Background The association between periodontitis and atherosclerotic cardiovascular diseases (ACVD) has been established in some modestly sized studies (35 years (period 1998–2013). A participant was recorded as having periodontitis based on diagnostic and treatment codes. Any affirmative answer for cerebrovascular accidents, angina pectoris and/or myocardial infarction labelled a participant as having ACVD. Other risk factors for ACVD, notably age, sex, smoking, diabetes, hypertension, hypercholesterolaemia and social economic status, were also extracted. Logistic regression analyses were used to evaluate the adjusted associations between periodontitis and ACVD. Results 60 174 individuals were identified; 4.7% of the periodontitis participants (455/9730) and 1.9% of the non-periodontitis participants (962/50 444) reported ACVD; periodontitis showed a significant association with ACVD (OR 2.52; 95% CI 2.3 to 2.8). After adjustment for the confounders, periodontitis remained independently associated with ACVD (OR 1.59; 95% CI 1.39 to 1.81). With subsequent stratification for age and sex, periodontitis remained independently associated with ACVD. Conclusions This cross-sectional analysis of a large cohort in the Netherlands of 60 174 participants shows the independent association of periodontitis with ACVD.

Tooth loss reflects the endpoint of two major dental diseases: dental caries and periodontitis. These comprise 2% of the global burden of human diseases. A lower number of teeth has been associated with various systemic diseases, in particular, atherosclerotic cardiovascular diseases (ACVD). The aim was to summarize the evidence of tooth loss related to the risk for ACVD or death. Cohort studies with prospective follow-up data were retrieved from Medline-PubMed and EMBASE. Following the PRISMA guidelines, two reviewers independently selected articles, assessed the risk of bias, and extracted data on the number of teeth (tooth loss; exposure) and ACVD-related events and all-cause mortality (ACM) (outcome). A total of 75 articles were included of which 44 were qualified for meta-analysis. A lower number of teeth was related to a higher outcome risk; the pooled risk ratio (RR) for the cumulative incidence of ACVD ranged from 1.69 to 2.93, and for the cumulative incidence of ACM, the RR ranged from 1.76 to 2.27. The pooled multiple adjusted hazard ratio (HR) for the incidence density of ACVD ranged from 1.02 to 1.21, and for the incidence density of ACM, the HR ranged from 1.02 to 1.30. This systematic review and meta-analyses of survival data show that a lower number of teeth is a risk factor for both ACVD and death. Health care professionals should use this information to inform their patients and increase awareness on the importance of good dental health and increase efforts to prevent tooth loss.

Aim: To investigate whether and which diseases co‐occur with periodontitis (PD) to assess the prevalence of comorbidities and multimorbidity and to identify patterns and profiles of comorbidity and multimorbidity and the influence of demographic and lifestyle factors to identify distinct groups of multimorbid patients.Materials and Methods: A database from the Academic Centre of Dentistry Amsterdam (ACTA) with 37,801 adult individuals containing information about demographic (age, sex, socio‐economic position [SEP]) and lifestyle factors (smoking, alcohol use and addictive substance use) and PD and systemic diseases was constructed. PD assessment was based on clinical information by the use of claim codes and systemic diseases data were derived from self‐reported medical history. For analyses, univariable and multivariable (adjusted for age, sex, SEP, smoking, alcohol use and addictive substance use) logistic regression analyses and cluster analysis were used.Results: Individuals with PD more often had one or multiple diseases. The adjusted odds ratio (OR) for PD patients having up to four systemic diseases ranged from 1.46 to 1.20. Co‐occurrence of PD with several systemic diseases and a higher prevalence of multimorbidity was found (adjusted OR comorbidity = 1.36; 95% confidence interval (CI): 1.30–1.43; multimorbidity = 1.18; 95% CI: 1.11–1.25). Four clusters existed: cluster 1 was defined as a periodontal and systemically healthy group and cluster 4 as burdened with PD but not containing any systemic diseases. Individuals in cluster 1 were of the lowest age (44.9 [SD: 15.5]) and had the lowest prevalence of the lifestyle factors of smoking (13.6%) and alcohol use (3.9%). Clusters 2 and 3 contained both PD and had several systemic diseases but were different from each other. Cluster 2 contained 34.5% of PD individuals and had mainly respiratory tract, immune system and digestive system diseases. Cluster 3 contained 45.9% of PD individuals and had mainly cardiometabolic diseases. Cluster 2 had the highest prevalence of females (63.1%) and the highest prevalence of smokers (23.8%) and addictive substance users (8.9%). Cluster 3 included individuals of the highest age (63.5 [SD: 11.9]), and had highest prevalence of alcohol users (17.7%) and lowest prevalence of addictive substance users (3.8%).Conclusions: This study shows that individuals with PD are more often burdened with comorbidity and multimorbidity. Presence of distinct clusters suggests overlap in pathophysiology between certain types of PD and specific systemic diseases. Therefore, PD can be considered as part of multimorbidity, as one of the systemic diseases co‐occurring in certain groups of individuals.

Objectives: Although many studies have reported a higher risk of atherosclerotic cardiovascular diseases (ACVD) in people with periodontitis (PD), this has been tested in a few large‐scale population‐based studies with a longitudinal design. The aim of this study was to investigate whether people with PD status have an increased risk of a nonfatal ACVD event compared to people without PD status.Methods: A cohort of 1.2 million participants from a healthcare insurance claims database was studied longitudinally for a period of 8 years. PD status was derived from PD‐related insurance claims and ACVD status from ACVD‐related insurance claims. Person‐time at risk (PTAR) was calculated from the start of follow‐up (01 January 2007) for participants with and without PD status until ACVD or event‐free censoring (31 December 2014). Time‐dependent Cox proportional hazard models were used to calculate the hazard ratio (HR) and to adjust for shared risk factors (age, sex, socioeconomic position and diabetes mellitus).Results: The prevalence of PD was 20.1%, and the cumulative incidence of nonfatal ACVD events was 7.5%. The univariable and multivariable analyses revealed a limited risk of ACVD for participants with PD status (HR: 1.12; 95% CI 1.10–1.14, HR: 1.06; 95% CI 1.04–1.08, respectively). A subgroup analysis of participants ≤35 and > 35 years of age showed that those ≤35 years of age with PD status had a higher ACVD risk (univariable HR: 1.20; 95% CI 1.05–1.37, multivariable HR: 1.21; 95% CI 1.05–1.39). ACVD risk was not increased in participants >35 years of age with PD status (univariable HR: 0.92; 95% CI 0.91–0.94, multivariable HR: 0.96; 95% CI 0.94–0.98).Conclusions: This study based on a healthcare insurance cohort shows that PD can hardly be regarded as a risk factor for nonfatal ACVD. The increased risk is of minor size, and therefore, the proposed role of PD in the development of ACVD events should be reconsidered. Possibly PD plays a role as a risk factor in younger people due to overlapping genetic risk factors of ACVD and a more aggressive course of PD.

Objectives: Periodontitis (PD) patients frequently suffer from comorbidities, necessitating increased attention to disease management and monitoring. The aim of this study is to describe the prevalence and patterns of comorbidities among patients with PD in a private periodontal referral practice. Methods: This study involved 3171 adults with PD. Data on demographics, lifestyle, number of teeth, pockets of size ≥ 6 mm, bleeding on probing, periodontal inflammatory surface area, and comorbidities were extracted from electronic patient records. Descriptive and statistical analyses, including t-tests, chi-square tests, cluster analysis, binomial logistic regression analysis, and hypergraph network analysis, were performed. Results: Among this PD population, 47% had a comorbidity, and 20% had multimorbidity (≥2 diseases). Based on the disease patterns, two distinct clusters emerged: Cluster 1 was dominated by respiratory tract conditions (asthma, lung disease, and allergic rhinitis), allergies, and hypothyroidism, while Cluster 2 primarily included cardiometabolic diseases (angina pectoris, hypertension, diabetes mellitus (DM), and hyperthyroidism). The hypergraph network analysis for those with multimorbidity identified two main groups: (i) pulmonary conditions (lung disease, asthma, allergic rhinitis, and allergies) and (ii) cardiometabolic disorders (hypertension, myocardial infarction, cerebrovascular disease, and DM). Hypertension, allergies, and allergic rhinitis showed high centrality, serving as central nodes frequently co-occurring with other diseases. Conclusions: Nearly half of the PD patients in a private periodontal referral practice were found to have comorbidities, primarily clustering into cardiometabolic and respiratory tract diseases. These findings, based on real-world data, should encourage dental professionals to integrate systemic conditions into their care strategies. They could also guide policymakers and practitioners in developing evidence-based approaches to mitigate the reciprocal negative effects of PD and comorbidities.

Treatment of periodontitis plays an important role in preventing tooth loss. Over the years, various treatment modalities have been proposed, researched and applied in the dental practice. The non-surgical periodontal therapy of cleaning the root surfaces is still the golden standard in treatment of periodontitis. If pockets of ≥ 6 mm remain after the non-surgical therapy, surgical periodontal therapy could be considered. People with periodontal disease should agree with lifelong periodontal therapy, because after the 'active' (non-surgical and surgical) periodontal therapy, lifelong periodontal maintenance is the most important thing to guarantee periodontal health and stability. The ultimate goal of periodontal therapy is preservation of the natural dentition. Many studies have shown that this goal can be achieved, providing the following circumstances are met: a good oral hygiene and high patient motivation, optimal periodontal treatment, and smoking cessation.