A new study published in the Journal of Periodontology showed that a lower severity of periodontitis was linked to a larger poverty–income ratio (PIR). Periodontitis severity is controlled by a complex interaction of social and clinical characteristics, such as socioeconomic level, oral hygiene practices, smoking, systemic disorders, and access to dental care, all of which influence disease development and treatment outcomes. Thus, this study examined the relationship between the poverty-income ratio (PIR) and periodontitis severity utilizing the 2018 Periodontal Status Classification to Epidemiological Survey Data (ACES) framework.This study included three NHANES cycles (2009–2014) with 10,598 participants aged ≥30 who had comprehensive periodontal exams. Extent (localized/generalized), grade (A–C), and staging (I–IV) were determined. The poverty-income ratio was the main exposure. The factors were BMI, HbA1c, and smoking status (present, past, or never). For the PIR major effects, n = 9708 was the analytical sample. Binary logistic regression was employed for extent, whereas multinomial logistic regression was utilized for stage/grade. The main effects and interactions were included in full models; interactions that were not significant were eliminated. Stage IV vs I RRR = 0.58, stage III 0.73, and stage II 0.87 (p < 0.001); grade C versus A 0.74, grade B 0.83 (p < 0.001); and generalized extent OR = 0.93 (p < 0.001) were all protected by a higher PIR. There was a graded risk associated with smoking: stage III RRR = 2.19, stage IV 3.82 (p < 0.001); grade B 1.57, grade C 2.18 (p < 0.001); generalized OR = 1.46 (p < 0.001); former versus never generalized OR not significant (p = 0.24).Higher severity was linked to the HbA1c increases: grades B/C against A 1.58/1.82 (p < 0.001); stages II–IV versus I RRRs = 1.56/1.97/2.14 (all p < 0.001); extent OR = 1.00 (p = 0.81). Stage II/III/IV RRRs = 0.69/0.48/0.30 (all p < 0.001); grade B/C 0.54/0.43 (p < 0.001); extent OR for PIR = 0.93 (p < 0.001); and BMI OR = 1.00 (p = 0.184) were all significantly correlated with PIR.Overall, a greater PIR was linked to reduced periodontitis stage, grade, and generalized extent in NHANES 2009–2014 cycles including people categorized by the 2018 system using the ACES framework. While previous smoking was not significantly correlated with extent, current smoking status was linked to higher stage, grade, and likelihood of widespread illness.Source:Chen, M. X., Yu, Y., Wei, C. X., Sabri, H., & Saleh, M. H. A. (2026). Periodontitis severity and its social and clinical determinants: An ACES framework-based NHANES analysis. Journal of Periodontology. https://doi.org/10.1002/jper.70064