{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,28]],"date-time":"2026-02-28T08:48:22Z","timestamp":1772268502958,"version":"3.50.1"},"reference-count":88,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"The Department of Oral Medicine and Diagnostic Sciences University of Illinois Chicago, College of Dentistry"},{"name":"Research Open Access Publishing (ROAAP) fund of the University of Chicago"},{"name":"The University of Illinois Cancer Center Biostatistics Shared Resource"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Periodontal disease is associated with systemic conditions such as diabetes, arthritis, and cardiovascular disease, all diseases with large inflammatory components. Some, but not all, reports show periopathogens\n                      <jats:italic>Porphyromonas gingivialis<\/jats:italic>\n                      and\n                      <jats:italic>Tannerella forsythia<\/jats:italic>\n                      at higher levels orally in people with one of these chronic diseases and in people with more severe cases. These oral pathogens are thought to be positively associated with systemic inflammatory diseases through induction of oral inflammation that works to distort systemic inflammation or by directly inducing inflammation at distal sites in the body. This study aimed to determine if, among patients with severe periodontal disease, those with multi-morbidity (or many chronic diseases) showed higher levels of periodontal pathogens.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A total of 201 adult subjects, including 84 with severe periodontal disease were recruited between 1\/2017 and 6\/2019 at a city dental clinic. Electronic charts supplied self-reported diseases and conditions which informed a morbidity index based on the number of chronic diseases and conditions present. Salivary composition was determined by 16S rRNA gene sequencing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      As expected, patients with severe periodontal disease showed higher levels of periodontal pathogens in their saliva. Also, those with severe periodontal disease showed higher levels of multiple chronic diseases (multimorbidity). An examination of the 84 patients with severe periodontal disease revealed some subjects despite being of advanced age were free or nearly free of systemic disease. Surprisingly, the salivary microbiota of the least healthy of these 84 subjects, defined here as those with maximal multimorbidity, showed significantly lower relative numbers of periodontal pathogens, including\n                      <jats:italic>Porphyromonas gingivalis<\/jats:italic>\n                      and\n                      <jats:italic>Tannerella Forsythia<\/jats:italic>\n                      , after controlling for active caries, tobacco usage, age, and gender. Analysis of a control group with none to moderate periodontal disease revealed no association of multimorbidity or numbers of medications used and specific oral bacteria, indicating the importance of severe periodontal disease as a variable of interest.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      The hypothesis that periodontal disease patients with higher levels of multimorbidity would have higher levels of oral periodontal pathogens is false. Multimorbidity is associated with a reduced relative number of periodontal pathogens\n                      <jats:italic>Porphyromonas gingivalis<\/jats:italic>\n                      and\n                      <jats:italic>Tannerella forsythia.<\/jats:italic>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.15502","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T07:29:18Z","timestamp":1689319758000},"page":"e15502","source":"Crossref","is-referenced-by-count":4,"title":["Unexpected lower level of oral periodontal pathogens in patients with high numbers of systemic diseases"],"prefix":"10.7717","volume":"11","author":[{"given":"Michael T.","family":"Shen","sequence":"first","affiliation":[{"name":"Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Betti","family":"Shahin","sequence":"additional","affiliation":[{"name":"Restorative Dentistry, University of Illinois Chicago, Chicago, IL, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhengjia","family":"Chen","sequence":"additional","affiliation":[{"name":"Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States of America"},{"name":"Biostatistics Shared Resource Core, University of Illinois Cancer Center, University of Illinois Chicago, Chicago, IL, United States of America"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guy R.","family":"Adami","sequence":"additional","affiliation":[{"name":"Oral Medicine and Diagnostic Sciences, College of Dentistry, University of Illinois Chicago, Chicago, IL, United States of America"},{"name":"University of Illinois Cancer Center, 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