Oral infections and orofacial pain in Alzheimer's disease: case report and review

Siqueira, Silvia Regina Dowgan T. de; Rolim, Thaís de Souza; Teixeira, Manoel Jacobsen; Nitrini, Ricardo; Anghinah, Renato; Siqueira, José Tadeu T. de

doi:10.1590/S1980-57642010DN40200012

Abstract

Dental infections, frequent in the general population, are a common cause of inflammation with systemic impact, and are the most common cause of orofacial pain. Temporomandibular disorders are also frequent in the elderly and represent an important cause of secondary headache. Both inflammation and pain can also contribute to cognitive, functional and behavioral impairment of the elderly and aggravate symptoms of patients with Alzheimer's disease (AD). We report a case of a 74-year-old woman with AD and chronic facial pain who had a significant improvement in functional activities as well as in cognition and depressive symptoms after successful treatment of her facial pain. Patients with AD have higher compromise of oral health with infections and teeth loss. The investigation of orofacial pain should be performed in patients with AD, because of the associations reviewed and given the potential for improvement as highlighted by this case.

Key words:
Alzheimer's disease; elderly; dementia; temporomandibular disorder; orofacial pain.

Resumo

Infecções dentárias, frequentes na população e geral, são uma causa comum de inflamação com impacto sistêmico e a causa mais comum de dor orofacial. Disfunções temporomandibulares também são prevalentes nos idosos, causam cefaléia secundária. Tanto a dor quanto a inflamação podem também contribuir com o comprometimento cognitivo, funcional e comportamental em idosos e agravar sintomas em pacientes com doença de Alzheimer (DA). Este é um relato de um caso de uma mulher com 74 anos de idade com DA e dor orofacial crônica que apresentou uma melhora significante nas atividades funcionais assim como na cognição e sintomas depressivos depois do tratamento da dor facial. Pacientes com DA tem alto comprometimento da saúde oral com infecções e perdas dentárias. A investigação da dor orofacial deveria ser realizada em pacientes com DA devido às associações revisadas e à possibilidade de melhora como destacadas por este relato.

Palavras-chaves:
doença de Alzheimer; idoso; demência; disfunção temporomandibular; dor orofacial.

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Full text available only in PDF format.

References

¹
Gomes JCP. Pain in the elderly. In: Teixeira MJ. Manual for the general practitioner. São Paulo: Atheneu; 2006:423-435.
²
Finch CE, Morgan TE. Systemic inflammation, infection, ApoE alleles, and Alzheimer disease: a position paper. Curr Alzheimer Res 2007;4:185-189.
³
Herrera E Jr, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-Dwelling Brazilian population. Alzheimer Disease Assoc Dis 2002;16:103-108.
⁴
Caixeta L. Dementia: Multidisciplinary assessment. São Paulo. Atheneu; 2006.
⁵
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.
⁶
Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12:189-198.
⁷
Pfeffer RI, Kurosaki TT, Harrah CH Jr, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
⁸
IASP: International Association for the study of pain subcommittee on taxonomy: classification of chronic pain, description of chronic pain syndromes and definitions of pain terms. Pain 2006;3:S1-S225.
⁹
Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;50:971-979.
¹⁰
Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115-121.
¹¹
Seminowicz DA, Davis KD. A re-examination of pain-cognition interactions: implications for neuroimaging. Pain 2007; 130:8-13.
¹²
Sessle BJ. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates. Crit Rev Oral Biol Med 2000;11: 57-91.
¹³
Rubin S, Chawla S. Chronic pain in the dental patient. Dent Clin North Am 1999;43:421-433.
¹⁴
Van Oijen M, de Maat MP, Kardys I, et al. Polymorphisms and haplotypes in the C-reactive protein gene and risk of dementia. Neurobiol Aging 2007;28:1361-1366.
¹⁵
Dimopoulos N, Piperi C, Salonicioti A, et al. Indices of low-grade chronic inflammation correlate with early cognitive deterioration in an elderly Greek population. Neurosci Lett 2006;398:118-123.
¹⁶
Griffin WS. Inflammation and neurodegenerative diseases. American J Clin Nut 2006; 83:470S-474S.
¹⁷
Haan MN, Aiello AE, West NA, Jagust WJ. C-reactive protein and rate of dementia in carriers and non carriers of Apolipoprotein APOE4 genotype. Neurobiol Aging 2008;29:1774-1782.
¹⁸
Mrak RE, Griffin WS. Interleukin-1, neuroinflammation, and Alzheimer's disease. Neurobiol Aging 2001;22:903-908.
¹⁹
Rogers J, Lue LF. Microglial chemotaxis, activation, and phagocytosis of amyloid beta-peptide as linked phenomena in Alzheimer's disease. Neurochem Int 2001;39:333-340.
²⁰
Schmidt R, Schmidt H, Curb JD, Masaki K, White LR, Launer LJ. Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study. Ann Neurol 2002;52:168-174.
²¹
Tan ZS, Beiser AS, Vasan RS, et al. Inflammatory markers and the risk of Alzheimer disease: the Framingham Study. Neurology 2007;68:1902-1908.
²²
Lalla E, Kaplan S, Yang J, Roth GA, Papapanou PN, Greenberg S. Effects of periodontal therapy on serum C-reactive protein, sE-selectin, and tumor necrosis factor-alpha secretion by peripheral blood-derived macrophages in diabetes: a pilot study. J Periodont Res 2007;42:274-282.
²³
Nilsson M, Kopp S. Gingivitis and periodontitis are related to repeated high levels of circulating tumor necrosis factor-alpha in patients with rheumatoid arthritis. J Periodontol 2008;79: 1689-1696.
²⁴
Loos BG. Systemic effects of periodontitis. Ann R Aust Coll Dent Surg 2006;18:27-29.
²⁵
Nóbrega JC, Siqueira SR, Siqueira JT, Teixeira MJ. Differential diagnosis in atypical facial pain: a clinical study. Arq Neuropsiquiatr 2007;65 256-261.
²⁶
Awawdeh LA, Lundy FT, Linden GJ, Shaw C, Kennedy JG, Lamey PJ. Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in gingival crevicular fluid associated with painful human teeth. Eur J Oral Sci 2002;110: 185-191.
²⁷
Ide M, Jagdev D, Coward PY, Crook M, Barclay GR, Wilson RF. The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-6. J Periodontol 2004;75:420-428.
²⁸
Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C-reactive protein levels: a systematic review and meta-analysis. J Periodontol 2006;77: 1635-1642.
²⁹
Beck JD, Offenbacher S. Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J Periodontol 2005;76(Suppl):2089-2100.
³⁰
Pussinen PJ, Jousilahti P, Alfthan G, Palosuo T, Asikainen S, Salomaa V. Antibodies to periodontal pathogens are associated with coronary heart disease. Arteriosclerosis Thrombosis Vasc Biol 2003;23:1250-1254.
³¹
Gazelius B, Edwall B, Olgart L, Lundberg JM, Hokfelt T, Fisher JA. Vasodilatory effects and coexistence of calcitonin gene-related peptide (CGRP) and substance P in sensory nerves of cat dental pulp. Acta Physiol Scand 1987;130:33-40.
³²
Linden GJ, McKinnel J Shaw FT. Substance P and neurokinin A in gingival crevicular fluid in periodontal health and disease. J Clin Periodontol 1997;24:799-803.
³³
Lundy FT, Shaw C, McKinell J, Lamey P-J, Linden GJ. Calcitonin gene-related peptide in gingival crevicular fluid in periodontal health and disease. J Clin Periodontol 1999;26:212-216.
³⁴
Blum A, Front E, Peleg A. Periodontal care may improve systemic inflammation. Clin Invest Med 2007;30:E114-117.
³⁵
Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, Winblad B. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontol 2004;21:17-26.
³⁶
Henriksen BM, Engedal K, Axéll T. Cognitive impairment is associated with poor oral health in individuals in long-term care. Oral Health Prevent Dent 2005;3:203-207.
³⁷
Newton JP. Dementia, oral health and the failing dentition. Gerodontol 2007;24:65-66.
³⁸
Stein PS, Desrosiers M, Donegan SJ, Yepes JF, Kryscio RJ. Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc 2007;138:1314-1322.
³⁹
Syrjälä AM, Ylöstalo P, Sulkava R, Knuuttila M. Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland. Acta Odontologica Scand 2007;65:103-108.
⁴⁰
Miura H, Yamasaki K, Kariyasu M, Miura K, Sumi Y. Relationship between cognitive function and mastication in elderly females. J Oral Rehab 2003;30:808-811.
⁴¹
Padilha DM, Hugo FN, Hilgert JB, Dal Moro RG. Hand function and oral hygiene in older institutionalized Brazilians. J Am Ger Soc 2007;55(90):1333-1338.
⁴²
Rogers J. The inflammatory response in Alzheimer's disease. J Periodontol. 2008;79(8 Suppl):1535-1543.
⁴³
Kamer AR, Craig RG, Dasanayake AP, Brys M, Sobanska LG, Leon MJ. Inflammation and Alzheimer's disease: possible role of periodontal diseases. Alz Dementia 2008;4:242-250.
⁴⁴
Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomand Dis 1992;6:301-355.
⁴⁵
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25:284-290.

Publication Dates

Publication in this collection
Apr-Jun 2010

History

Received
19 Feb 2009
Accepted
20 Apr 2010

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Gomes JCP. Pain in the elderly. In: Teixeira MJ. Manual for the general practitioner. São Paulo: Atheneu; 2006:423-435.

[2] ²
Finch CE, Morgan TE. Systemic inflammation, infection, ApoE alleles, and Alzheimer disease: a position paper. Curr Alzheimer Res 2007;4:185-189.

[3] ³
Herrera E Jr, Caramelli P, Silveira ASB, Nitrini R. Epidemiologic survey of dementia in a community-Dwelling Brazilian population. Alzheimer Disease Assoc Dis 2002;16:103-108.

[4] ⁴
Caixeta L. Dementia: Multidisciplinary assessment. São Paulo. Atheneu; 2006.

[5] ⁵
McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology 1984;34:939-944.

[6] ⁶
Folstein MF, Folstein SE, McHugh PR. Mini-mental state: a practical method for grading the cognitive state of patients for the clinician. J Psych Res 1975;12:189-198.

[7] ⁷
Pfeffer RI, Kurosaki TT, Harrah CH Jr, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[8] ⁸
IASP: International Association for the study of pain subcommittee on taxonomy: classification of chronic pain, description of chronic pain syndromes and definitions of pain terms. Pain 2006;3:S1-S225.

[9] ⁹
Melzack R, Wall PD. Pain mechanisms: a new theory. Science 1965;50:971-979.

[10] ¹⁰
Lipton JA, Ship JA, Larach-Robinson D. Estimated prevalence and distribution of reported orofacial pain in the United States. J Am Dent Assoc 1993;124:115-121.

[11] ¹¹
Seminowicz DA, Davis KD. A re-examination of pain-cognition interactions: implications for neuroimaging. Pain 2007; 130:8-13.

[12] ¹²
Sessle BJ. Acute and chronic craniofacial pain: brainstem mechanisms of nociceptive transmission and neuroplasticity, and their clinical correlates. Crit Rev Oral Biol Med 2000;11: 57-91.

[13] ¹³
Rubin S, Chawla S. Chronic pain in the dental patient. Dent Clin North Am 1999;43:421-433.

[14] ¹⁴
Van Oijen M, de Maat MP, Kardys I, et al. Polymorphisms and haplotypes in the C-reactive protein gene and risk of dementia. Neurobiol Aging 2007;28:1361-1366.

[15] ¹⁵
Dimopoulos N, Piperi C, Salonicioti A, et al. Indices of low-grade chronic inflammation correlate with early cognitive deterioration in an elderly Greek population. Neurosci Lett 2006;398:118-123.

[16] ¹⁶
Griffin WS. Inflammation and neurodegenerative diseases. American J Clin Nut 2006; 83:470S-474S.

[17] ¹⁷
Haan MN, Aiello AE, West NA, Jagust WJ. C-reactive protein and rate of dementia in carriers and non carriers of Apolipoprotein APOE4 genotype. Neurobiol Aging 2008;29:1774-1782.

[18] ¹⁸
Mrak RE, Griffin WS. Interleukin-1, neuroinflammation, and Alzheimer's disease. Neurobiol Aging 2001;22:903-908.

[19] ¹⁹
Rogers J, Lue LF. Microglial chemotaxis, activation, and phagocytosis of amyloid beta-peptide as linked phenomena in Alzheimer's disease. Neurochem Int 2001;39:333-340.

[20] ²⁰
Schmidt R, Schmidt H, Curb JD, Masaki K, White LR, Launer LJ. Early inflammation and dementia: a 25-year follow-up of the Honolulu-Asia Aging Study. Ann Neurol 2002;52:168-174.

[21] ²¹
Tan ZS, Beiser AS, Vasan RS, et al. Inflammatory markers and the risk of Alzheimer disease: the Framingham Study. Neurology 2007;68:1902-1908.

[22] ²²
Lalla E, Kaplan S, Yang J, Roth GA, Papapanou PN, Greenberg S. Effects of periodontal therapy on serum C-reactive protein, sE-selectin, and tumor necrosis factor-alpha secretion by peripheral blood-derived macrophages in diabetes: a pilot study. J Periodont Res 2007;42:274-282.

[23] ²³
Nilsson M, Kopp S. Gingivitis and periodontitis are related to repeated high levels of circulating tumor necrosis factor-alpha in patients with rheumatoid arthritis. J Periodontol 2008;79: 1689-1696.

[24] ²⁴
Loos BG. Systemic effects of periodontitis. Ann R Aust Coll Dent Surg 2006;18:27-29.

[25] ²⁵
Nóbrega JC, Siqueira SR, Siqueira JT, Teixeira MJ. Differential diagnosis in atypical facial pain: a clinical study. Arq Neuropsiquiatr 2007;65 256-261.

[26] ²⁶
Awawdeh LA, Lundy FT, Linden GJ, Shaw C, Kennedy JG, Lamey PJ. Quantitative analysis of substance P, neurokinin A and calcitonin gene-related peptide in gingival crevicular fluid associated with painful human teeth. Eur J Oral Sci 2002;110: 185-191.

[27] ²⁷
Ide M, Jagdev D, Coward PY, Crook M, Barclay GR, Wilson RF. The short-term effects of treatment of chronic periodontitis on circulating levels of endotoxin, C-reactive protein, tumor necrosis factor-alpha, and interleukin-6. J Periodontol 2004;75:420-428.

[28] ²⁸
Ioannidou E, Malekzadeh T, Dongari-Bagtzoglou A. Effect of periodontal treatment on serum C-reactive protein levels: a systematic review and meta-analysis. J Periodontol 2006;77: 1635-1642.

[29] ²⁹
Beck JD, Offenbacher S. Systemic effects of periodontitis: epidemiology of periodontal disease and cardiovascular disease. J Periodontol 2005;76(Suppl):2089-2100.

[30] ³⁰
Pussinen PJ, Jousilahti P, Alfthan G, Palosuo T, Asikainen S, Salomaa V. Antibodies to periodontal pathogens are associated with coronary heart disease. Arteriosclerosis Thrombosis Vasc Biol 2003;23:1250-1254.

[31] ³¹
Gazelius B, Edwall B, Olgart L, Lundberg JM, Hokfelt T, Fisher JA. Vasodilatory effects and coexistence of calcitonin gene-related peptide (CGRP) and substance P in sensory nerves of cat dental pulp. Acta Physiol Scand 1987;130:33-40.

[32] ³²
Linden GJ, McKinnel J Shaw FT. Substance P and neurokinin A in gingival crevicular fluid in periodontal health and disease. J Clin Periodontol 1997;24:799-803.

[33] ³³
Lundy FT, Shaw C, McKinell J, Lamey P-J, Linden GJ. Calcitonin gene-related peptide in gingival crevicular fluid in periodontal health and disease. J Clin Periodontol 1999;26:212-216.

[34] ³⁴
Blum A, Front E, Peleg A. Periodontal care may improve systemic inflammation. Clin Invest Med 2007;30:E114-117.

[35] ³⁵
Avlund K, Holm-Pedersen P, Morse DE, Viitanen M, Winblad B. Tooth loss and caries prevalence in very old Swedish people: the relationship to cognitive function and functional ability. Gerodontol 2004;21:17-26.

[36] ³⁶
Henriksen BM, Engedal K, Axéll T. Cognitive impairment is associated with poor oral health in individuals in long-term care. Oral Health Prevent Dent 2005;3:203-207.

[37] ³⁷
Newton JP. Dementia, oral health and the failing dentition. Gerodontol 2007;24:65-66.

[38] ³⁸
Stein PS, Desrosiers M, Donegan SJ, Yepes JF, Kryscio RJ. Tooth loss, dementia and neuropathology in the Nun study. J Am Dent Assoc 2007;138:1314-1322.

[39] ³⁹
Syrjälä AM, Ylöstalo P, Sulkava R, Knuuttila M. Relationship between cognitive impairment and oral health: results of the Health 2000 Health Examination Survey in Finland. Acta Odontologica Scand 2007;65:103-108.

[40] ⁴⁰
Miura H, Yamasaki K, Kariyasu M, Miura K, Sumi Y. Relationship between cognitive function and mastication in elderly females. J Oral Rehab 2003;30:808-811.

[41] ⁴¹
Padilha DM, Hugo FN, Hilgert JB, Dal Moro RG. Hand function and oral hygiene in older institutionalized Brazilians. J Am Ger Soc 2007;55(90):1333-1338.

[42] ⁴²
Rogers J. The inflammatory response in Alzheimer's disease. J Periodontol. 2008;79(8 Suppl):1535-1543.

[43] ⁴³
Kamer AR, Craig RG, Dasanayake AP, Brys M, Sobanska LG, Leon MJ. Inflammation and Alzheimer's disease: possible role of periodontal diseases. Alz Dementia 2008;4:242-250.

[44] ⁴⁴
Dworkin SF, LeResche L. Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomand Dis 1992;6:301-355.

[45] ⁴⁵
Slade GD. Derivation and validation of a short-form oral health impact profile. Community Dent Oral Epidemiol 1997; 25:284-290.

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