Smoking, Periodontitis Linked With Increased Risk of Psoriasis


Patients with periodontitis had a potential increased risk of developing psoriasis, particularly those who smoked.

Periodontitis was shown to be a potential independent risk factor for the development of psoriasis, with smoking indicated to further increase this risk. Findings were published recently in Dermatology.

As a common chronic inflammatory condition involving the periodontium, patients with periodontitis have been linked in prior research with increased incidence and prevalence rates of several immune-mediated systemic inflammatory disorders, including obesity, cardiovascular disease, and rheumatoid arthritis.

A prior study assessing the association between periodontitis and diabetes found that preventive measures, such as brushing teeth 2 times and 3 times each day, was linked with a 10% and 14% reduced risk of developing diabetes in adults younger than 51 years, respectively, compared with those who brushed once a day or not at all.

“Bacterial colonization in the oral cavity may induce an exaggerated immune response in a susceptible host, leading to an inflammatory process associated with autoimmune disorders,” explained researchers.

However, they note that the link between periodontitis and psoriasis, another chronic inflammatory disorder, has yet to be determined, with no large-scale, nationwide cohort studies having examined the association.

Assessing the relationship between periodontitis and risk of psoriasis, the study authors conducted a nationwide population-based study of data derived from the National Health Insurance System (NHIS) claims database in Korea.

In the study, participants 20 years and older registered in the health screening database, a subdataset of the Korean NHIS database, underwent health examinations from January to December 2009, and were followed for 9 years.

Patients with periodontitis (n = 1,063,004) and those without (n = 8,655,587) were compared on risk of incident psoriasis via Cox proportional hazards regression analyses adjusted for potential confounders, including age, sex, and income level. A separate subgroup analysis assessed risk of psoriasis according to periodontitis and smoking status.

According to the presence of periodontitis, incidence rates of psoriasis per 1000 person-years were 3.477 in patients with the condition and 2.904 in the control group. After adjusting for covariates, findings of the multivariable analysis indicated that patients with periodontitis were at significantly higher risk of developing psoriasis than those without (HR, 1.116; 95% CI, 1.101-1.13).

Furthermore, results of the subgroup analysis showed a similar 11% increased risk of psoriasis in nonsmokers with periodontitis compared to nonsmokers without periodontitis (HR, 1.11; 95% CI, 1.094-1.127), which increased to a 26.5% elevated risk of psoriasis in smokers with periodontitis (HR, 1.265; 95% CI, 1.234-1.296).

“The results suggest that periodontitis and smoking may synergistically increase the risk of psoriasis,” concluded the researchers. “Patients with periodontitis should be monitored for psoriasis, and increased focus on lifestyle correction may be warranted.”


Han JH, Park JW, Han KD, Park JB, Kim M, Lee JH. Smoking and periodontitis can play a synergistic role in the development of psoriasis: A nationwide cohort study. Dermatology. Published online September 15, 2021. doi:10.1159/000518296

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