Abstract
BACKGROUND: To examine whether the associations between periodontitis and multiple systemic conditions increase with increasing severity of periodontitis using a multi-center electronic health record (EHR) repository. METHODS: A cross-sectional analysis was conducted using EHR data from 9 dental schools in the United States. We included 264,913 adults (≥18 years) receiving periodontal therapy between 2013 and 2023. Periodontitis severity (no, mild/moderate, severe) was determined, and out of 98 systemic and behavioural conditions, associations with 24 conditions were evaluated using weighted uni- and multi-variate multinomial logistic regressions (with no periodontitis as reference) by 2 adjusted models accounting for age, sex, smoking, and diabetes. Model fit and assumptions were checked using Akaike information criterion (AIC), likelihood ratio test (LRT), false discovery rate (FDR) -adjusted p-values, and variance inflation factor (VIF) < 10. The manuscript was prepared following the Oral Health Statistical reporting guidelines (OHStat) and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. RESULTS: Among 264,913 adult patients, 166,207 had no periodontitis, and 98,706 had periodontitis. In fully adjusted models of 24 selected systemic comorbidities, the odds ratios (ORs) for severe periodontitis consistently exceeded those for mild/moderate periodontitis. For instance, smoking showed ORs of 1.78 (mild/moderate) versus 5.21 (severe), diabetes (2.20 vs. 5.59), cardiovascular disease (1.53 vs. 2.21), human immunodeficiency virus (HIV) (2.25 vs. 4.07), and Alzheimer's disease (1.84 vs. 3.20). Inverse correlations also strengthened with severity where asthma was 0.80 versus 0.72 in severe compared to mild/moderate periodontitis. CONCLUSIONS: The results of this population-based study demonstrate that as periodontitis severity escalates, positive and negative associations with systemic conditions become more pronounced. PLAIN LANGUAGE SUMMARY: This study examined how various chronic health conditions may increase the likelihood of developing more severe gum disease, also known as periodontitis. Using electronic health record data from over 260,000 adults treated at 9 U.S. dental schools, we investigated whether people with systemic diseases-like diabetes, cardiovascular disease, or human immunodeficiency virus (HIV)-were more likely to have mild or severe periodontitis. The results showed that several conditions significantly increased the odds of having more severe gum disease. For instance, individuals with diabetes or cardiovascular problems had more than double the risk of severe periodontitis, while those with HIV or dementia showed even stronger associations. Some conditions, such as asthma or anorexia, were linked to lower odds of gum disease, suggesting that these relationships may be complex and deserve further study. Although this study cannot determine cause and effect, it highlights a pattern: people with chronic diseases are more likely to have more severe gum problems. This emphasizes the need for medical and dental care providers to work together when managing patients with chronic health issues, and it reinforces the importance of oral health as a part of overall well-being.