Patients' awareness of the association between periodontitis and other diseases: Still a long way to go

Periodontitis is a chronic inflammatory disease of the tooth supporting tissues associated with a dysbiotic oral microbiota. Evidence has shown that periodontitis is associated with an increased risk of development and progression of several other chronic diseases, such as type-2 diabetes, atherosclerotic and cardiometabolic diseases.^1-3 Common immune-inflammatory pathways and the role of periodontal pathogens are the most probable factors explaining the link between periodontitis and other diseases.^{4, 5} While a substantial amount of literature informed the medical community about this link, little is known about the patient's awareness. This study aimed to investigate the level of awareness about the link between periodontitis and other diseases in a weighted data set representative of patients living with chronic conditions in France.

We analyzed data from a self-reported questionnaire on oral and periodontal health sent to all participants from the Community of Patients for Research (ComPaRe), a nationwide cohort of patients with at least one chronic disease (defined as a condition requiring health care for at least 6 months), in France. Participants are regularly followed up using patient-reported outcome and experience measurements. For this cross-sectional analysis, we used a data set obtained by calibration on margins with sex-specific weights for age and educational level derived from National Census data describing the French population reporting at least one chronic condition.⁶ The ComPaRe study was approved by the local authority (IRB No. 0008367).

The online questionnaire included the evaluation of periodontitis risk (French-validated version of the CDC/AAP questionnaire),⁷ and oral health-related quality of life (OHIP-14).⁸ Severe periodontitis was assessed by calculating the Periodontal Screening Score (PESS) on selected questions, age and smoking.⁷ Awareness was evaluated via a specific question asking the patients whether they have been informed, and by whom, about the link between periodontitis and general health. We described the answer to the questionnaire and studied the factors associated with the awareness of the link between periodontitis and other diseases. Statistical analyses were performed using SPSS (version 29·0; SPSS Inc., Chicago, Illinois, USA).

We included 8537 adults in the analysis (response rate: 33%). In the weighted data set, mean age was 56.34 years (SD: 16.99), 59.8% were affected by two or more chronic diseases, 13.5% were current smokers, and 45.6% were former smokers (Table S1). Overall, 56.4% reported to have visited their dentists and 43.3% to have received a scaling within the previous year. Only 2230 (26.1%) patients reported to be aware of a link between periodontitis and other diseases, with the highest level of awareness among patients with cancer (36.1%), obstructive sleep apnea (36.1%) and cardiovascular diseases (32.4%). Information came from dentists (27.7%), physicians (21.3%), advertisements (5.7%) or other sources (45.3%). The prevalence of severe periodontitis (PESS ≥5) was 54.2%, and among them, only 32.3% were aware of the link with general diseases.

Furthermore, among aware patients, 72.4% were also informed that tobacco smoking is a major risk factor for periodontitis, whereas 68% of those not being aware also ignored the link with smoking.

In the regression analysis, several factors were associated with an increased odds of being aware, including patient's age, female, higher education, cardiovascular diseases, cancer, obstructive sleep apnea, inflammatory bowel disease, rheumatoid arthritis, severe periodontitis and recent visit to the dentist. Conversely, being a smoker was associated with significantly lower odds of being aware (Table 1).

This is the first study investigating the level of awareness about the link between periodontitis and other diseases among patients suffering from chronic diseases. These findings demonstrate that approximately 75% of patients, independently from their socio-economic status, periodontal health status, frequency of dental visits and perceived access to care, still ignored the link between periodontitis and other diseases. The level of awareness was low even among patients suffering from periodontitis or from cardiovascular diseases, cancer and diabetes, which have been extensively associated with periodontitis. This study is strengthened by the use of a weighted data set and a large sample of participants that contribute to minimize the risk of selection bias. Yet, it has limitations, such as a potential residual selection bias inherent to the e-cohort design and a low response rate (although similar to other studies using data from e-cohorts). Moreover, data were self-reported, including the assessment of severe periodontitis.

In all, the present findings highlight the urgent need to promote communication and knowledge transfer about the link between periodontitis and other chronic diseases. Interventions to promote awareness should target both healthcare professionals, who play a key role in informing patients regarding the risk factors for their diseases, and the general public, to empower individuals to take proactive steps in managing their periodontal health for the benefits of their oral and general health.

ComPaRe was initially funded by the Université Paris Cité and the Assistance Publique Hôpitaux de Paris. No specific funding was received for the present analyses.

All authors have no conflict of interest to disclose.