Social Determinants of Health and Periodontitis in Postmenopausal Women

Objectives: To identify the social determinants of health (SDH) factors associated with the prevalence of severe periodontal disease in postmenopausal women (PMW) and to compare periodontal parameters with demographic, lifestyle factors, anthropometric measurements and pre-existing diseases in the northeast region of Ohio.
Methods: Retrospective, cross-sectional study was conducted using the Case Cleveland Clinic Postmenopausal Wellness Consortium (CCCPWC), a database of over 900 PMW. Subjects were divided into two groups based on the prevalence of periodontal disease (PD): healthy, n=214; and severe, n=113. Periodontal parameters including: median number of teeth loss (MNTL), median probing depth (MPD), median recession (MR), and bleeding on probing (BOP) were recorded. Additionally, anthropometric measurements: body mass index (BMI) and fracture risk assessment tool (FRAX) score, lifestyle factors: smoking, average alcohol consumption (AAC), multivitamin supplement use (MSU), socio-economic status: ethnicity/race, household income, and education level, and pre-existing diseases: secondary osteoporosis, and diabetes were collected. Data were analyzed using the Pearson’s chi-square, Fisher’s exact test and non-parametric tests: Spearman’s rho, Kruskal-Wallis, and Mann-Whitney U (α = 0.05).
Results: MNTL, and BMI in PMW with healthy and severe PD were (5, 0-32 vs. 8, 0- 32; p=0.016), and (25.9, 13.0-51.0 vs. 24.6, 14.0-57.0; p=0.003), respectively. BOP, MSU, and lower household income were significantly associated with healthy and severe PD (37.3% vs 96.3%; p<0.001), (27.8% vs 40.7%; p=0.046), and (43.5% vs 28.6%; p=0.001), respectively. FRAX score (osteoporotic fracture) was significantly correlated with MNTL (r=0.427; p<0.001).
Conclusions: MNTL, BMI, BOP, MSU, and lower household income were significantly associated with periodontal disease. ACC and ethnicity/race do not appear to significantly contribute to periodontitis. The results underscore a need to raise public awareness of the importance of periodontal health in PMW.