# Elevated Salivary Theobromine and Long‐Term Improvement of Periodontal Health in Two Cohort Studies

## TL;DR

Higher levels of theobromine in saliva are linked to better long-term periodontal health in two large studies.

## Contribution

This study is the first to show a long-term association between salivary theobromine and improved periodontal health in prospective cohort data.

## Key findings

- Higher salivary theobromine levels were associated with lower mean probing depth.
- Theobromine was linked to fewer sites with probing depth ≥ 3 mm.
- Results were replicated in two independent cohorts over 7 and 10 years.

## Abstract

Theobromine, a methylxanthine mainly found in chocolate, has been suggested to possess various health‐promoting properties. This study aimed to investigate the long‐term effect of salivary theobromine levels on periodontitis severity using 7‐ and 10‐year follow‐up data from the prospective Studies of Health in Pomerania (SHIP‐TREND and SHIP‐START).

We conducted a non‐targeted metabolomics analysis of salivary methylxanthines in 679 participants from SHIP‐TREND and 953 participants from SHIP‐START. Inverse‐probability‐of‐treatment‐weighted generalised linear models were used to assess the relationship between salivary theobromine and periodontal variables, including bleeding on probing, probing depth and clinical attachment loss.

Higher salivary theobromine levels were significantly associated with improved periodontal health, as evidenced by lower mean probing depth and a reduced percentage of sites with probing depth ≥ 3 mm. The results were successfully replicated in the SHIP‐START data and extended to a lower clinical attachment loss.

Our cohort studies suggest that elevated salivary theobromine levels are associated with improved periodontal parameters over 7 and 10 years. These results indicate the potential for theobromine‐containing products to support periodontal health, warranting further investigation through randomised controlled trials.