Healthy lifestyles and better periodontal health: Results from two large population‐based surveys

Abstract Aim To ascertain whether healthy lifestyles are associated with periodontal diseases in two large‐scale surveys in the US (National Health and Nutrition Examination Survey – NHANES) and the UK Biobank. Methods 9854 US adults and 111 679 UK adults were included in the analyses. A healthy lifestyle score (HLS), ranging between 0 and 5, was calculated based on the reported number of healthy behaviours, including never smoking, no heavy alcohol consumption, top third of leisure‐time physical activity, higher dietary quality, and ideal sleep duration. The prevalence of periodontal diseases was the primary outcome in both surveys. In the NHANES, periodontal status was assessed through a full‐mouth periodontal examination, while in the UKB, only self‐reported periodontal status was available. Results Multiple regression analyses confirmed that the presence of at least 2–3 healthy behaviours (vs. 0–1) was associated with lower odds of overall and severe periodontitis (ORs 0.5, 0.4–0.6; p < .001 and 0.5, 0.3–0.8; p = .003, respectively) in the NHANES, and of bleeding gums (OR = 0.9, 0.8–1.0; p = .092) and loose teeth (OR = 0.6, 0.5–0.7; p < .001) in UKB. This association increased when considering prevalence of 4–5 healthy behaviours (vs. 0–1) in both the NHANES (periodontitis: OR = 0.3, 0.2–0.4; p < .001; severe periodontitis: OR = 0.1, 0.01–0.2; p < .001) and the UKB (bleeding gums: OR = 0.8, 0.7–0.9; p < .001; loose teeth: OR = 0.5, 0.4–0.6; p < .001). Mediation analyses revealed how these protective associations could be partially mediated (1–14%) by differences in biomarkers of systemic inflammation (white blood cells and neutrophils count as well as C‐reactive protein). Conclusions Adoption of healthy lifestyle behaviours is associated with a lower prevalence of periodontal diseases within two large population‐based samples. This relationship exhibits a dose–response pattern, implying that greater adherence to healthy habits leads to a more significant protective effect against the odds of periodontal diseases. Additionally, our findings suggest that this protective effect is, in part, mediated by reductions in systemic inflammation.