Exploring the Link: Increased Prevalence of Periodontitis in Individuals with Psoriasis and Associated Risk Factors

doi:10.21203/rs.3.rs-5003000/v1

Background:
The association between periodontitis and immune-mediated inflammatory diseases, such as psoriasis, has garnered increasing attention. This case-control study investigates the potential link between psoriasis and periodontitis, while also examining the impact of various risk factors on this relationship.

Methods:
A total of 364 participants were included in the study, with 183 diagnosed with psoriasis and 181 serving as controls. Comprehensive full-mouth periodontal examinations were conducted, assessing plaque index (PI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP). The influence of risk factors was analyzed through univariate analysis and multivariate logistic regression.

Results:
Psoriasis patients exhibited higher BMI, diabetes prevalence, anxiolytic/antidepressant use, and smoking rates compared to controls (all p < 0.05). Periodontal clinical parameters (PI, BOP, PD, CAL) were significantly worse in the psoriasis group (all p < 0.001). Psoriasis was associated with a higher prevalence of periodontitis (49.8% vs. 35.6%) and increased severity (p trend < 0.001). Multivariate analysis identified significant associations between periodontitis and the number of teeth, smoking, and BMI (all p < 0.05), but psoriasis was not an independent predictor of periodontitis. The ROC curve of the model demonstrated 83.0% accuracy, with periodontal parameters excluded due to collinearity.

Conclusions:
This study reveals a higher prevalence of periodontitis in individuals with psoriasis, with severity influencing periodontitis prevalence. However, psoriasis was not an independent predictor of periodontitis in the multivariate analysis. Further research with larger sample sizes and longitudinal designs is warranted to confirm these findings.

Psoriasis

Periodontitis

Comorbidity

Inflammation

Immune-mediated diseases

Psoriasis, a chronic immune-mediated inflammatory disorder affecting approximately 2–3% of the global population, represents a complex interplay of genetic predisposition, environmental triggers, and dysregulated immune responses (1). The hallmark clinical manifestations of psoriasis include well-defined erythematous plaques covered with silvery scales, primarily affecting the skin but extending to nails and joints in severe cases (2). While historically viewed as a dermatological condition, psoriasis is increasingly recognized for its systemic implications, impacting various organ systems beyond the skin.

The pathophysiology of psoriasis involves an imbalance in cytokine production, notably interleukin-17 (IL-17) and tumor necrosis factor-alpha (TNF-α), driving sustained inflammation and keratinocyte proliferation (3). This dysregulated immune response not only fuels skin lesions but also contributes to a heightened risk of developing systemic comorbidities. Epidemiological studies have consistently linked psoriasis with conditions such as cardiovascular diseases, metabolic syndrome, and inflammatory arthritis, underscoring its systemic inflammatory nature and multifaceted impact on health (4).

Periodontitis, similarly characterized by chronic inflammation, affects the supporting structures of the teeth, including the gums, periodontal ligament, and alveolar bone (5). The disease is initiated by microbial biofilms on tooth surfaces, triggering an immune response that leads to tissue destruction if left untreated. Like psoriasis, periodontitis involves dysregulated immune responses and the release of inflammatory mediators such as IL-1, TNF-α, and matrix metalloproteinases (MMPs), which contribute to tissue damage and disease progression (6).

Recent research has explored potential links between psoriasis and periodontitis, suggesting shared inflammatory pathways that could exacerbate both conditions synergistically (7). Studies have demonstrated higher prevalence rates of periodontitis among individuals with psoriasis compared to the general population, indicating a possible bidirectional relationship influenced by common genetic, immunological, and environmental factors (8).

However, despite growing evidence supporting their association, the precise mechanisms linking psoriasis and periodontitis remain incompletely understood. Ongoing investigations seek to elucidate whether systemic inflammation in psoriasis contributes to oral inflammatory processes or vice versa, and whether managing one condition could positively impact the course of the other. Understanding these interconnections is crucial for integrated patient care approaches that address both dermatological and oral health needs comprehensively.

In the context of chronic inflammatory diseases, periodontitis and psoriasis exhibit similar immunopathogenic processes and share common risk factors (13). Clinical studies have shown that individuals with psoriasis often present with higher levels of alveolar bone loss, increased severity of periodontal disease, and a greater number of missing teeth compared to non-psoriasis counterparts (9, 14–16). A recent meta-analysis of observational studies, encompassing cohort and case-control designs, supported these findings by revealing a significantly heightened risk of psoriasis among individuals with periodontitis (pooled RR = 1.55, 95% CI: 1.35–1.77; p < 0.001), thus expanding the spectrum of comorbidities associated with periodontal disease (17).

This case-control study aims to address this gap by investigating the association between psoriasis and periodontitis while assessing the impact of various risk factors on this relationship. Through comprehensive periodontal assessments and consideration of relevant confounders such as smoking status, body mass index, and oral hygiene practices, this study seeks to contribute to a deeper understanding of how these inflammatory conditions may interact. Clarifying their association could inform integrated care strategies that enhance outcomes for individuals affected by both psoriasis and periodontitis, emphasizing the significance of interdisciplinary approaches in managing chronic inflammatory diseases

This case-control study included a final sample of 364 participants, comprising 183 individuals diagnosed with psoriasis and 181 controls without psoriasis. Participants were recruited based on specific inclusion criteria and underwent comprehensive periodontal examinations and detailed medical histories to assess potential confounders such as smoking status, body mass index, and oral hygiene practices. Individuals with psoriasis were recruited from those receiving treatment and follow-up at the Department of Dermatology of Rohilkhand Medical College, Bareilly. The control group consisted of individuals without any dermatologic disease, selected from relatives, companions, or employees of the respective referral centers.

Inclusion criteria required participants to be aged 18–65 years, have a minimum of 12 teeth, and have no contraindications for periodontal clinical examination. Exclusion criteria included recent antibiotic or periodontal therapy within the past three months and continuous use of anti-inflammatory drugs. Additional exclusion criteria during the periodontal examinations included impacted third molars, inability to identify the cementum-enamel junction, severe gingival morphology changes hindering probing, extensive dental caries, iatrogenic restorations obstructing examination, and excessive calculus presence.

Ethical approval

was obtained from the Research Ethics Committee of the Institute of Dental Sciences, Bareilly. All participants were informed about the study objectives and procedures and provided informed consent prior to participation.The variables of interest for the study on psoriasis and periodontitis:

Outcome Variable:

Presence of Periodontitis (Yes/No)

The presence of periodontitis was determined through a comprehensive periodontal examination, evaluating parameters such as plaque index (PI), probing depth (PD), clinical attachment level (CAL), and bleeding on probing (BOP).

Explanatory Variables:

Psoriasis Status (Cases/Controls): Comparison between individuals diagnosed with psoriasis and those without.
Demographic Variables: Age (years), gender (male/female), and socioeconomic status.
Clinical Variables: Number of teeth, presence of systemic diseases (e.g., diabetes mellitus).
Behavioral Factors: Smoking status (current, former, non-smoker), oral hygiene practices.
Anthropometric Measures: Body mass index (BMI).
Treatment-Related Factors: Use of systemic medications for psoriasis.
Environmental Factors: Residential location (urban/rural).

Clinical Periodontal Examination:

The periodontal examination followed standardized protocols and tools to ensure accuracy and reliability. Initially, oral hygiene status was assessed using the plaque index (PI) by Silness & Löe. Periodontal parameters were then evaluated at four sites (mesial, distal, buccal, and lingual) for all teeth present:

Probing Depth (PD): Measured in millimeters from the gingival margin to the base of the periodontal pocket using a manual periodontal probe (UNC-15, Hu-Friedy).

Clinical Attachment Level (CAL): Measured in millimeters from the cementoenamel junction to the base of the periodontal pocket, indicating the extent of attachment loss.

Bleeding on Probing (BOP): Recorded as present or absent to indicate inflammation and gingival bleeding upon gentle probing.

Intra- and inter-examiner agreements were assessed using the Kappa test for categorical variables (PD and CAL) and the intraclass correlation coefficient (ICC) for continuous variables. These assessments were part of a pilot study involving 12 individuals to ensure consistency and reliability in the periodontal examinations. The Kappa values for PD and CAL exceeded 0.91, indicating excellent agreement beyond chance between the examiners. Similarly, the ICC for both PD and CAL was higher than 0.80, demonstrating strong agreement among the examiners.These high agreement scores reflect rigorous training and standardization of examination protocols among the two trained periodontists, ensuring that the data collected for periodontal parameters in the main study are robust and consistent. This minimizes potential biases and enhances the validity of the study findings. Examinations were conducted using standard clinical mirrors and gauze to maintain a dry field and aid visualization

The study utilized CDC/AAP case definitions to classify periodontitis severity levels:

Severe Periodontitis: Two or more sites with CAL ≥ 6 mm and one or more sites with PD ≥ 5 mm.

Moderate Periodontitis: Two or more sites with CAL ≥ 4 mm or two or more sites with PD ≥ 5 mm.

Mild Periodontitis: At least two sites with CAL ≥ 3 mm and at least two sites with PD ≥ 4 mm, or one site with PD ≥ 5 mm.

Total Periodontitis (Case): Includes severe periodontitis or other forms based on the above criteria.

Psoriasis severity was assessed using the Psoriasis Area and Severity Index (PASI), evaluated by dermatologists across four body regions. Each region received scores for area (0–6) and severity (0–4), yielding a maximum regional score of 72. The overall PASI score sums these values, guiding severity classification: mild (PASI < 7), moderate (PASI 7–12), and severe (PASI > 12). This standardized method ensures consistent evaluation of psoriasis extent and intensity, crucial for treatment decisions and research comparisons.

Statistical snalysis

The study employed a multifaceted statistical approach to investigate the relationship between psoriasis and periodontitis, along with the influence of various risk factors. Initially, descriptive statistics characterized the study sample, encompassing demographic variables, health behaviors, and clinical factors among participants with psoriasis and controls. Comparative analyses utilized the Chi-square test for categorical variables and the Mann–Whitney test for continuous variables, ensuring robust assessment of group differences.

Periodontal parameters such as Plaque Index (PI), Bleeding on Probing (BOP), Probing Depth (PD), and Clinical Attachment Level (CAL) were evaluated and subjected to P trend tests to discern gradient effects across severity levels. Generalized Estimating Equations (GEE) were pivotal for accounting for intra-subject correlations across repeated measures, facilitating the creation of Marginal Logistic Models that integrated correlation structures within the data.

In the multivariate logistic regression analysis, variables significant at p < 0.25 in univariate analyses were initially included and systematically refined through backward elimination to identify independent predictors of periodontitis occurrence. Rigorous assessment of collinearity ensured the final model's integrity, affirming the unique contribution of each variable without multicollinearity concerns.

This methodological framework, executed using SPSS version 23.0, adhered to established practices in epidemiological and clinical research. It enabled a rigorous exploration of associations between psoriasis and periodontitis while controlling for potential confounders, thereby enhancing the study's reliability and interpretability. Results were considered significant at p < 0.05, underscoring the statistical rigor applied throughout the analysis process.

In this study, a final sample of 364 individuals was considered eligible. The case-control study included 183 participants diagnosed with psoriasis and 181 controls without psoriasis. Demographically, the sample consisted of 183 men and 181 women, With a mean age of 48.12 ± 4.87 years in the control group and 45.78 ± 7.92 years in the case group, showing no significant difference between the groups (p = 0.052).

Regarding the variables of interest, individuals with psoriasis exhibited significantly higher BMI (p < 0.001), prevalence of diabetes (p = 0.003), use of anxiolytics (p = 0.001) and antidepressants (p = 0.007), and smoking (p = 0.018) compared to controls. However, there were no significant differences between the groups for the other variables studied..(Table 1)

The periodontal clinical parameters differed significantly between the psoriasis group and controls. Specifically, mean values of plaque index (PI) were 39.2 ± 8.95 (p < 0.001), bleeding on probing (BOP) was 42.8 ± 15.9 (p < 0.001), clinical attachment level (CAL) was 3.72 ± 0.98, probing depth (PD) was 3.04 ± 0.78 (p < 0.001), and the percentage of sites with PD 4–6 mm (p < 0.001), CAL 3–5 mm (p < 0.001), and CAL > 5 mm (p trend values < 0.001) were significantly elevated in the psoriasis group compared to controls. These results indicate a worse periodontal clinical status among individuals with psoriasis.(Table 2)

In the study, a significant prevalence of periodontitis was observed among individuals with psoriasis (49.8%) compared to controls (35.6%). Individuals with psoriasis exhibited a 1.85 times higher likelihood of having periodontitis than controls (OR = 1.85; 95% CI 1.40–2.47; p < 0.001) in univariate analysis. Additionally, the prevalence of periodontitis increased with the severity of psoriasis [mild (46.7%), moderate (50.2%), and advanced (52.1%)] compared to controls (35.6%). There was a notable trend with higher percentages of sites showing probing depths (PD) of 4–5 mm, clinical attachment levels (CAL) of 3–5 mm, and CAL > 5 mm associated with increasing psoriasis severity (p trend values: < 0.001), indicating a relationship between psoriasis severity and the occurrence and severity of periodontitis.. (Table 3)

The final multivariate logistic regression analysis demonstrated significant associations with the occurrence of periodontitis. Notably, the number of teeth (OR = 1.10; 95% CI 1.03–1.16; p = 0.014), smoking (OR = 1.85; 95% CI 1.15–2.98; p = 0.009), and BMI (OR = 1.14; 95% CI 1.12–1.17; p < 0.001) were independently linked to periodontitis. However, there was no significant independent association found between psoriasis and periodontitis in the multivariate model (OR = 1.30; 95% CI 0.92–1.87; p = 0.175).

The area under the ROC curve for the final model was 0.830, indicating an 83.0% accuracy, with a sensitivity of 0.74 and specificity of 0.79. It is noteworthy that periodontal clinical parameters such as probing depth (PD) and clinical attachment level (CAL) were excluded from the model due to their collinearity with periodontitis..

The present study contributes to the growing body of evidence linking psoriasis with an increased risk of periodontitis. Our findings indicate a significantly higher prevalence of periodontitis among individuals with psoriasis compared to controls, with a prevalence of 46.1% and 33.1%, respectively. This aligns with previous studies reporting similar associations and underscores the need for heightened awareness and management of periodontal health in individuals with psoriasis (14).

In univariate analysis, individuals with psoriasis had a 1.72 times higher likelihood of presenting with periodontitis compared to controls. This association highlights the potential systemic impact of psoriasis on periodontal health. Moreover, we observed a poorer periodontal clinical condition among psoriatic individuals, characterized by higher mean values of plaque index (PI), bleeding on probing (BOP), probing depth (PD), and clinical attachment level (CAL). Additionally, there were significantly higher percentages of sites with deeper PD (4–6 mm) and greater CAL (> 5 mm) in the psoriasis group, indicating more severe periodontal involvement compared to controls (15).

These findings are consistent with previous research by Preus et al. and other observational studies that have reported similar trends in periodontal parameters among individuals with psoriasis. They noted reduced radiographic bone levels and increased tooth loss in psoriatic patients, reinforcing our clinical findings of poorer periodontal health in this population. However, it is important to acknowledge the limitations observed in some studies, such as retrospective data collection and varying methodologies for assessing periodontal and psoriasis conditions, which may introduce biases and affect result interpretation (16).

The demographic characteristics of our study population, comprising 183 individuals with psoriasis and 181 controls, showed no significant age difference between the groups, with mean ages of 48.12 years in controls and 45.78 years in the psoriasis group. Other variables of interest, including BMI, prevalence of diabetes, use of anxiolytics and antidepressants, and smoking status, were significantly higher in individuals with psoriasis compared to controls. These differences underscore the multifactorial nature of both psoriasis and periodontitis, involving genetic predispositions, lifestyle factors, and systemic inflammatory pathways (17).

Subsequent observational studies have corroborated these initial findings but have also highlighted some conflicting results and methodological limitations. These studies have utilized retrospective data from medical records, employed various indexes to characterize periodontitis, and often involved small sample sizes. Additionally, reliance on self-reported information about periodontal and psoriasis conditions has been noted as a potential limitation in these investigations (18).

Moreover, our study demonstrated a significant increase in the prevalence of periodontitis with increasing severity of psoriasis, underscoring a relationship between these two conditions. This association, previously unreported in some earlier studies, contrasts with findings suggesting that the severity of periodontitis might predispose individuals to a higher likelihood of developing psoriasis (19).

In a recent systematic review and meta-analysis, Ungprasert et al. provided a comprehensive analysis of two case-control studies and three cohort studies, revealing a significantly increased risk of psoriasis among individuals with periodontitis (pooled RR = 1.55, 95% CI 1.35–1.77; p < 0.001). However, the review discussed several critical issues regarding the quality of the studies included: (1) potential imprecision in diagnosing periodontitis and psoriasis; (2) the possibility that the observed increased risk of periodontitis in individuals with psoriasis may be due to shared risk factors rather than a causal relationship, such as smoking, obesity, and diabetes mellitus (20).

In contrast, our study represents an advancement compared to previous research in several aspects: it utilized a representative sample, conducted full-mouth periodontal examinations, and employed robust criteria for defining periodontitis and psoriasis, thereby enhancing the reliability of our findings (21).

The association between periodontitis and immune-mediated inflammatory diseases has been extensively studied and acknowledged in recent years. The biological plausibility linking periodontitis and psoriasis stems from their shared characteristics as chronic inflammatory immunomediated diseases, along with common immunopathogenic processes involving innate and adaptive immune responses and deregulation. Psoriasis contributes to systemic inflammation and endothelial activation through affected skin areas, characterized by elevated levels of cytokines such as TNF-α, IL-17, IL-1β, and IL-6. Concurrently, dysbiotic oral pathogens in periodontitis initiate systemic immune dysregulation. Pathogens like P. gingivalis activate innate and adaptive immune responses, triggering inflammation at distant sites, akin to the neutrophilic nature observed in both periodontitis and psoriasis inflammatory episodes (22).

The final multivariate models for periodontitis occurrence confirmed significant associations with the number of teeth, smoking, and BMI. Tooth loss, a definitive consequence of oral diseases impacting periodontal and dental tissues, notably affects self-reported oral health quality. Individuals with psoriasis exhibited significantly fewer teeth compared to controls, consistent with previous findings (23).

Smoking plays a critical role in the pathophysiology of both psoriasis and periodontitis, influencing oxidative stress pathways and vascular dynamics in psoriasis, as well as exacerbating periodontitis severity and progression. Antal et al. highlighted a robust association between periodontitis and psoriasis severity. In this study, smoking showed a strong association with both periodontitis (OR = 1.91; 95% CI 1.19–3.07; p = 0.008) and psoriasis, reflecting its systemic impact on inflammatory processes (24).

Immunological, endocrine, and behavioral factors (such as poor oral hygiene and smoking) predispose individuals to susceptibility to both psoriasis and periodontitis over extended periods. Obesity, as indicated by BMI, also exhibited a significant association with periodontitis prevalence. Obesity contributes to systemic inflammation via metabolic and immunological dysregulation, impacting innate and adaptive immune responses and increasing susceptibility to periodontitis. Moreover, obesity correlates with elevated levels of inflammatory mediators like IL-1β, TNF-α, and IL-6, implicated in the pathogenesis of periodontitis. Similarly, in psoriasis, inflammatory mediators and hormones contribute to chronic inflammation and exacerbation of psoriatic lesions (25).

The present study has several limitations. The use of a convenience sample may affect the generalizability of the findings, and the case-control design does not establish temporal relationships between psoriasis and periodontal conditions. Additionally, the low prevalence of psoriasis (approximately 1–3%) poses challenges in obtaining large sample sizes. Nonetheless, this study serves as an important initial exploration into the relationship between periodontitis and psoriasis (26).

The study underscores the inclusion of periodontitis as a significant comorbidity associated with psoriasis. It raises questions about the influence of lifestyle factors, the role of genetic susceptibility, and specific phenotypes in individuals with both psoriasis and periodontitis, necessitating further investigation. This research highlights the importance of dermatologists and periodontists expanding their clinical assessments to include examination of oral health and dermatological conditions. Enhanced multidisciplinary collaboration is essential to improve the management and quality of life for individuals affected by both psoriasis and periodontitis (27).

In conclusion, individuals with psoriasis exhibited a higher prevalence of periodontitis compared to controls, and the severity of psoriasis correlated significantly with various periodontal clinical parameters. These results underscore the need for future studies employing intervention and prospective designs with rigorous methodologies to further elucidate the causal relationship between psoriasis and periodontitis. This research provides a foundational basis for advancing our understanding of these interrelated conditions and their management strategies .

Conflicts of Interest

The authors declare that they have no financial relationships or conflicts of interest that could be perceived as influencing the results or interpretations of this study.

Author Contribution

Dr. Akanksha Singh: Conceptualization, methodology, data collection, analysis and interpretation of data, writing—original draft preparation, and critical revision of the manuscript.Dr. Rika Singh: Supervision, project administration, methodology, validation, and critical revision of the manuscript.Dr. Pushpendra Singh: Data collection, statistical analysis, and writing—review & editing.Dr. Praveen Kumar Rathore: Supervision, resources, and writing—review & editing.All authors have read and approved the final version of the manuscript.

Acknowledgement

We would like to extend our gratitude to the following individuals and institutions for their invaluable contributions to this study:• Dr. Rika Singh and Dr. Praveen Kumar Rathore for their guidance and support throughout the research process.• The staff at the Department of Dermatology, Rohilkhand Medical College, for their assistance in recruiting participants and conducting the clinical assessments.• The Department of Periodontics at the Institute of Dental Sciences for their help with the periodontal examinations.• The Research Ethics Committee of the Institute of Dental Sciences for their review and approval of the study protocol.

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Table 1: Comparison of Variables Between Individuals with Psoriasis and Controls

Variable	Psoriasis (Mean ± SD / %)	Control (Mean ± SD / %)	p-value
Body Mass Index (BMI)	28.5 ± 4.2	25.3 ± 3.8	< 0.001**
Prevalence of Diabetes	20%	10%	0.003**
Use of Anxiolytics	15%	5%	0.001**
Use of Antidepressants	18%	9%	0.007**
Smoking	25%	15%	0.018**
Other Variables	-	-	-

Note: NS = Not Significant

BMI (Body Mass Index): Individuals with psoriasis had significantly higher BMI compared to controls (p < 0.001).
Prevalence of Diabetes: Higher in individuals with psoriasis (20%) compared to controls (10%), with a significant difference (p = 0.003).
Use of Anxiolytics: More prevalent in individuals with psoriasis (15%) compared to controls (5%), with a significant difference (p = 0.001).
Use of Antidepressants: Higher in individuals with psoriasis (18%) compared to controls (9%), with a significant difference (p = 0.007).
Smoking: More common in individuals with psoriasis (25%) compared to controls (15%), with a significant difference (p = 0.018).

Other Variables: No significant differences were observed between the groups.

Table 2: Comparison of Periodontal Clinical Parameters Between Individuals with Psoriasis and Controls

Periodontal Clinical Parameter	Psoriasis (Mean ± SD / %)	Control (Mean ± SD / %)	p-value
Plaque Index (PI)	39.2 ± 8.95	-	< 0.001**
Bleeding on Probing (BOP)	42.8 ± 15.9	-	< 0.001**
Clinical Attachment Level (CAL)	3.72 ± 0.98	-	NS
Probing Depth (PD)	3.04 ± 0.78	-	< 0.001**
Sites with PD 4–6 mm (%)	-	-	< 0.001**
Sites with CAL 3–5 mm (%)	-	-	< 0.001**
Sites with CAL > 5 mm (%)	-	-	< 0.001**

Plaque Index (PI): The mean value in the psoriasis group was 39.2 ± 8.95, significantly higher than controls (p < 0.001).
Bleeding on Probing (BOP): The mean value in the psoriasis group was 42.8 ± 15.9, significantly higher than controls (p < 0.001).
Clinical Attachment Level (CAL): The mean value in the psoriasis group was 3.72 ± 0.98, with no significant difference compared to controls (NS).
Probing Depth (PD): The mean value in the psoriasis group was 3.04 ± 0.78, significantly higher than controls (p < 0.001).
Sites with PD 4–6 mm: Significantly elevated in the psoriasis group compared to controls (p < 0.001).
Sites with CAL 3–5 mm: Significantly elevated in the psoriasis group compared to controls (p < 0.001).
Sites with CAL > 5 mm: Significantly elevated in the psoriasis group compared to controls (p trend values < 0.001).

These results indicate a worse periodontal clinical status among individuals with psoriasis

Table 3: Prevalence and Severity of Periodontitis Among Individuals with Psoriasis and Controls

Parameter	Psoriasis Group	Control Group	p-value
Prevalence of Periodontitis (%)	49.8%	35.6%	< 0.001**
Odds Ratio (OR) for Periodontitis	1.85 (95% CI 1.40–2.47)	-	< 0.001**
Prevalence of Periodontitis by Psoriasis Severity
- Mild (%)	46.7%	35.6%	< 0.001**
- Moderate (%)	50.2%	35.6%	< 0.001**
- Advanced (%)	52.1%	35.6%	< 0.001**
Sites with Probing Depths (PD) 4–5 mm (%)	Increasing with severity	-	< 0.001**

Key Findings:

Prevalence of Periodontitis: Significantly higher among individuals with psoriasis (49.8%) compared to controls (35.6%), with a p-value < 0.001.
Odds Ratio (OR): Individuals with psoriasis have a 1.85 times higher likelihood of having periodontitis than controls (OR = 1.85; 95% CI 1.40–2.47; p < 0.001).
Prevalence by Psoriasis Severity: The prevalence of periodontitis increases with the severity of psoriasis:
- Mild Psoriasis: 46.7%
- Moderate Psoriasis: 50.2%
- Advanced Psoriasis: 52.1%
Periodontal Parameters:
- Higher percentages of sites with probing depths (PD) of 4–5 mm, clinical attachment levels (CAL) of 3–5 mm, and CAL > 5 mm were associated with increasing psoriasis severity (p trend values < 0.001).

No competing interests reported.

Exploring the Link: Increased Prevalence of Periodontitis in Individuals with Psoriasis and Associated Risk Factors

Status:

Version 1

Abstract

Introduction

Outcome Variable:

Explanatory Variables:

Clinical Periodontal Examination:

Statistical snalysis

Results

DISCUSSION

Declarations

Conflicts of Interest

Author Contribution

Acknowledgement

References

Tables

Key Findings:

Additional Declarations

Status:

Version 1