Impact of periodontitis on mortality

Background + Aims

• Periodontitis affects up to 45% of adults in the United States (US) and has been significantly associated with various systemic health conditions such as diabetes and cardiovascular disease. Current research suggests that periodontal disease may not only impact oral health but also influence overall mortality. Periodontitis is a chronic inflammatory disease resulting from bacterial dysbiosis, and chronic inflammation has been further implicated in the pathogenesis of several non-communicable diseases that contribute to mortality. Despite growing evidence of these links, there is limited large-scale, long-term data on how periodontal diseases specifically affect mortality rates and causes of death. Understanding this link will allow for a more patient-specific and holistic approach to the management of periodontitis and improving life expectancy.
• This study aims to examine all-cause and cause-specific mortality in a diverse US adult population over an extended follow-up period. The study seeks to clarify whether individuals with periodontal diseases are at an increased risk of death from all causes or specific causes (such as cardiovascular diseases, diabetes, cancer, or respiratory illnesses) compared to those without these conditions.

Materials + Methods

• This study adopted a longitudinal cohort design (the researchers followed a large group of US adults over time (1999-2014)) to assess how periodontal diseases affected their mortality outcomes.
• The study population included adults from the US who were part of a large, nationally representative health survey. Participants were selected based on specific inclusion criteria, such as age, baseline health status, and availability of periodontal and mortality data.
• Periodontal health was assessed using clinical dental examinations. The researchers classified participants into different categories based on the severity of their periodontal disease (e.g., no disease, mild, moderate, severe periodontitis) using standardised diagnostic criteria.
• The study collected comprehensive data on participants, including demographic information, lifestyle factors (such as smoking, diet, and physical activity), medical history, and other relevant health behaviours. Mortality data, including all-cause and cause-specific deaths, were obtained from national death registries and linked to the participants.
• Analyses of the data included Cox proportional hazards models to estimate the hazard ratios (HRs) for all-cause and cause-specific mortality associated with different levels of periodontal disease, adjusting for potential confounders such as age, sex, socioeconomic status, and other health-related factors.

Results

• The study found that individuals with periodontal diseases had a significantly higher (22%) risk of all-cause mortality compared to those without periodontal disease. The risk was progressively higher with increasing severity of periodontal disease, with a 4% increased risk in participants with mild/moderate periodontal disease and approximately 40% for severe periodontal disease.
• The study revealed a strong association between periodontal disease and cardiovascular-related mortality. The risk of mortality by cardiovascular disease was about 20% higher in participants with periodontal disease. Individuals with severe periodontitis had a notably higher risk of death from cardiovascular diseases compared to participants with mild/moderate periodontal disease.
• Participants with periodontal disease had a significantly increased risk of diabetes-related mortality, with individuals with severe periodontal disease having a 59% increased risk.
• Participants with severe periodontitis showed a 28% increased risk of malignancy-related mortality.
• The results indicated that periodontal disease was linked to a higher risk of death from influenza and pneumonia and lower respiratory disease. Participants with severe periodontitis had a 62% increase in mortality by lower respiratory diseases.
• The risk of mortality with Alzheimer’s disease and renal disease was not associated with periodontal disease.
• The study’s findings remained robust even after adjusting for various potential confounders, including age, sex, smoking status, socioeconomic status, and other health behaviours. This suggests that the observed associations were not merely due to these other factors but were related to the presence and severity of periodontal disease. The associations between periodontal disease and mortality were consistent across different demographic subgroups, although the strength of the association varied slightly depending on factors like age and smoking status.

Limitations