However, more clinical research is required to establish alcohol consumption as a risk factor for periodontal diseases. Mt Sinai J Med. 1999 May;70(5):478-84. doi: 10.1902/jop.1999.70.5.478. USA.gov. The periodontal problems which are associated with HIV infection include specific forms of gingivitis and necrotizing periodontal diseases, as well as with possible exacerbation of pre-existing periodontal disease 58, 59. The periodontal breakdown has been found to be more among smokers as compared to non-smokers 14, 15. The gingival overgrowth is also associated with increased accumulation of local factors, thus, facilitating the progression of periodontal disease. Underlying immuno-deficiencies—e.g., AIDS 8. The association between diabetes mellitus and periodontitis has been found to be bi-directional. Crooked teeth 7. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Bridges that no longer fit properly 11. Periodontol 2000. The maintenance visits should be planned depending on the periodontal status of the patient and the presence of risk factors. PMID: 12102708 [Indexed for MEDLINE] Periodontal risk assessment is the overall evaluation of the patient to assess the risk for the development of periodontitis. 2005 Oct;39(1):118-31. Contents available in the book…………, The HIV infection is associated with a compromised immune response which predisposes the individual to various infections. The reason suggested for this difference is a better education level and more access to oral health care services by individuals with good socioeconomic status. A detailed description of stress as a risk factor for periodontitis has been given in chapter “Stress as a risk factor for periodontal diseases”. Female hormonal changes, such as with pregnancy or the use of oral contraceptives Many studies and reviews have been published which support a relationship between periodontitis and diabetes, Psychological stress is another risk factor for periodontal diseases, Non-modifiable risk factors (Risk determinants), Present data strongly suggest that genetic factors are important risk factors for periodontal disease progression. Various mechanisms have been suggested to explain the effects of obesity on the severity of periodontal disease 62-64. Subgingival margins of the restorations have been shown to have a positive correlation with the presence of gingival inflammation, Bleeding on probing is one of the earliest indicators of gingival inflammation. For optimal treatment results, systemic risk factors must be modified or eliminated. Furthermore, the position of the margin of restoration is also related to the gingival health. The reduction of this pathogenic microflora has been found to be strongly associated with improvement in periodontal health 10-13. Contents available in the book…………. The individuals with low socioeconomic status have been shown to have more periodontal destruction as compared to those having average or high socioeconomic status. Certain factors increase the risk for periodontal disease: 1. However, it has been demonstrated that absence of bleeding on probing is a good indicator of periodontal health 71, 72. The patient may have a single or multiple risk factors or determinants. Original articles that reported on the risk factors for periodontal disease were included. Epub 2020 Aug 12. Introduction to risk factors for periodontal diseases. It has been observed that stressed, anxious, or depressed persons tend to neglect their oral hygiene. Dental Clinics. 2020 Sep 2;20(1):243. doi: 10.1186/s12903-020-01231-2. 1. On the other hand, individuals with minimum periodontal loss of attachment have less risk for future periodontal breakdown. Local trauma. Bleeding on probing is one of the earliest indicators of gingival inflammation. Some are under the patient’s control, and may, therefore, require lifestyle changes to achieve significant modification. This site needs JavaScript to work properly. Bacterial species, including, The periodontal breakdown has been found to be more among smokers as compared to non-smokers, The association between diabetes mellitus and periodontitis has been found to be bi-directional. Psychological stress is another risk factor for periodontal diseases 24. © 1996 American Academy of Periodontology. The presence of faulty restorations and overhanging margins of crowns facilitate the accumulation of food particles and debris at the tooth-soft tissue interface. NIH Current view of risk factors for periodontal diseases. Stress has been shown to result in elevated levels of cortisols which further have been positively associated with the extent and severity of periodontitis 25. Other risk factors include: 1. In the following sections, we shall study in brief about these risk factors with their details in the upcoming chapters. Save my name, email, and website in this browser for the next time I comment. While it is accepted that the primary etiology of periodontitis is bacterial infection and a susceptible host response,15,16 the initiation and rate of destruction is affected by systemic and local risk factors. There are multiple mechanisms by which hyperglycemic state worsens the periodontal status of the patient. van Winkelhoff AJ, Bosch-Tijhof CJ, Winkel EG, van der Reijden WA. Initiation and progression of periodontal infections are affected by local and systemic conditions. 2020 Oct-Dec;10(4):514-518. doi: 10.1016/j.jobcr.2020.07.020. Relationship between herpesviruses and adult periodontitis and periodontopathic bacteria. It may alter the pH of the oral cavity, thus affecting plaque composition 67. The information presented in this website has been collected from various leading journals, books and websites. Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors in children, juveniles, and young adults. Relationship between the presence of certain bacterial pathogens and periodontal status of urban Thai adults. Risk factors which we know today as important include diabetes mellitus, especially in individuals in whom metabolic control is poor, and cigarette smoking. Stress management has been shown to improve the periodontal status of patients with periodontitis 27. Stress 5. Present data strongly suggest that genetic factors are important risk factors for periodontal disease progression. Journal of the International Academy of Periodontology. Recent studies also point to several potentially important periodontal risk indicators. Anatomical features. 2020 Aug 27;12(9):2614. doi: 10.3390/nu12092614. In a study, it was shown that salivary cortisol level was a significant predictor of the number of missing teeth and also of the number of teeth with clinical attachment loss of ≥5 mm 26. Genetics 10. Older age 5. NLM Rough …………… Contents available in the book…………. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Calculus. Local risk factors for periodontal disease 21. J Periodontol. Current view of risk factors for periodontal diseases. However, the relationship between socioeconomic status and periodontitis is less direct as compared to gingivitis 42, 48-50. Diseases such as rheumatoid … These include stress and coping behaviors, and osteopenia associated with estrogen deficiency. Smoking cessation has been shown to improve periodontal health.  |  Smoking is the No. Xerostomia. There is strong evidence in favor of the role of periodontal pathogenic microorganisms in the initiation and progression of periodontal diseases. On the other hand, periodontitis results in increased pro-inflammatory cytokines locally and then systemically. IL-1 and TNF-α gene polymorphism have been studied extensively and a positive correlation has been demonstrated between periodontitis and these polymorphisms, The present research on the etiopathogenesis of periodontal disease suggests that most of the tissue destruction caused by host-microbial interaction is primarily by host-derived chemical mediators. Step 1. Periodontal diseases are infections, and many forms of the disease are associated with specific pathogenic bacteria which colonize the subgingival area. 2018 Dec 30;49(4):280-287. doi: 10.25100/cm.v49i3.3919. Calculus (supra- and subgingival) Restorations. As already stated, the non-modifiable risk factors are also referred to as risk determinants. However, it should be noted that this association is not reliable as it entirely depends on the maintenance of oral hygiene and not on gender. Family studies, twin studies, population studies and single nucleotide polymorphisms (SNP) have been done to find out the genetic basis of periodontal diseases. This is because bleeding on probing indicates the presence of inflammation but not the severity of periodontal attachment loss. Thus, reduction in the microbial load around the teeth is the cornerstone of periodontal therapy. Systemic risk factors include poorly controlled diabetes mellitus and tobacco smoking. The book is usually delivered within one week anywhere in India and within three weeks anywhere throughout the world. Further, it has been found that certain individuals mount an abnormal host response to the microbial challenge. Various longitudinal studies done on non-surgical and surgical periodontal therapy have demonstrated that patients who regularly visit the dental office for periodontal maintenance have a better periodontal status as compared to those who infrequently visit the dental office (more details in. Contents available in the book…………. In many instances, the entrance of such furcations are restricted enough to limit access for proper hygiene maintenance. 1998 Oct-Nov;65(5-6):362-9. Clipboard, Search History, and several other advanced features are temporarily unavailable. Contents available in the book…………. In general, males have been shown to have more overall periodontal destruction as compared to females. The risk assessment is done based on the patient’s demographic data, medical history, dental history, and clinical examination. This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. In other words, it can be said that periodontal risk assessment involves identifying elements that either may predispose a patient to develop periodontal disease or may influence the progression of the disease that already exists. Periodontology 2000. 1. increase in developing gingivitis and periodontitis 2. increase the risk of developing more sever disease when gingivitis/periodontitis is already present Heredity 6. Microbial factors
  • Over 500 bacteria have
  • been identified
  • Authors categorized
  • bacterial species into
  • colour coded groups
  • based on … Khouja T, Miller RG, Moore PA, Orchard TJ, Costacou T. J Diabetes Complications. Epub 2019 Jun 3. In a study, it was observed that adolescents (11-18 years old) have a reduced intake of raw fruits and non-potato vegetables, which are sources of vitamin C. Furthermore, an increased intake of soft drinks and non-citrus juices were observed in this age group. Thus, a low dietary intake of vitamin-C and calcium can adversely affect the periodontal status of the individual 65. Poor oral hygiene 4.  |  2019 Sep;33(9):603-609. doi: 10.1016/j.jdiacomp.2019.05.025. Gingivitis 2. A lot of research has been done in the last few decades to find out various risk factors responsible for periodontal disease progression. Host response modulation therapeutic agents in periodontics, Role of genetics in the pathogenesis of periodontal diseases, Periodontal maintenance (Supportive periodontal therapy), Orthodontic-periodontal interrelationship, Piezosurgery in periodontics and oral implantology. Albandar JM. Systemic risk factors recently have been identified by large epidemiologic studies using multifactorial statistical analyses to correct for confounding or associated co-risk factors. Stańdo M, Piatek P, Namiecinska M, Lewkowicz P, Lewkowicz N. Nutrients. While these cannot be modified, recognizing them can help oral health professionals determine the most appropriate interventions. However, it must be noted that the periodontal destruction observed in elderly individuals is a cumulative destruction over several years rather than a result of increased rates of destruction. 1 Age is weakly related to the prevalence of periodontal diseases. A periodontal exam and assessment of both new and current patients in the dental practice is more important than ever. Local Risk Factors for Periodontal Diseases. Howev… Systemic conditions associated with reduced neutrophil numbers or function are also important risk factors … Data. However, it should be noted that the development of periodontal lesions vary among HIV-positive patients depending on the status of their immune system and maintenance of oral hygiene. Contents available in the book…………. 2009 Jan;80(1):122-9. doi: 10.1902/jop.2009.080248. A decreased estrogen production following menopause is associated with a decreased mineral density of bones 56. For example, if the patient is a smoker, the smoking cessation protocol should be included in the treatment plan. A detailed description of the relationship between diabetes and periodontitis has been given in “Diabetes and periodontitis: a bidirectional relationship”. 1 environmental and behavioral risk factor for periodontal disease, increasing the rate of bone resorption, chronic inflammation, and suppression of antibodies, which facilitates bacterial flourishing. Poor oral hygiene and pathogenic microflora: There is strong evidence in favor of the role of periodontal pathogenic microorganisms in the initiation and progression of periodontal diseases. Furcation anatomy. The periodontal problems which are associated with HIV infection include specific forms of gingivitis and necrotizing periodontal diseases, as well as with possible exacerbation of pre-existing periodontal disease, Recent research has demonstrated a positive association between obesity and periodontitis and obesity can be considered as a risk factor for periodontal disease, Alcohol intake has been associated with an increased severity of clinical attachment loss in a dose-dependent manner. At least two of these microorganisms, Porphyromonas gingivalis and Actinobacillus actinomycetemcomitans, also invade the periodontal tissue and are virulent organisms. This is because bleeding on probing indicates the presence of inflammation but not the severity of periodontal attachment loss. Van Dyke TE, Dave S. Risk factors for periodontitis. A risk factor that can be used to predict the future course of the disease is known a risk marker. Evaluation of social and psychological factors in periodontal disease. As already stated, the non-modifiable risk factors are also referred to as risk determinants. These include anti-hypertensive drugs, narcotic analgesics, some tranquilizers and sedatives, antihistamines, and antimetabolites. However, the relationship between socioeconomic status and periodontitis is less direct as compared to gingivitis, Osteoporosis is characterized by a decreased bone-mineral density throughout the skeletal system, including the jaws. Family studies, twin studies, population studies and single nucleotide polymorphisms (SNP) have been done to find out the genetic basis of periodontal diseases. Research demonstrates that stress can make it more difficult for the body to fight off infection, including periodontal diseases. Certain medications that cause dry mouth or gum changes 11. The risk factors for periodontal diseases can be classified broadly into two categories: modifiable risk factors and non-modifiable risk factors. Various studies have demonstrated that with increasing age the severity of periodontal diseases increases 10, 39-43. However, it must be remembered that bleeding on probing does not indicate the severity of periodontal breakdown. In a 12 month study, it was demonstrated that patients who had continuously refrained from smoking for the entire study period had a significant reduction in probing depths as compared to smokers 17. J Periodontol. A reduction or elimination of risk factor(s) should be included in the treatment protocol designed for a particular patient. The poor glycemic control worsens periodontal disease status and poor periodontal health has been shown to worsen the glycemic control. The local factors include pre-existing disease as evidenced by deep probing depths and plaque retention areas associated with defective restorations. The poor glycemic control worsens periodontal disease status and poor periodontal health has been shown to worsen the glycemic control. Contents available in the book…………. Bacterial species, including Porphyromonas gingivalis 1, Aggregatibacter actinomycetemcomitans 2, 3, Bacteroides forsythus 4, Prevotella intermedia 5, Peptostreptococcus micros 6, Fusobacterium nucleatum 7 and spirochetes 8, 9 have been specifically found to contain the virulence factors responsible for evasion of host response and periodontal breakdown. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Stress also is a risk factor for periodontal disease. Subgingival margins of the restorations have been shown to have a positive correlation with the presence of gingival inflammation 68-70. Investigation of the levels of different salivary stress markers in chronic periodontitis patients. Risk determinants are those risk factors that cannot be modified. Thus, stress can be considered as a modifiable risk factor that may influence the severity of periodontal diseases. HHS Patients having existing severe attachment loss are at a higher risk for future attachment loss. Certain drugs have been shown to be associated with decreased salivary flow. Further, it has been found that certain individuals mount an abnormal host response to the microbial challenge. This disorder has been shown to be positively associated with periodontal bone loss, …………… Contents available in the book…………. MEDLINE (1980 to Jan 2014), PubMed (using medical subject headings), and Google Scholar were searched using the following terms in different combinations: “periodontal disease,” “periodontitis,” “risk factors,” and “causal.” This was supplemented … Journal of periodontology. 1994 May;65:479-88. Hormonal changes (sometimes caused by pregnancy or menopause) 2. However, there are at least two significant risk factors-smoking and diabetes-which demand attention in current management of periodontal disease. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Gene poly-morphisms have been shown to have a positive correlation with increased severity of periodontal disease. Michalowicz BS. The reason suggested for this finding is the ignorance of oral hygiene, which is usually observed among males. Mouth breathing and lack of lip seal. Recent research has demonstrated a positive association between obesity and periodontitis and obesity can be considered as a risk factor for periodontal disease 60, 61. Thus, aging cannot be considered as a risk factor per se 44. The study of risk in periodontal disease is a rapidly emerging field and much is yet to be learned. A decreased salivary flow is associated with a decreased flushing effect of saliva in the oral cavity, which may contribute to the increased periodontal disease activity. This website is a small attempt to create an easy approach to understand periodontology for the students who are facing difficulties during the graduation and the post-graduation courses in our field. However, age is only one of the risk factors of periodontal disease. These include genetic factors, host response, age, gender and socioeconomic status. Keywords: In a study, Adhering strictly to the periodontal maintenance protocol has been shown to have a beneficial effect on the overall dentition and periodontium of the patients. Substance abuse 7. 2002;29:177-206. These areas become inaccessible for cleaning by the patient and promote the formation of a periodontal pocket. Risk indicators are probable or putative risk factors that have been identified in cross-sectional studies, but not confirmed through longitudinal studies. Certain drugs which are in a chewable form, commonly have sugar as one of their constituents. Genetics 3. three primary mechanisms by which local factors can increase the risk of developing periodontal disease or increase the severity of existing periodontal disease. Genco RJ. Obesity 8. These include smoking, uncontrolled diabetes mellitus, interleukin-1 genotype, BOP, poor oral hygiene, deep probing depth (> 6 mm), severity of alveolar bone loss, age, socioeconomic status and iatrogenic factors (Table 3). Our patients need to be educated on what periodontitis is and the associated risk factors for the disease. Furthermore, the position of the margin of restoration is also related to the gingival health. Modifiable risk factors are usually environmental or behavioral in nature, whereas non-modifiable risk factors are usually intrinsic to the individual and therefore can not be easily changed. These areas become inaccessible for cleaning by the patient and promote the formation of a periodontal pocket. Postmenopausal osteoporosis in females is an important risk factor associated with increased severity of periodontal diseases. Fraenal attachments. These include anti-hypertensive drugs, narcotic analgesics, some tranquilizers and sedatives, antihistamines, and antimetabolites. The present research on the etiopathogenesis of periodontal disease suggests that most of the tissue destruction caused by host-microbial interaction is primarily by host-derived chemical mediators. According to the CDC, periodontal disease increased with age. However, it has been demonstrated that absence of bleeding on probing is a good indicator of periodontal health, Periobasics A Textbook of Periodontics and Implantology, Text Book of Basic Sciences for MDS Students. Journal of periodontology. Thus, smoking can be considered as a modifiable risk factor for the development and progression of periodontal diseases. Matrix metalloproteinases (MMPs) are responsible for the remodeling of connective tissue. Risk factors may be environmental, behavioral or biologic in nature that when present increases the likelihood of a disease. Obesity, salivary glands and oral pathology. Contents available in the book…………. IL-6 and TNF-α are two main chemical mediators which relate periodontitis to diabetes. –Anatomy – The local anatomic risk factors for periodontal disease include:, 1. Initiation and progression of periodontal infections are clearly modified by local and systemic conditions called risk factors. Although, smokers have reduced clinical signs of periodontal inflammation as compared to non-smokers but they have an accelerated periodontal breakdown. Other factors increasing the risk of developing periodontal disease: Bridges that no longer fit properly trap food debris and allow dental plaque to accumulate and grow between the crown and gums Malocclusion - Crooked teeth make difficult the removal of dental plaque In fact, 70.1% of adults65 years and older have periodontal disease. However, it must be remembered that bleeding on probing does not indicate the severity of periodontal breakdown. Substance abuse 5. The presence of hyperactive neutrophils and monocytes in individuals showing severe periodontal breakdown has been demonstrated in many studies 32-35. Local risk factors could influence directly the periodontium, the most often involved local risk factors being dental calculus, malocclusions, improper or aged and degraded dental or prosthetic treatments, orthodontic appliances, affecting also the masticatory, esthetical and phonetical function consequently decreasing the quality of life. These two risk factors markedly affect the initiation and progression of periodontitis, and attempts to manage these factors are now an important component of prevention and treatment of adult periodontitis. Multiple risk factors do not increase the risk in an additive manner, but rather in an exponential manner. Rather, the disease has already occurred and the modifying factor alters the progression of the disease by modifying the body’s response to the disease itself or to the treatment. Torrungruang K, Bandhaya P, Likittanasombat K, Grittayaphong C. J Periodontol. 1996 Oct;67:1041-9. Local predisposing factors in periodontal disease Are oral conditions or habits that increase an individual`s susceptibility to periodontal disease These factors don't initiate gingivitis or periodontitis but contribute to the disease process initiated by dental plaque Increase plaque retention Interfere with plaque removal Induce direct damage to periodontal tissues 3. Genetic and heritable risk factors in periodontal disease. Contents available in the book…………. Global risk factors and risk indicators for periodontal diseases. What 3 things do local contributory factors cause? 2001 May;72(5):666-71. doi: 10.1902/jop.2001.72.5.666. Local risk factors can increase the risk of development and progression of periodontal disease by acting as plaque retention factors. increase plaque biofilm retention; increase plaque biofilm pathogenicity; cause direct damage to the periodontium. Controlling Systemic Risk Factors.Several risk factors have well established associations with both periodontal and systemic diseases, such as diabetes, smoking, stress, immunodeficiency, medications, obesity, hormones, and nutrition. A decreased salivary flow is associated with a decreased flushing effect of saliva in the oral cavity, which may contribute to the increased periodontal disease activity. Epidemiology and risk factors of periodontal diseases. These include poor oral hygiene and pathogenic microflora, tobacco smoking, diabetes, and psychological stress. BMC Oral Health. This finding establishes tobacco smoking as an important risk factor for the development of periodontitis. There are also background determinants associated with periodontal disease including gender (with males having more disease), age (with more disease seen in the elderly), and hereditary factors. Contents available in the book…………. A detailed description of the genetic basis of periodontal diseases has been given in “Role of genetics in pathogenesis of periodontal diseases”. (adsbygoogle = window.adsbygoogle || []).push({}); The risk factors for periodontal diseases can be classified broadly into two categories: modifiable risk factors and non-modifiable risk factors. COVID-19 is an emerging, rapidly evolving situation. The dietary habits of young and adolescents are different from that of older individuals. Effects of probiotic bacterium Weissella cibaria CMU on periodontal health and microbiota: a randomised, double-blind, placebo-controlled trial. It can be concluded from the above discussion that risk factors play an important role in the etiopathogenesis of periodontal diseases, as well as they affect the overall treatment plan designed for the patient. A number of studies have discussed each factor’s relationship to disease progression. Certain medications 8. 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