Dose-dependent association of systemic comorbidities with periodontitis severity: A large population cross-sectional study

Journal of Periodontology

Muhammad H. A. Saleh, Hamoun Sabri 

This large cross-sectional study analyzed electronic health records from 264,913 adults seen at 9 US dental schools to investigate whether associations between periodontitis and 24 systemic conditions strengthen as periodontitis severity increases. Using weighted multinomial regression models with progressive adjustments (age, sex, smoking, and diabetes), higher odds ratios (ORs) were observed for severe periodontitis compared with mild/moderate periodontitis across various comorbidities, highlighting diabetes, cardiovascular disease, HIV, and Alzheimer’s disease. Additionally, some conditions showed negative associations with periodontitis after full adjustment, such as asthma and anorexia. The results suggest that periodontitis severity is more strongly associated with a broader set of systemic conditions, underscoring the need for closer collaboration between medical and dental care.

Key Points

• Reinforces the idea that greater periodontitis severity associates with higher odds of multiple systemic comorbidities.
• Diabetes, cardiovascular disease, and HIV showed consistent increases in ORs as periodontitis progressed from mild/moderate to severe.
• Alzheimer’s/Dementia maintained strong associations, especially with severe periodontitis.
• Hypothyroidism and asthma exhibited complex patterns, with hypothyroidism showing a negative association after full adjustment.
• Caution that, despite the large sample, results may reflect small effect sizes reaching significance; interpreting effects should consider effect size.
• Biological hypothesis: shared systemic inflammation and immune response may explain links with non-communicable diseases and multimorbidity.
• Limitations include the cross-sectional design, use of treatment codes as proxies for severity, and potential selection bias from patients seeking dental care.