Study protocol: Dental and periodontal characteristics of older adults in Atahualpa, Ecuador within the Atahualpa Project cohort

This study protocol describes an observational, cross-sectional investigation of oral health in community-dwelling older adults from Atahualpa, a rural village in Ecuador, embedded within the long-standing Atahualpa Project cohort. Using a door-to-door survey approach (all registered residents aged ≥60 years; n=410), participants will be attended twice a week to the School of Dentistry of University through six coordinated stations: (1) Oral diagnosis and entry of general data of the people using the unique identifier of the Atahualpa cohort of each participant, (2) periodontics, where records of the periodontal status will be performed according to the AAP/EFP 2018 clinical guidelines. In addition, subgingival biofilm sampling will be performed for 16S rRNA sequencing and gingival crevicular fluid for multiplex cytokine profiling, (3) Intra Oral Scanning (IOS) to obtain high-resolution digital models for dental morphometrics, (4) maxillofacial imaging with bimaxillary cone-beam computed tomography (CBCT) to support periodontal charting, and complementary structural findings, (5) indicated dental procedures: restorations, root canals, extractions, and prosthesis using computer-aided design and computer-aided manufacturing (CAD/CAM) and (6) patient education sessions and conducting validated surveys such as the Geriatric Oral Health Assessment Index (GOHAI), the European Health Literacy Survey-16 (HLS-EU-Q16) (in its Spanish version) and the Short Health Literacy Screen (BHLS). Primary objectives are to quantify associations between periodontitis severity, microbial composition, and local inflammatory profiles with neurocognitive and neuroimaging outcomes already available in the cohort (total MoCA and a composite cerebral small vessel disease score), controlling.