Hyperuricemia and Elevated Uric Acid/Creatinine Ratio are Associated with a Higher Risk of Periodontitis: A Population- based Cross-Sectional Study

Objectives To explore the relationship between hyperuricemia and the risk of developing periodontitis. Materials and Methods A representative dataset of 10,158 adults was extracted from the National Health and Nutrition Examination Survey (NHANES) 2009–2014. The relationship between hyperuricemia (the primary exposure) and the risk of periodontitis (outcome) were evaluated using weighted logistic regression models. Serum uric acid (UA) levels and the UA to creatinine (UA/Cr) ratio were used as secondary exposures. Their associations with the risk of periodontitis were analyzed using weighted logistic regression or restricted cubic spline regression. Results The prevalence of moderate/severe periodontitis was 56.7% among individuals with hyperuricemia and 44.8% among those without. After adjustment, individuals with hyperuricemia had a 26.9% higher risk of developing moderate/severe periodontitis compared to those without hyperuricemia (adjusted OR  = 1.269, 95% CI  = 1.080 to 1.492, P  = 0.006). This increased risk could be explained by a linear relationship with the serum UA/Cr ratio and a U-shaped relationship with serum UA levels. Each unit increase in the serum UA/Cr ratio was associated with a 4.6% higher risk of developing moderate/severe periodontitis (adjusted OR  = 1.046, 95% CI  = 1.008 to 1.086, P  = 0.021). Additionally, each 1 mg/dL increase in serum UA was associated with a 10.2% higher risk (adjusted OR  = 1.102, 95% CI  = 1.008 to 1.206, P  = 0.035) of developing moderate/severe periodontitis when UA levels were greater than 5.5 mg/dL, but a 10.6% lower risk when UA levels were 5.5 mg/dL or lower (adjusted OR  = 0.894, 95% CI  = 0.800 to 0.998, P  = 0.046). Sensitivity analyses validated the robustness of the findings. Conclusions This study provides the first direct evidence that hyperuricemia is associated with an increased risk of developing periodontitis, especially the moderate and severe forms. Clinical Relevance Individuals with hyperuricemia may represent a subgroup of the population susceptible to periodontitis. It may be prudent to initiate timely systemic and periodontal interventions in patients with hyperuricemia to halt the progression of periodontitis.