional dentures or bridges, and increases upon the biting force capable with a traditional denture.[vii]
The literature has observed that restoration of masticatory performance has been proven to partially reverse pathological changes to the cerebral cortex and hippocampus that negatively impact cognitive function.[viii]
Where an implant is the chosen restoration, it’s important to stress the need for function over mere presence. Improvement in brain activity is only seen once the implant is loaded, meaning it is not just the existence of the prosthetic that is important.[ix]Such findings suggest that the closer a restoration resembles the function of the original dentition, the more the sensorimotor system will achieve the re-establishment of its original characteristics.viii
The speed at which a dental implant can affect cognitive function is incredible. A 2020 study observed a decline in cognitive function 1 week after implant placement, but at 6 week and 12 month follow ups, there were a wide range of improvements that returned to or even moved beyond the established baseline.viii The initial fall off could simply be attributed to mild post-operative pain and discomfort following placement.[x]
Food for thought
The prevention of cognitive decline could also be aided by an effective diet. The partially edentulous patient may adjust their choice of daily foods due to a newfound difficulty or pain when eating certain foods. Individuals experiencing tooth loss are likely to reduce their consumption of fruits and vegetables like apples and carrots, and eat more meat and fish.[xi]
When we think about diet and cognition, these changes go directly against what we believe improves brain function in older patients. The decrease in fresh produce and increased meat, in particular, are the antithesis of the Mediterranean diet, which has an association with better cognitive function in old age, as well as a lower risk of Alzheimer’s disease.[xii], [xiii]
Providing effective care
The potential effects of a dental implant on a patient’s cognitive abilities, especially in older age, are exceptional. A clinician must ensure they are confident and competent in their implant placement capabilities to ensure edentulous patients have the greatest opportunity to maintain cognitive function. To learn the effective and modern techniques available today, clinicians must invest in high-quality education that advances their abilities.
One To One Implant Education offers leading courses on implant dentistry, including the Postgraduate Diploma in Implant Dentistry, for those looking to begin their clinical development in this area. The course covers all aspects of the treatment workflow, and prepares clinicians for a wide variety of real-world needs through a mix of theory and hands-on sessions. You are never without support, as world-class tutors are assigned as dedicated mentors to each and every delegate, in relationships that can last a lifetime.
Dental implants are known as a brilliant aesthetic solution, but their impact on function and cognition must not go ignored. The literature points to a positive relationship, placing clinicians in a position of great influence over the way the population, quite literally, thinks.
To reserve your place or to find out more, please visit
https://121implanteducation.co.uk or call 020 7486 0000.
Dr Fazeela Khan-Osborne is the founding clinician of the FACE dental implant multi-disciplinary team for the One To One Dental Clinic based on Harley Street, London. She has always had a passion and special interest in implant dentistry, particularly in surgical and restorative full arch rehabilitation of the maxilla. She has been involved in developing treatment modalities for peri-implantitis within clinical practice.
Dr Khan-Osborne is also the Founding Course Lead for the One To One Education Programme, now in its 20th year. As a former Lead Tutor on the Diploma in Implant Dentistry course at the Royal College of Surgeons (England), she lectures worldwide on implant dentistry and is an active full member of the Association of Dental Implantology, the British Academy of Aesthetic Dentistry and the International Congress of Oral Implantologists.
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Nikolas is a Senior Implant and Restorative Surgeon in private clinics in London and Edinburgh. His special interest and main qualifications are in Oral Surgery and Oral Implantology, while he has vast experience in all areas of Aesthetic Dentistry. He has been a practising Dental Surgeon since 2005 after graduating from the prestigious Military Academy Medical School at the University of Thessaloniki, Greece.
Nikolas started his training in the Oral and Maxillofacial Surgery Department of the 401 Military Hospital in Athens, Greece. As a military officer, he then went on to serve as a team leader in a field hospital in Kabul, Afghanistan – an experience, which shaped his commitment and dedication to his chosen field. On returning to Greece, he furthered his training completing a Postgraduate Diploma in Oral Implantology from the University of Athens, Greece and a Master of Science Degree in Oral Surgery/Implantology from Göethe University of Frankfurt, Germany. He recently obtained an Advanced Surgical Master Curriculum in Regenerative Implant Dentistry next to Dr Istvan Urban in Budapest, Hungary. Nikolas is lecturing about Dental Implants and Regenerative Dentistry, and he is holding a program for introducing and mentoring dentists in Implant Dentistry. He is a Member of the Association of Dental Implantology and the International Team for Implantology.
[i] Fisher, G. G., Chacon, M., & Chaffee, D. S. (2019). Theories of cognitive aging and work. In Work across the lifespan (pp. 17-45). Academic press.
[ii] Murman, D. L. (2015). The impact of age on cognition. In Seminars in hearing (Vol. 36, No. 03, pp. 111-121). Thieme Medical Publishers.
[iii] Alzheimer’s Society, (N.D.). Mild cognitive impairment (MCI). (Online) Available at: https://www.alzheimers.org.uk/about-dementia/types-dementia/mild-cognitive-impairment-mci [Accessed February 2024]
[iv] Kim, T. H. (2021). Effects of masticatory exercise on cognitive function in community-dwelling older adults. Technology and Health Care, 29(S1), 125-131.
[v] Harvard Health Publishing, (2010). The aging mouth – and how to keep it younger. (Online) Available at: https://www.health.harvard.edu/diseases-and-conditions/the-aging-mouth-and-how-to-keep-it-younger [Accessed February 2024]
[vi] Alvarenga, M. O. P., Ferreira, R. D. O., Magno, M. B., Fagundes, N. C. F., Maia, L. C., & Lima, R. R. (2019). Masticatory dysfunction by extensive tooth loss as a risk factor for cognitive deficit: A systematic review and meta-analysis. Frontiers in Physiology, 10, 832.
[vii] Yetman, D., Archibald, J., (2022). What Are the Benefits and Drawbacks of Dental Implants? Healthline. (Online) Available at: https://www.healthline.com/health/dental-and-oral-health/benefits-of-dental-implants [Accessed February 2024]
[viii] Tan, D., Foster, S., Korgaonkar, M. S., Oxenham, V., Whittle, T., & Klineberg, I. (2020). The role of progressive oral implant rehabilitation in mastication, cognition and oral health‐related quality of life outcomes—A pilot to define the protocol. Journal of Oral Rehabilitation, 47(11), 1368-1381.
[ix] Banu R, F., Veeravalli, P. T., & Kumar V, A. (2016). Comparative evaluation of changes in brain activity and cognitive function of edentulous patients, with dentures and two‐implant supported mandibular overdenture‐pilot study. Clinical Implant Dentistry and Related Research, 18(3), 580-587.
[x] Maria, M. T. S., Hasegawa, Y., Khaing, A. M. M., Salazar, S., & Ono, T. (2023). The relationships between mastication and cognitive function: A systematic review and meta-analysis. Japanese Dental Science Review, 59, 375-388.
[xi] Kotronia, E., Brown, H., Papacosta, A. O., Lennon, L. T., Weyant, R. J., Whincup, P. H., … & Ramsay, S. E. (2021). Poor oral health and the association with diet quality and intake in older people in two studies in the UK and USA. British Journal of Nutrition, 126(1), 118-130.
[xii] Luciano, M., (2022). Diet and brain health. AgeUK. (Online) Available at: https://www.ageuk.org.uk/information-advice/health-wellbeing/mind-body/staying-sharp/looking-after-your-thinking-skills/diet-and-brain-health/ [Accessed February 2024]
[xiii] Fu, J., Tan, L. J., Lee, J. E., & Shin, S. (2022). Association between the mediterranean diet and cognitive health among healthy adults: A systematic review and meta-analysis. Frontiers in Nutrition, 9, 946361.
