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This study aimed to investigate the long\u2010term effect of salivary theobromine levels on periodontitis severity using 7\u2010 and 10\u2010year follow\u2010up data from the prospective Studies of Health in Pomerania (SHIP\u2010TREND and SHIP\u2010START).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a non\u2010targeted metabolomics analysis of salivary methylxanthines in 679 participants from SHIP\u2010TREND and 953 participants from SHIP\u2010START. Inverse\u2010probability\u2010of\u2010treatment\u2010weighted generalised linear models were used to assess the relationship between salivary theobromine and periodontal variables, including bleeding on probing, probing depth and clinical attachment loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Higher salivary theobromine levels were significantly associated with improved periodontal health, as evidenced by lower mean probing depth and a reduced percentage of sites with probing depth \u2265\u20093\u2009mm. The results were successfully replicated in the SHIP\u2010START data and extended to a lower clinical attachment loss.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Our cohort studies suggest that elevated salivary theobromine levels are associated with improved periodontal parameters over 7 and 10\u2009years. These results indicate the potential for theobromine\u2010containing products to support periodontal health, warranting further investigation through randomised controlled trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jcpe.70072","type":"journal-article","created":{"date-parts":[[2025,12,13]],"date-time":"2025-12-13T05:31:30Z","timestamp":1765603890000},"page":"445-454","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Elevated Salivary Theobromine and Long\u2010Term Improvement of Periodontal Health in Two Cohort Studies"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9605-2822","authenticated-orcid":false,"given":"Thomas","family":"Kocher","sequence":"first","affiliation":[{"name":"Department of Restorative Dentistry, Periodontology and Endodontology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-6602","authenticated-orcid":false,"given":"Sebastian\u2010Edgar","family":"Baumeister","sequence":"additional","affiliation":[{"name":"Institute of Health Services Research in Dentistry University of M\u00fcnster  M\u00fcnster Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7003-399X","authenticated-orcid":false,"given":"Henry","family":"V\u00f6lzke","sequence":"additional","affiliation":[{"name":"Institute for Community Medicine University Medicine Greifswald  Greifswald Germany"},{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6678-7964","authenticated-orcid":false,"given":"Matthias","family":"Nauck","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, University Medicine Greifswald  Greifswald Germany"},{"name":"Institute of Clinical Chemistry and Laboratory Medicine University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0243-2435","authenticated-orcid":false,"given":"Peter","family":"Meisel","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Periodontology and Endodontology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9638-3912","authenticated-orcid":false,"given":"Karsten","family":"Suhre","sequence":"additional","affiliation":[{"name":"Bioinformatics Core Weill Cornell Medicine\u2010Qatar, Education City  Doha Qatar"},{"name":"Englander Institute for Precision Medicine Weill Cornell Medicine, Belfer Research Building  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5689-3448","authenticated-orcid":false,"given":"Uwe","family":"V\u00f6lker","sequence":"additional","affiliation":[{"name":"Interfaculty Institute for Genetics and Functional Genomics, Department of Functional Genomics University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1017-7622","authenticated-orcid":false,"given":"Nele","family":"Friedrich","sequence":"additional","affiliation":[{"name":"German Center for Cardiovascular Research (DZHK), Partner Site Greifswald, University Medicine Greifswald  Greifswald Germany"},{"name":"Institute of Clinical Chemistry and Laboratory Medicine University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6541-3127","authenticated-orcid":false,"given":"Birte","family":"Holtfreter","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, Periodontology and Endodontology University Medicine Greifswald  Greifswald Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Agency E. 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