Understanding the risk factors of periodontal disease greatly benefits dentists and patients. Modifiable risk factors are able to be reduced through lifestyle changes and proper dental care. While non modifiable risk factors cannot be changed, they allow for proactive monitoring and early intervention.
Modifiable risk factors
Tobacco use is correlated with decreased effectiveness of treatments. Compared with non-smokers, smokers have greater levels of bone loss, attachment loss, deep periodontal pockets and tooth loss. Smoking decreases vascularisation which is associated with poor healing processes.
Poor oral hygiene involving inadequate or infrequent brushing and flossing can lead to the build up of plaque. This also means that anaerobic organisms colonise to cause deeper destruction. These include Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and Tannerella forsythia. When they penetrate deeper into the periodontium, they trigger the release of inflammatory mediators, and other defensive products. There is shift in the microbiological status from aerobic bacterial species into obligate anaerobes.
Unhealthy diet involving low nutrients such as vitamin C, can compromise the body's ability to fight infections, including those in the gums.
Diabetes: insulin resistance in diabetes causes the presence of free radicals. The effect on the gums is oxidative stress, which causes a surge in inflammatory cytokines, and a hyper-inflammatory state. This inflammatory state can alter the metabolic and hormonal state of cells. causing destructive changes. Hence, in diabetics with poor glycaemic control, they often have enhanced periodontal breakdown and impaired wound healing.
Medications such as certain antihypertensive and antiepileptic drugs, may have side effects that affect gym health.
Stress may weaken the eimmune system and the gums more susceptible to infection.
Bruxism (teeth grinding) grinding or ckenching the teeth can cause damage to the periodontium.
Obesity is linked to systemic inflammation associated with excess body fat.
Non-modifiable risk factors
Age: Older individuals have a more severe inflammatory response to plaque deposition, with the response containing many inflammatory cells. Moreover, with ageing being associated with a loss of dexterity, older individuals tend to be less diligent with oral hygiene maintenance.
Genetics: Genetically, some people may be predisposed to periodontal disease.
Systemic diseases such as authoimmune and blood disorders can increase the risk of periodontal disease. Several genetically linked systemic disorders have been shown to manifest as periodontal diseases. These include Down Syndrome, Ehlers-Danlos syndrome (types IV and VIII), and Crohn Disease. Osteoporosis is linked to an increase likelihood of bone breakdown.
Hormonal changes such as pregnancy, puberty and menopause. This can promote inflammatory responses linked to gingivitis and periodontitis. Maternal hormones are linked to bacteria such as Porphyromonas gingivalis, which is a key player in periodontitis.
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