Background: Self-reported periodontal or 'gum' health may be a useful measure for service planning and for monitoring periodontal health in developing and resource-limited countries, where the cost of clinical oral surveys may be major barriers to risk factor surveillance. Little is known about chronic systemic health conditions as a risk for poor oral health in South Africa. Objectives: To determine the systemic health and lifestyle factors associated with self-reported poor periodontal health status in South Africa. Data source: The 2003-2004 South African Demographic and Health Survey (SADHS). Methods: This secondary data analysis involved dentate adults >=15 years-old who participated in the SADHS (n=6,319). Information obtained using an interviewer-administered questionnaire included socio-demographic data, health risk behaviours (tobacco and alcohol use) and any history of nurse/physician-diagnosed chronic disease(s). Taking account of the multi-stage sampling used in the SADHS, data analysis included t-test, chi-square and multiple logistic regression analysis. Results: Of the respondents, 4.6% (95%CI; 3.9 - 5.5) self-reported having had a 'gum problem' or poor periodontal health in the six months prior to the survey date. Those who reported poor periodontal health were significantly older than those who did not report poor periodontal health (38.8yrs vs. 36.2yrs; p = 0.02) and were more likely to be alcoholics (OR = 2.53; 95%CI = 1.68 - 3.82) as compared to non-drinkers. Having suffered stroke (OR = 4.13; 1.53 - 11.11) or suffering from arthritis (OR = 1.70; 1.00 - 2.90) were significantly associated with higher odds of reporting poor periodontal health. Blacks had the highest odds of reporting poor periodontal health (OR = 3.91; 1.38 - 11.05) when compared to whites. Conclusions: The study findings demonstrated racial disparity in periodontal health and highlight the need to integrate oral health promotion with general health promotion programmes, especially those targeted at chronic disease prevention and rehabilitation.