Association Between Periodontal Disease and Blood Biomarkers in U.S. Adults: A Cross-Sectional Study

Background: Periodontal disease (PD) is a chronic inflammatory condition linked to systemic immunologic and metabolic alterations. This study evaluated associations between PD and three routinely measured blood biomarkers-white blood cell (WBC) count, serum albumin, and mean corpuscular hemoglobin concentration (MCHC)-using data from 4669 adults aged ≥30 years in the 2013-2014 National Health and Nutrition Examination Survey (NHANES). Methods: PD was defined dichotomously according to the Centers for Disease Control and Prevention/American Academy of Periodontology (CDC/AAP) surveillance criteria. All analyses incorporated NHANES sampling weights, strata, and primary sampling units. Weighted descriptive statistics compared characteristics by PD status. Stepwise survey-weighted logistic regression examined associations between biomarkers and PD, adjusting for sociodemographic, behavioral, and health-related confounders. Restricted cubic splines assessed nonlinearity, and biomarker effects were additionally scaled per standard deviation (SD). Results: Higher WBC counts (OR = 1.08; 95% CI: 1.04-1.11) and higher MCHC values (OR = 1.14; 95% CI: 1.06-1.22) were positively associated with PD, whereas serum albumin showed an inverse association (OR = 0.76; 95% CI: 0.62-0.93). Spline models demonstrated significant nonlinear components for all biomarkers, and SD-scaled estimates confirmed consistent gradients. Conclusions: These findings support links between periodontal inflammation and systemic hematologic alterations. Longitudinal studies are needed to clarify underlying mechanisms.