Systemic Inflammation And The Relationship Between Periodontitis, Edentulism, And All-Cause Mortality: A 17-Year Prospective Cohort Study

Aim The aim was to investigate the role of systemic inflammation in the relationship between periodontitis, edentulism, and all-cause mortality in a group of men in Northern Ireland aged 58-72 years. Materials and methods A representative sample of 1558 men had a detailed dental examination between 2001 and 2003. The primary end point was death from any cause. Cox's proportional hazards model was used to assess the longitudinal relationship between periodontitis, edentulism, and all-cause mortality. Accelerated failure time modelling was performed to investigate the mediating role of systemic inflammation. Results Mean age of the men at baseline was 64.3 (standard deviation 2.9) years. During a median follow-up of 17 years, 500 (32.1%) men died. After adjustment for confounding variables, compared to men with no/mild periodontitis, edentulous men had a hazard ratio for all-cause mortality of 1.52 (95% confidence interval [CI] 1.16-1.99) p < .01 and for those with severe periodontitis, it was 1.34 (95% CI 1.06-1.70) p = .01. Systemic inflammation accounted only for a minor mediating pathway effect of 10%. Conclusions There was evidence in this group of men that those who were edentulous or had severe periodontitis had a significantly increased risk of all-cause mortality. Systemic inflammation was not a major explanatory mediator of this association.