Multimorbid disease trajectories for people with periodontitis

Aim Periodontitis is a multifactorial condition linked to increased risk of systemic diseases. This study aimed to identify disease trajectories of people with periodontitis using the process mining technique as a heuristic approach. Material and methods A total of 188,863 participants from the UK Biobank cohort were included. Self-reported oral health indicators (bleeding gums, painful gums, loose teeth) were surrogates for periodontitis at baseline. Systemic disease diagnoses and dates formed the process mining event log. Relative risk (RR) of systemic diseases, disease trajectories and Cox proportional hazard ratio (HR) models for mortality were compared to age and sex-matched controls who did not report history of periodontitis. Results Participants with loose teeth had shorter median time to most systemic diseases and crude RR were increased for several diseases including cardiovascular disease (crude RR: 1.15, 95% CI: 1.03-1.28), hypertension (crude RR: 1.14, 95% CI: 1.05-1.24) and depression (crude RR: 1.33, 95% CI: 1.09-1.61). Participants with loose teeth had increased RR for 20 disease trajectories, though these were not significant after adjustments. Participants with bleeding/painful gums had similar disease trajectories compared to matched controls. Conclusions Self-reported periodontitis may be associated with early and frequent multimorbidity development, though further evidence is required to confirm this hypothesis. People with periodontitis should be informed of the risks of disease progression and be targeted in prevention initiatives.