Abstract
Background: Chronic periodontitis (CP) and metabolic dysfunction-associated steatotic liver disease (MASLD) have emerged as interconnected conditions with shared mechanisms, such as systemic inflammation and metabolic dysregulation. However, the risk of CP in the newly classified subgroups of steatotic liver disease (SLD), including MASLD and metabolic alcohol-associated liver disease (MetALD), has not been extensively studied. This study investigated the association between SLD subtypes and the incidence of CP in a nationwide cohort. Methods: This retrospective cohort study used data from the Korean National Health Insurance Service database. The study included 115,619 participants aged 40 and older who underwent health screenings between 2009 and 2010. The participants were classified into four groups: normal without risk factors, normal with risk factors, MASLD, and MetALD. The primary outcome was the incidence of CP as defined by ICD-10 codes and dental treatment records. Hazard ratios (HRs) were calculated using the Cox proportional hazards model and adjusted for demographic, clinical, and lifestyle factors. Results: Over a mean follow-up of 7.4 years, individuals with MASLD and MetALD had significantly higher risks of developing CP compared with the normal group without risk factors (MASLD: adjusted HR 1.14, 95% confidence interval (CI): 1.11-1.17; MetALD: adjusted HR 1.21, 95% CI: 1.15-1.27). The risk was more pronounced for severe CP, particularly for those with MetALD (adjusted HR 1.29, 95% CI: 1.22-1.36). Subgroup and sensitivity analyses confirmed these findings across the various definitions of hepatic steatosis and metabolic risk factors. Conclusions: This study reveals that individuals with MASLD and MetALD are at an elevated risk of developing CP, highlighting the need for integrated care strategies that address both periodontal health and metabolic liver conditions. These findings underscore the importance of periodontal health management in reducing the risk of CP among SLD populations.