A relationship between poor oral health conditions and cognitive decline has been clinically observed. A bidirectional association between periodontitis and Alzheimer's disease has been repeatedly identified in clinical and pre-clinical studies. This association is supported by four major overlapped pathways and mechanisms, including the microbiota-gut-brain axis via the vagus nerve pathway, periodontopathogen-involved neuroinflammation via the trigeminal nerve pathway, proinflammatory cytokines, and trained immunity. Partly linked with periodontitis, increased levels of proinflammatory cytokines and decreased levels of anti-inflammatory cytokines can exacerbate the abnormal accumulation of amyloid beta plaques and hyperphosphorylation of tau protein. Periodontitis is considered an important environmental factor involved in Alzheimer's disease development. This review discusses the bidirectional relationship between Alzheimer's disease and periodontitis, focusing on the association between cognitive decline and poor oral health conditions. Thus, oral health intervention strategies have been proposed as potential therapeutic methods for the prevention and management of Alzheimer's disease. [ Psychiatr Ann . 2024;54(8):e230–e234.]
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