Association between chronic diseases and severe periodontal disease progression: A retrospective cohort study in a city of Japan

Background: Chronic periodontal disease primarily causes tooth loss and oral frailty and is linked to chronic conditions such as diabetes mellitus. However, its progression and broader studies on chronic diseases have not been well explored. This study aimed to investigate this association using claims data.

Methods: This retrospective cohort study used linked medical, dental, and pharmacy claims data from a local municipality in Japan. The study included participants aged 40-70 years who had received medical care between April 2017 and March 2018. Exposures included age, sex, and common chronic diseases previously reported to be associated with periodontal diseases (21 diseases). We defined the outcome, "progression of severe periodontitis" as the worsening of periodontal disease to a severe stage requiring surgery or tooth extraction, determined by the presence of a periodontal surgery code or a deeper probing pocket depth (≥6 mm) code along with the tooth extraction procedure code. The participants were followed up until March 2022, and multivariate analysis was conducted using Cox proportional hazard models.

Results: Among 28,846 participants, 1035 (3.6%) progressed to severe periodontal disease. In the multivariate analysis, only diabetes mellitus was significantly associated with severe periodontal disease, with a hazard ratio of 1.26 (95% confidence interval, 1.08-1.53) among all chronic diseases.

Conclusion: Patients with diabetes mellitus had a high risk of severe periodontal disease progression, suggesting that proactive dental visits should be recommended to prevent severe periodontal disease.