Periodontitis severity and its social and clinical determinants: An ACES framework‐based NHANES analysis

Gum disease is common and tied to overall health. People with less income and consequently fewer resources for preventative care may face a higher risk for disease. We analyzed three cycles of the US National Health and Nutrition Examination Survey (2009-2014). Adults aged ≥30 years with complete dental examinations (n = 10,598) were classified using the 2018 staging/grading system that defines disease severity (stage) and the risk for progression (grade). Socioeconomic status was measured by the poverty-income ratio (PIR). We examined links between PIR and disease stage, grade, and whether the disease was localized or generalized, and considered smoking, blood sugar (HbA1c), and body mass index (BMI). Our results demonstrated that a higher PIR (more resources) was consistently linked to less severe and less widespread disease. Current smoking showed strong, stepwise increases in severity and spread; former smoking was not linked to spread. A higher HbA1c was tied to more severe stages and grades, but not to spread. The BMI showed only small, inconsistent effects. Overall, lower income, smoking, and poor blood-sugar control tracked with worse periodontal status.