{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T20:58:52Z","timestamp":1793134732103,"version":"4.5.0"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T00:00:00Z","timestamp":1773705600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cardiovascular disease (CVD) and periodontal disease are prevalent chronic conditions that share common risk factors and may be linked through systemic inflammation. Emerging evidence suggests that individuals with periodontal disease are more likely to be diagnosed with CVD, potentially influencing health care costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study analyzed deidentified commercial insurance claims data from 192,500 United States (U. S.) adults aged 21\u201364 with CVD diagnoses between 2015 and 2022. Patients were categorized based on periodontal treatment received in 2020\u20132021: none, 1\u20133 visits, or 4\u202f+\u202fvisits. Gamma regression and multinomial propensity score matching (PSM) models assessed associations between periodontal treatment and 2022 health care costs (overall, outpatient, inpatient, and prescription), controlling for demographic and clinical covariates. Reported percentage reductions and average treatment effect on treated (ATET) dollar difference reflect estimates derived from PSM-weighted models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients with four or more periodontal visits had significantly lower overall medical costs (9.6% reduction; ATET\u202f=\u202f\u2212$1,960.39, 95% confidence interval (CI)\u202f=\u202f\u2212$2,684.33, \u2212$1,236.44,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.005) and outpatient costs (5.3% reduction; ATET\u202f=\u202f\u2212$599.09, 95% CI\u202f=\u202f\u2212$1,019.34, \u2212$178.84,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.005) compared to those without treatment. Patients with 1\u20133 visits had an 8% reduction in prescription costs (ATET\u202f=\u202f\u2212$387.53, 95% CI\u202f=\u202f\u2212$653.31, \u2212$119.75,\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.005). Gamma regression analyses confirmed these associations after adjusting for confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Findings suggest that periodontal treatment may be associated with lower health care costs among individuals with CVD, potentially attributed to reduced systemic inflammation. The cost differences were most pronounced with four or more periodontal visits, supporting risk-based recall strategies. These results underscore the relevance of integrating oral health into chronic disease management and indicate that greater access to periodontal care may be associated with economic and health benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1741942","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:28:43Z","timestamp":1773757723000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Periodontal therapy among patients with cardiovascular disease: exploring its association with lower medical spending"],"prefix":"10.3389","volume":"14","author":[{"given":"Morgan","family":"Santoro","sequence":"first","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caroline","family":"McLeod","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa J.","family":"Heaton","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah J.","family":"Cheung","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"O\u2019Malley","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madison","family":"Vinson","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Preston","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric P.","family":"Tranby","sequence":"additional","affiliation":[{"name":"CareQuest Institute for Oral Health","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,17]]},"reference":[{"key":"ref1","year":"2023"},{"key":"ref2","year":"2023"},{"key":"ref3","year":"2023"},{"key":"ref4","year":"2025"},{"key":"ref5","year":"2023"},{"key":"ref6","year":"2023"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"2197779","DOI":"10.1080\/20002297.2023.2197779","article-title":"Current concepts in the pathogenesis of periodontitis: from symbiosis to dysbiosis","volume":"15","author":"Abdulkareem","year":"2023","journal-title":"J Oral Microbiol"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1327","DOI":"10.1016\/j.hlc.2018.05.102","article-title":"Periodontal disease, systemic inflammation and the risk of cardiovascular disease","volume":"27","author":"Carrizales-Sep\u00falveda","year":"2018","journal-title":"Heart Lung Circ"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"576","DOI":"10.1016\/j.adaj.2018.04.023","article-title":"Periodontitis in US adults: National Health and nutrition examination survey 2009\u20132014","volume":"149","author":"Eke","year":"2018","journal-title":"J Am Dent Assoc"},{"key":"ref10","year":"2023"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1902\/jop.2015.140520","article-title":"Update on prevalence of periodontitis in adults in the United States: NHANES 2009 to 2012","volume":"86","author":"Eke","year":"2015","journal-title":"J Periodontol"},{"key":"ref12","year":"2023"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1554","DOI":"10.1902\/jop.2000.71.10.1554","article-title":"Identification of periodontal pathogens in atheromatous plaques","volume":"71","author":"Haraszthy","year":"2000","journal-title":"J Periodontol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1016\/j.atherosclerosis.2005.03.017","article-title":"Associations between IgG antibody to oral organisms and carotid intima\u2013medial thickness in community-dwelling adults","volume":"183","author":"Beck","year":"2005","journal-title":"Atherosclerosis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1161\/01.atv.0000157982.69663.59","article-title":"Serum antibody levels to Actinobacillus actinomycetemcomitans predict the risk for coronary heart disease","volume":"25","author":"Pussinen","year":"2005","journal-title":"Arterioscler Thromb Vasc Biol"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.ijcard.2008.05.057","article-title":"Periodontal status and Prevotella intermedia antibody in acute coronary syndrome","volume":"137","author":"Soejima","year":"2009","journal-title":"Int J Cardiol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"1308","DOI":"10.1186\/s12903-024-04907-1","article-title":"Periodontal disease and cardiovascular disease: umbrella review","volume":"24","author":"Arbildo-Vega","year":"2024","journal-title":"BMC Oral Health"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"E5237","DOI":"10.3390\/ijerph17145237","article-title":"Cross-sectional analysis of the association between periodontitis and cardiovascular disease using the Korean genome and epidemiology study data","volume":"17","author":"Byun","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1178","DOI":"10.1016\/j.jvs.2011.10.008","article-title":"Association between periodontal disease and stroke","volume":"55","author":"Sfyroeras","year":"2012","journal-title":"J Vasc Surg"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1390","DOI":"10.1161\/CIR.0000000000001390","article-title":"Periodontal disease and atherosclerotic cardiovascular disease: a scientific statement from the American Heart Association","volume":"153","author":"Tran","year":"2025","journal-title":"Circulation"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1016\/j.amjcard.2022.05.028","article-title":"Association between periodontal disease and cardiovascular disease (from NHANES)","volume":"178","author":"Sumayin Ngamdu","year":"2022","journal-title":"Am J Cardiol"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"943","DOI":"10.1002\/JPER.21-0342","article-title":"Periodontal disease measures and risk of incident peripheral artery disease: the ARIC study","volume":"93","author":"Arsiwala","year":"2022","journal-title":"J Periodontol"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1038\/s41432-023-00868-6","article-title":"Is periodontal therapy an effective treatment modality for preventing or managing cardiovascular disease in patients with periodontitis?","volume":"24","author":"Goyal","year":"2023","journal-title":"Evid Based Dent"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"CD009197","DOI":"10.1002\/14651858.cd009197.pub5","article-title":"Periodontal therapy for primary or secondary prevention of cardiovascular disease in people with periodontitis","volume":"10","author":"Ye","year":"2022","journal-title":"Cochrane Database Syst Rev"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"e16495","DOI":"10.7717\/peerj.16495","article-title":"Estimation of serum C-reactive protein activity in periodontal health and disease and response to treatment","volume":"11","author":"Saquib Abullais","year":"2023","journal-title":"PeerJ"},{"key":"ref26","year":"2018"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"625579","DOI":"10.3389\/fcvm.2020.625579","article-title":"Association between periodontal disease and atherosclerotic cardiovascular diseases: revisited","volume":"7","author":"Zardawi","year":"2021","journal-title":"Front Cardiovasc Med"},{"key":"ref28","year":"2023"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"373","DOI":"10.1002\/JPER.21-0111","article-title":"Economic burden of periodontitis in the United States and Europe: an updated estimation","volume":"93","author":"Botelho","year":"2022","journal-title":"J Periodontol"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1016\/j.amepre.2014.04.001","article-title":"Impact of periodontal therapy on general health: evidence from insurance data for five systemic conditions","volume":"47","author":"Jeffcoat","year":"2014","journal-title":"Am J Prev Med"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"114","DOI":"10.3390\/dj10070133","article-title":"Association between periodontal treatment and healthcare costs in patients with coronary heart disease: a cohort study based on German claims data","volume":"10","author":"Blaschke","year":"2022","journal-title":"Dent J (Basel)"},{"key":"ref32","first-page":"130","article-title":"Association between preventive dental care and healthcare cost for enrollees with diabetes or coronary artery disease","volume":"43","author":"Borah","year":"2022","journal-title":"Compend Contin Educ Dent"},{"key":"ref33","year":"2024"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"e2531532","DOI":"10.17061\/phrp2531532","article-title":"Categorising major cardiovascular disease hospitalisations from routinely collected data","volume":"25","author":"Joshy","year":"2015","journal-title":"Public Health Res Pract"},{"key":"ref35","volume-title":"CDT 2024: Current Dental Terminology","year":"2023"},{"key":"ref36","volume-title":"Agency for Healthcare Research and Quality. Elixhauser Comorbidity Software (ICD-10-CM)","year":"2025"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"709438","DOI":"10.3389\/fphys.2021.709438","article-title":"Periodontal inflammation and systemic diseases: an overview","volume":"12","author":"Mart\u00ednez-Garc\u00eda","year":"2021","journal-title":"Front Physiol"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.adaj.2015.01.026","article-title":"Evidence-based clinical practice guideline on the nonsurgical treatment of chronic periodontitis","volume":"146","author":"Smiley","year":"2015","journal-title":"J Am Dent Assoc"},{"key":"ref39","doi-asserted-by":"publisher","first-page":"1256","DOI":"10.1161\/CIR.0b013e31825719f3","article-title":"Periodontal disease and atherosclerotic cardiovascular disease: does the evidence support an independent association?","volume":"82","author":"Teles","year":"2011","journal-title":"J Periodontol"},{"key":"ref40","first-page":"30","article-title":"Determining recare intervals for periodontal maintenance","volume":"18","author":"Rudick","year":"2020","journal-title":"Dimens Dent Hyg"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1902\/jop.2000.71.5-S.849","article-title":"Parameter on periodontal maintenance","volume":"71","year":"2000","journal-title":"J Periodontol"},{"key":"ref42","year":"2023"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"236","DOI":"10.1038\/s41415-021-2612-0","article-title":"Effectiveness of different dental recall strategies: the INTERVAL dental recalls randomized controlled trial","volume":"230","author":"Clarkson","year":"2021","journal-title":"Br Dent J"},{"key":"ref44","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2337\/diaspect.24.4.187","article-title":"The oral-systemic link: an opportunity for collaboration","volume":"24","author":"Gesko","year":"2011","journal-title":"Diabetes Spectr"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"e0181189","DOI":"10.1371\/journal.pone.0181189","article-title":"Oral health and cardiovascular care: perceptions of people with cardiovascular disease","volume":"12","author":"Sanchez","year":"2017","journal-title":"PLoS One"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"E10","DOI":"10.1097\/JCN.0000000000000388","article-title":"Oral healthcare and cardiovascular disease: a scoping review of current strategies and implications for nurses","volume":"32","author":"Ajwani","year":"2017","journal-title":"J Clin Nurs"},{"key":"ref47","doi-asserted-by":"publisher","first-page":"1389853","DOI":"10.3389\/fpubh.2024.1389853","article-title":"Oral health education strategies for patients living with cardiovascular disease within hospital settings: a scoping review","volume":"12","author":"Church","year":"2024","journal-title":"Front Public Health"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1111\/cdoe.12999","article-title":"Efficiency of periodontal treatment to improve type 2 diabetes mellitus outcomes: a systematic review and meta-analysis of economic evaluations","volume":"53","author":"S\u00e1enz-Ravello","year":"2025","journal-title":"Community Dent Oral Epidemiol"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"e001478","DOI":"10.1136\/bmjdrc-2020-001666","article-title":"Effect of periodontal treatment on diabetes-related healthcare costs: a retrospective study","volume":"8","author":"Smits","year":"2020","journal-title":"BMJ Open Diabetes Res Care"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1111\/jcpe.13441","article-title":"Effects of periodontal management for patients with type 2 diabetes on healthcare expenditure and hospitalisation","volume":"48","author":"Shin","year":"2021","journal-title":"J Clin Periodontol"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"519","DOI":"10.1002\/hec.3316","article-title":"Relationship between periodontal interventions and healthcare costs and utilization","volume":"26","author":"Nasseh","year":"2017","journal-title":"Health Econ"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1016\/j.adaj.2022.12.011","article-title":"Periodontal treatment associated with decreased diabetes mellitus\u2013related treatment costs","volume":"154","author":"Thakkar-Samtani","year":"2023","journal-title":"J Am Dent Assoc"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"100574","DOI":"10.1016\/j.ijcchd.2025.100574","article-title":"The root of the matter: linking oral health to chronic disease prevention","volume":"19","author":"D\u2019Aiuto","year":"2025","journal-title":"Int J Cardiol Congenit Heart Dis"},{"key":"ref54","doi-asserted-by":"publisher","first-page":"1184","DOI":"10.1016\/j.amjmed.2024.08.004","article-title":"Inclusion of dental services in Medicare to improve oral and general health for older Americans","volume":"137","author":"Scannapieco","year":"2024","journal-title":"Am J Med"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1741942\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T14:28:45Z","timestamp":1773757725000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2026.1741942\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,17]]},"references-count":54,"alternative-id":["10.3389\/fpubh.2026.1741942"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2026.1741942","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,17]]},"article-number":"1741942"}}