Cerebral Small Vessel Disease as a Novel Risk Indicator for Periodontitis Progression

BACKGROUND: To assess whether cerebral small vessel disease (CSVD) is a risk indicator for accelerated periodontitis progression. MATERIALS AND METHODS: In this prospective cohort study, longitudinal data from 458 participants in the Taizhou Imaging Study (TIS) were analysed. CSVD was defined by the presence of lacunes (LAC), white matter hyperintensities (WMH), and cerebral microbleeds (CMB) on brain magnetic resonance imaging (MRI). Periodontitis progression was reflected by increases in mean probing depth (ΔmeanPD) and clinical attachment loss (ΔmeanCAL), number of teeth lost (ΔTL) and teeth with interproximal attachment loss progression exceeding 3 mm (Tooth_CAL3). Univariable and multivariable analyses evaluated the associations between CSVD markers and periodontitis progression. Two sensitivity analyses were also conducted, one was a model that excluded the variable toothbrushing frequency after multiple imputation, and the other was a conventional model that incorporated variables such as sociodemographic, behavioural, and general health risk indicators. RESULTS: Multivariable analysis showed CSVD was positively associated with ΔmeanPD (P < .01) and ΔmeanCAL (P < .01); WMH was positively associated with ΔmeanPD (P = .01), ΔmeanCAL (P < .01), and Tooth_CAL3 (P < .01); CMB was positively associated with ΔmeanCAL (P = .03). Sensitivity analyses confirmed the robustness of the results. CONCLUSIONS: CSVD may serve as a risk indicator for an accelerated progression of periodontitis in older adults. The specific CSVD markers of WMH and CMB show significant associations with worsening clinical periodontal parameters. CLINICAL SIGNIFICANCE: This study emphasises the critical importance of integrating regular periodontal surveillance and preventive care into the clinical management of patients with CSVD.