Individuals with lower cognitive scores may be at higher risk of gum disease

Vienna, 12 May 2025 – A large study presented at EuroPerio11, the world’s leading congress in periodontology and implant dentistry, organised by the European Federation of Periodontology (EFP), has revealed a significant link between cognitive performance and gum health in young and middle-aged adults ^[i]. The findings, based on data from nearly 46,000 individuals, suggest that those with lower cognitive test scores are more likely to suffer from periodontitis, a severe form of gum disease that can damage the tissues and bone supporting the teeth.

Periodontitis, also known as gum disease, is a chronic inflammatory condition. If left untreated, it can lead to tooth loss and has been linked to other health problems, including heart disease and diabetes. “Most previous studies focused on elderly people and cognitive decline,” said Doctor Gabriel Mizraji, lead author of the study and specialist in periodontology at the Hadassah Medical Centre, The Hebrew University of Jerusalem, Israel. “Our research looks at something different: the association between cognitive ability, assessed in late adolescence, and periodontal health in young to middle-aged adults. This age group has been relatively overlooked in this area of research.”

The study analysed data from the DOME (Dental, Oral, Medical Epidemiological) project, which integrates medical, dental, and socio-demographic records from a large, nationally representative sample of Israeli military personnel who attended routine dental exams in 2015. “The DOME is a large electronic record-based study aimed at identifying predictors of dental-oral-systemic morbidity,” said Doctor Mizraji speaking on behalf of the research team. “This work reflects the joint efforts of a multidisciplinary group committed to exploring associations between oral and general health.”

As part of the standard military assessment in Israel, participants had taken a General Intelligence Score (GIS) ^[ii] test at age 17. This is a validated measure of overall intellectual ability that evaluates skills in mathematics, language, reasoning, and problem-solving. Years later, their gum health was assessed through full dental exams and X-rays.

Among the 45,898 participants, 12.2% were diagnosed with periodontal disease. The study found that individuals in the lowest cognitive performance group were 40% more likely to have gum disease compared to those with the highest scores and remained significantly high even after adjusting for health-related habits such as smoking, diet, and brushing habits.

“This association remained strong even when we took lifestyle and social variables into account,” explained Doctor Mizraji. “It suggests that cognitive performance is independently associated to oral health, possibly through a complex mix of behavioural, and social factors.”

“This is a compelling study because it looks at cognitive ability early in life and follows its link to gum health later on,” said Professor Lior Shapira, scientific chair of EuroPerio11. “It offers robust data from a uniquely representative population. While the cross-sectional design means it cannot establish cause and effect, the findings still emphasize the need for interdisciplinary approaches in oral healthcare — and the importance of providing special support to individuals with lower cognitive performance. Although the results may not be directly applicable to other countries, they offer valuable insight into global oral health strategies”.

The researchers believe their findings have clear implications for how dental care is provided: “Cognitive function could be considered when assessing someone’s risk for gum disease,” said Mizraji. “Dental professionals might want to use simple assessments to evaluate a patient’s cognitive skills and help tailor oral health education and prevention strategies, especially for those who may struggle to maintain good oral hygiene.” The study also calls for closer collaboration between dental and mental health professionals. “Our findings support a more integrated and personalised approach to healthcare, one that addresses both mental and oral wellbeing,” Mizraji concluded.

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[i] PD040 Cognitive Performance and its Associations with Periodontal status: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-based Nationwide Study, A. Schwartz1, Y. Horev1, A. Wilensky1, G. Mizraji1, G. Almoznino2

[ii] Twig G, Gluzman I, Tirosh A, Gerstein HC, Yaniv G, Afek A, Derazne E, Tzur D, Karasik A, Gordon B, Fruchter E, Lubin G, Rudich A, Cukierman-Yaffe T. Cognitive function and the risk for diabetes among young men. Diabetes Care. 2014 Nov;37(11):2982-8. doi: 10.2337/dc14-0715. Epub 2014 Aug 4. PMID: 25092683.