Effects of Dental Extraction on Cognitive Functions in the Elderly

  • Sara Samur Ergüven DDS, PhD,
  • Ayşe Hande Arpacı MD, Assistant Professor, Anesthesiology and Reanimation Specialist,
  • Mustafa Arslan MD, Associate Professor Doctor, Anesthesiology and Reanimation Specialist
  • Berrin Işık MD, Professor Doctor, Anesthesiology and Reanimation Specialist,


Objective: Dental extraction can be a cause of short-term cognitive decline in elderly patients. In this research, we aimed to evaluate cognitive functions using the Mini-Mental State Examination before and after tooth extraction in elderly patients who have undergone dental extraction with local anesthesia. Methods: A group of 40 randomly selected patients >65 years old who underwent dental extraction were included. Mini-Mental State Examinations were performed before and after dental extraction. Results: The patients’ total Mini-Mental State Examination scores after dental extraction were statistically significantly lower than the patients’ scores before extraction (p < 0.0001). Conclusion: The results of this study suggest that tooth extraction can be a cause of short-term cognitive decline in elderly patients. However, the possibility that loss of teeth is another contributing factor to long-term cognitive decline should be evaluated in further comprehensive clinical studies.

Author Biographies

Sara Samur Ergüven, DDS, PhD,
Oral and Maxillofacial Surgery Specialist, 75th Yıl Oral and Dental Health Hospital, Oral Surgery Clinic, Ankara, Turkey
Ayşe Hande Arpacı, MD, Assistant Professor, Anesthesiology and Reanimation Specialist,
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University, Ankara, Turkey
Mustafa Arslan, MD, Associate Professor Doctor, Anesthesiology and Reanimation Specialist
Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara, Turkey
Berrin Işık, MD, Professor Doctor, Anesthesiology and Reanimation Specialist,
Department of Anesthesiology and Reanimation, Faculty of Medicine, Gazi University, Ankara, Turkey


Beydoun MA, Beydoun HA, Gamaldo AA, Teel A, Zonderman AB, Wang Y. Epidemiologic studies of modifiable factors associated with cognition and dementia: systematic review and meta-analysis. BMC Public Health 2014; 14:643. (PMID: 24962204)

Crawford TJ, Smith ES, Berry DM. Eye Gaze and Aging: Selective and Combined Effects of Working Memory and Inhibitory Control. Front Hum Neurosci. 2017; 11:563. (PMID:29230169)

Alley DE, Crimmins EM, Karlamangla A, Hu P, Seeman TE. Inflammation and rate of cognitive change in high-functioning older adults. J Gerontol A Biol Sci Med Sci 2008; 63(1):50-5. (PMID:18245760)

Bachkati KH, Mortensen EL, Brønnum-Hansen H, Holm-Pedersen P. Midlife cognitive ability, education, and tooth loss in older Danes. J Am Geriatr Soc 2017; 65(1): 194-9. (PMID:28111753)

Okamoto N, Morikawa M, Okamoto K, Habu N, Iwamoto J, Tomioka K, et al. Relationship of tooth loss to mild memory impairment and cognitive impairment: Findings from the Fujiwara-kyo study. Behav Brain Funct 2010; 6:77. (PMID:21194415)

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 Odontol Scand 2007; 65(2):103-8. (PMID:17453428)

Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98. (PMID:1202204)

Stein J, Luppa M, Maier W, Wagner M, Wolfsgruber S, Scherer M, et al. Assessing cognitive changes in the elderly: reliable change indices for the Mini-Mental State Examination. Acta Psychiatr Scand 2012; 126(3):208-18. (PMID:22375927)

Hansel A, Angermeyer MC, Riedel-Heller SG. Measuring cognitive change in older adults: reliable change indices for the Mini‐Mental State Examination. J Neurol Neurosurg Psychiatry 2007; 78(12):1298-303. (PMID:17442763)

Valentijn SA, van Boxtel MP, van Hooren SA, Bosma H, Beckers HJ, Ponds RW, et al. Change in sensory functioning predicts change in cognitive functioning: results from a 6-year follow-up in the maastricht aging study. J Am Geriatr Soc 2005; 53(3):374-80. (PMID:15743277)

Stephan BCM, Harrison SL, Keage HAD, Babateen A, Robinson L, Siervo M. Cardiovascular disease, the nitric oxide pathway and risk of cognitive impairment and dementia. Curr Cardiol Rep 2017; 19(9):87. (PMID:28801790)

Snyder HM, Corriveau RA, Craft S, Faber JE, Greenberg SM, Knopman D, et al. Vascular contributions to cognitive impairment and dementia including Alzheimer's disease. Alzheimers Dement 2015; 11(6):710-7. (PMID:25510382)

Lexomboon D, Trulsson M, Wårdh I, Parker MG. Chewing ability and tooth loss: association with cognitive impairment in an elderly population study. J Am Geriatr Soc 2012; 60(10):1951-6. (PMID:23035667)

Luo J, Wu B, Zhao Q, Guo Q, Meng H, Yu L, et al. Association between tooth loss and cognitive function among 3063 Chinese older adults: a community-based study. PLoS One 2015; 10(3): e0120986. (PMID:25803052)

Li J, Xu H, Pan W, Wu B. Association between tooth loss and cognitive decline: A 13-year longitudinal study of Chinese older adults. PLoS One 2017; 12(2):e0171404. (PMID:28158261)

Momose T, Nishikawa J, Watanabe T, Sasaki Y, Senda M, Kubota K, et al. Effect of mastication on regional cerebral blood flow in humans examined by positron-emission tomography with ¹⁵O-labelled water and magnetic resonance imaging. Arch Oral Biol 1997; 42(1):57-61. (PMID:9134116)

Onozuka M, Fujita M, Watanabe K, Hirano Y, Niwa M, Nishiyama K, et al. Age-related changes in brain regional activity during chewing: a functional magnetic resonance imaging study. J Dent Res 2003; 82(8):657-60. (PMID:12885854)

Sesay M, Tanaka A, Ueno Y, Lecaroz P, De Beaufort DG. Assessment of regional cerebral blood flow by xenon-enhanced computed tomography during mastication in humans. Keio J Med 2000; 49(1): A125-8. (PMID:10750361)

Peres MA, Bastos JL, Watt RG, Xavier AJ, Barbato PR, D'Orsi E. Tooth loss is associated with severe cognitive impairment among older people: findings from a population-based study in Brazil. Aging Ment Health 2015; 19(10):876-84. (PMID:25407512)

Avivi-Arber L, Seltzer Z, Friedel M, Lerch JP, Moayedi M, Davis KD, et al. Widespread volumetric brain changes following tooth loss in female mice. Front Neuroanat 2017; 10:121. (PMID:28119577)

Avivi-Arber L, Lee JC, Sood M, Lakschevitz F, Fung M, Barashi-Gozal M, et al. Long-term neuroplasticity of the face primary motor cortex and adjacent somatosensory cortex induced by tooth loss can be reversed following dental implant replacement in rats. J Comp Neurol 2015; 523(16):2372-89. (PMID:25921658)

Chen H, Iinuma M, Onozuka M, Kubo KY. Chewing maintains hippocampus-dependent cognitive function. Int J Med Sci 2015; 12(6):502-9. (PMID:26078711)

Sood M, Lee JC, Avivi-Arber L, Bhatt P, Sessle BJ. Neuroplastic changes in the sensorimotor cortex associated with orthodontic tooth movement in rats. J Comp Neurol 2015; 523(10): 1548-68. (PMID:25630427)

Yildiz S, Bademkiran F, Yildiz N, Aydogdu I, Uludag B, Ertekin C. Facial motor cortex plasticity in patients with unilateral peripheral facial paralysis. Neurorehabilitation 2007; 22(2):133-40. (PMID:17656839)

Onozuka M, Watanabe K, Nagasaki S, Jiang Y, Ozono S, Nishiyama K, et al. Impairment of spatial memory and changes in astroglial responsiveness following loss of molar teeth in aged SAMP8 mice. Behav Brain Res 2000; 108(2):145-55. (PMID:10701658)

Original Research