Periodontal Disease Study - Asia Pacific Hospitals

Executive Summary

This large-scale study of 11 million patients reveals significant associations between periodontal disease and multiple systemic conditions, with evidence of increasing risk over time.

Key Findings

Cardiovascular Impact: Heart failure risk increases from 2.5% at 1-year to 3.7% at 5-years (RR: 1.50)
Neurological Connection: Cognitive/dementia risk increases by 47% from 1-year to 5-year follow-up
Metabolic Outcomes: NAFLD risk more than doubles from 1-year to 5-year follow-up (RR: 2.09)
Age Effects: Adults 65+ show particularly elevated risks for cardiovascular and neurological outcomes
Gender Differences: Males show higher absolute risks for most outcomes, but females show greater relative risk increases over time

Clinical Implications

Periodontal patients require increased surveillance for cardiovascular disease, especially heart failure
Cognitive screening may be warranted in older adults with periodontal disease
Males 65+ with periodontal disease represent a particularly high-risk group for multiple comorbidities
Preventive interventions may be most effective when implemented early, as risks progressively increase over time
An integrated care approach between dental and medical providers could improve long-term outcomes

Study Overview

This research represents one of the largest analyses of periodontal disease outcomes, examining data from approximately 11 million patients across Asia Pacific Hospitals via the TrinetX platform.

We tracked patients with periodontal disease over both 1-year and 5-year periods to assess the relationship between periodontal health and various systemic conditions.

Key findings include:

Significant differences in risk patterns between different age and gender groups
Progressive increase in risks for multiple conditions from 1-year to 5-year follow-up
Strong associations between periodontal disease and cardiovascular outcomes
Notable connections to neurological conditions including cognitive decline
Associations with metabolic disorders such as obesity and NAFLD

Study Design & Methodology

Patient Selection Criteria

We defined our periodontal population as patients with ICD-10 code K05 (Periodontal diseases) who had no record of the following conditions for 2 years prior to their first K05 visit:

K05.0: Acute gingivitis
K05.2: Aggressive periodontitis
K08: Other disorders of teeth and supporting structures
K04: Diseases of pulp and periapical tissues
K12: Stomatitis and related lesions

Population Stratification

We stratified the periodontal patient population into 9 distinct demographic groups:

Category	Age ≤35	Age 36-64	Age 65+
Overall	All patients
Male	Male ≤35	Male 36-64	Male 65+
Female	Female ≤35	Female 36-64	Female 65+

Statistical Methodology

Competing Risk Analysis: We employed Aalen-Johansen estimator to calculate the cumulative incidence functions for various outcomes, accounting for competing risks.

Follow-up Periods: We analyzed outcomes at two distinct timepoints:

1-year follow-up after index date (first K05 diagnosis)
5-year follow-up after index date

Risk Ratio Calculation: We calculated risk ratios by comparing the 5-year cumulative incidence to the 1-year cumulative incidence for each outcome and population group, providing insight into how risks evolve over time.