Background: Immunoglobulin G (IgG) antibodies against periodontal microorganisms can be markers of periodontal infection because their levels rise following infection and remain elevated several years later. Methods:We evaluated the relationship between groups of IgG antibodies against 19 periodontal microorganisms and diabetes-related mortality over 27 years among participants of the National Health and Nutrition Examination Survey III (1988 to 1992) aged ≥40 years at the time of examination (N = 8,153). Results: Individuals in the highest versus lowest antibody tertiles were at 86% higher risk of dying due to diabetes-related causes in the Red-Green antibody cluster (T. forsythia, T. denticola, A. actinomycetemcomitans, E. corrodens, S. noxia, V. parvula, C. rectus) (hazard ratio [HR], 1.86; 95% CI, 1.09 to 3.20) and 55% lower in the Orange-Blue antibody cluster (E. nodatum, A. naeslundii) (HR, 0.45, 95% CI, 0.32 to 0.63) in multivariable models. In these models, individuals with diabetes at the time of examination had a 16-fold higher risk of dying due to diabetes-related causes (HR, 16.4; 95% CI,11.0 to 24.7). Conclusion:As a subset of periodontal microorganisms are associated with adverse systemic outcomes, antibody profiles may help in prediction of diabetesrelated mortality and identify subgroups of individuals among whom periodontal treatment may impact diabetes-related outcomes.

Introduction: Markers of poor oral health are associated with impaired cognition and higher risk of Alzheimer disease (AD) and thus may help predict AD. Objectives: The aim of this study was to evaluate the cross-sectional association between empirically derived groups of 19 IgG antibodies against periodontal microorganisms and cognition in middle-aged and older adults. Methods: The study population consisted of participants of the third National Health and Nutrition Examination Survey (NHANES III) (1988 to 1994), who were 60 y and older, among whom cognition and IgG antibodies against 19 periodontal microorganisms were measured (N = 5,162). Results: In multivariable quantile regression analyses, the Orange-Red (Prevotella melaninogenica, Prevotella intermedia, Prevotella nigrescens, Porphyromonas gingivalis) and Yellow-Orange (Staphylococcus intermedius, Streptococcus oralis, Streptococcus mutans, Fusobacterium nucleatum, Peptostreptococcus micros, Capnocytophaga ochracea) cluster scores were negatively associated with cognition. A 1-unit higher cluster score for the Orange-Red cluster was associated on average with a lower cognitive score (β for 30th quantile = −0.2640; 95% confidence interval [CI], −0.3431 to −0.1848). Similarly, a 1-unit higher score for the Yellow-Orange cluster was associated with a lower cognitive score (β for 30th quantile = −0.2445; 95% CI, −0.3517 to −0.1372). Conclusion: Groups of IgG antibodies against periodontal microorganisms were associated with lower cognition among free living adults 60 years and older, who were previously undiagnosed with cognitive impairment. Though poor oral health precedes the development of dementia and AD, oral health information is currently not used, to our knowledge, to predict dementia or AD risk. Combining our findings with current algorithms may improve risk prediction for dementia and AD. Knowledge Translation Statement: IgG antibodies against periodontal microorganisms were associated with lower cognition among adults 60 years and older previously undiagnosed with cognitive impairment. Periodontal disease may predict cognition among older adults.

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BackgroundAlzheimer disease (AD) has been linked with periodontal microorganisms such as Porphyromonas gingivalis in observational and mechanistic studies. IgG antibodies against periodontal microorganisms which are markers of past and current periodontal infection have been correlated with cognitive impairment. We examined associations between empirically derived groups of 19 IgG antibodies against periodontal microorganisms and AD mortality.MethodsIndividuals participating in the Third National Health and Nutrition Examination Survey (NHANES III) with complete data on IgG titers were followed up between 1988 and December 31, 2019. The outcome was AD mortality, and the main exposures were IgG antibodies against periodontal microorganisms classified into four mutually exclusive groups using cluster analysis. Survey‐weighted Cox proportional hazard models were used to evaluate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for the relationship between clusters and AD mortality.ResultsWith up to 21 years of follow‐up, 160 AD‐related deaths were documented. In the multivariable‐adjusted model, AD mortality overall was not associated with the Red‐Green (aHR 1.18; 95% CI, 0.46–3.07), Yellow‐Orange (aHR 1.36; 95% CI, 0.58–3.19), Orange‐Blue (aHR 0.63; 95%, CI, 0.33–1.21), and the Orange‐Red (aHR 0.79; 95% CI, 0.37–1.70) when the upper tertiles were compared to the bottom tertiles. However, the subgroup of middle‐aged individuals in the highest tertile of the Red‐Green cluster, but not older individuals, had a 13% higher risk of AD mortality (aHR 1.13; 95% CI, 1.02–1.26) compared with those in the bottom tertile.ConclusionClusters of IgG antibodies against periodontal microorganisms did not predict AD mortality in this study.