Association between self-reported poor oral health and subjective cognitive decline: a cross-sectional analysis of US survey data

Subjective cognitive decline (SCD) may represent an early stage of cognitive impairment. Although poor oral health has been linked to systemic inflammation and dementia, its association with SCD remains unexplored. This study investigated the relationship between poor oral health, delayed dental care, and SCD in a nationally representative sample of U.S. adults. We analyzed data from 94,812 adults aged ≥ 45 years using the 2020–2022 Behavioral Risk Factor Surveillance System (BRFSS). Poor oral health was defined as loss of ≥ 6 teeth; delayed dental care was defined as no dental visit within the past year. Multivariable logistic regression models assessed the associations between oral health measures and SCD, adjusting for demographic, socioeconomic, behavioral, and clinical covariates. Effect modification by age, sex and cardiovascular disease (CVD) was evaluated. Poor oral health was associated with 14% higher odds of SCD (adjusted OR: 1.14; 95% CI: 1.01–1.28), with stronger effects in individuals without CVD (OR: 1.19; 95% CI: 1.02–1.38; p for interaction = 0.017). Delayed dental care was not significantly associated with SCD after full adjustment, but similarly showed an association in individuals without CVD (OR: 1.19; 95% CI: 1.02–1.38; p for interaction = 0.007). Poor oral health was also associated with greater odds of functional limitations related to SCD, including giving up household activities (adjusted OR: 1.34; 95% CI: 1.06–1.70). Poor oral health was independently associated with SCD and related functional decline, particularly in individuals without CVD. These findings highlight the potential value of oral health maintenance as a modifiable strategy for early cognitive health promotion. Longitudinal studies are needed to clarify the directionality of this relationship and inform preventive intervention.