EFFECT OF PERIODONTAL TREATMENT ON ALZHEIMER DISEASE-ASSOCIATED OUTCOMES

Summary

Periodontitis is the most prevalent chronic infectious inflammatory disease in adults, leading to the destruction of tooth-supporting tissues. Beyond its local impact, periodontitis contributes to systemic inflammation through the release of periodontal pathogens and their byproducts into the bloodstream. Given that chronic intracerebral inflammation is a known driver of Alzheimer's disease (AD) progression, a biological link between the two conditions has been hypothesized. This study aims to evaluate whether periodontal treatment can influence AD progression by reducing systemic inflammation. We have designed a randomized controlled clinical trial including 70 patients diagnosed with both AD and stage 3 or 4 periodontitis, randomly allocated to receive either immediate (test group) or delayed (control group) periodontal therapy. All participants will undergo comprehensive periodontal treatment and be followed over a 24-month period. Cognitive assessments, periodontal evaluations, blood and saliva biomarker analyses, and neuroimaging will be conducted at multiple time points to assess the potential impact of periodontal therapy on AD progression. This trial represents the first clinical investigation into the effect of periodontal treatment on the course of Alzheimer's disease.

Interventions

• INITIAL PERIODONTAL THERAPY · PROCEDURE

  The intervention will be an initial periodontal therapy (step 1 and 2). Instrumentation will be performed by two calibrated periodontists (Y.A. \& L.S) using an ultrasonic piezoelectric device with specific micro-inserts (Newtron P5 XS Bled, Acteon, Satelec, France). Local subgingival disinfection will be performed using hydrogen peroxide and povidone iodine 1%. The patients will be trained to maintain good personal oral hygiene, including interdental hygiene (floss, brushes) and water for chemical plaque control containing 0.2% chlorhexidine, 3 - 4 weeks twice a day. This initial periodontal therapy will be carried out at different time points depending on the group (test group and control group).The initial periodontal therapy also include extractions of hopeless teeth. A clinical reevaluation will be conducted three months after completion of the initial periodontal therapy in the test group, and twelve months after baseline in the control group.

Published eligibility criteria

Verbatim from the registry. Only the site can decide how these apply to a specific patient.

Inclusion Criteria:

1. Have to suffer from AD
2. Must agree to have brain imaging (without contra-indication for MRI)
3. Possess a minimum of 10 residual teeth
4. Have an MMSE score greater than 15
5. Exhibit a DPSI score of ≥ 3+ indicating advanced periodontal disease

Exclusion Criteria:

1. Participation in another clinical trial (30 days)
2. Contra-indication for MRI
3. Use of antibiotics in the past 3 months
4. Immunosuppressive drugs or chemotherapy

Sites (1)

• CHU de Liège, Université de Liège Domaine du Sart Tilman, Liège, Belgium