Periodontitis and multimorbidity: A conceptual framework

Periodontitis is a chronic inflammatory disease that has been consistently linked to a range of chronic conditions, including diabetes, cardiovascular disease, and neurodegenerative disorders. Multimorbidity, defined as the co-occurrence of two or more chronic conditions in an individual, shares complex and multifactorial pathways with periodontitis, with both increasing in prevalence with age. However, the nature of their relationship, whether driven by shared risk factors or causal interactions, remains unclear. Several independent conceptual models have been developed to identify the determinants of periodontitis and multimorbidity. However, no unified frameworks currently exist to understand the interconnections between oral health, particularly periodontitis and chronic conditions. Given that oral health is an integral component of general health, developing an integrated conceptual model is essential to illustrate plausible pathways, guide future research, and support integrated prevention strategies. Therefore, this paper proposes an integrated conceptual framework to illustrate the potential association between periodontitis and multimorbidity, grounded in shared biological mechanisms and informed by the Common Risk Factor Approach and social determinants of health. The model integrates structural, behavioural, and biological factors within a single framework centred on biological pathways. This framework provides a foundation for future research and may support the development of integrated prevention and management strategies.