Risk Factors in Periodontology

In periodontology the maintenance of health depends on the balance of the relationship

between bacteria and the host response.
There are several risk factors that can cause periodontal problems, these include:
1. Oral hygiene
2. Local plaque retentive factors
3. Bacterial specificity
4. Systemic immune status
5. Smoking tobacco
6. Ethnic background
7. Age
8. Diet
9. Genetics
10.
Psychological state
11.
Socio-economic status
1. Oral Hygiene
We are seeking:
Clinically healthy gingiva is a term used to describe the level of gingival health that
may be attained by patients who clean their teeth in a meticulous manner.
The hostmicrobial balance must clearly change if gingivitis is to follow. Gingivitis will
follow if there is sufficient plaque accumulation and retention such that microbial
products evoke a more substantive inflammatory response.
The strictest oral hygienic programs were not effective in controlling certain periodontal
problems such as aggressive periodontitis and could not prevent the progression of
attachment loss in those individuals being susceptible to aggressive disease.
2. Local Plaque retentive factors:
A. Anatomic causes

Shape of the tooth

Orthodontic disorders
Shape and tightness of the contact point
Thickness and shape of the alveolar bone
Shape of the roots
Shape and position of the furcation area
Quality of the cement-enamel junction
Enamel developmental disorders
Dental calculus

B. Iatrogenic causes

Faulty restorations

A subgingivally placed or approximal crown margin-even with the best marginal

adaption- will provide a niche for bacterial accumulation.
All restorations are considered as plaque retentive factors. Consequently, the quality of
the restoration are a decisive factor in periodontal health.
3. Bacterial Specificity
Periodontitis will not develop without the presence of subginival bacterial biofilm.
The composition of the subgingival biofilm is decisive in the course of periodontitis.
Periodontitis is an opportunistic infection.
There are certain well defined bacterial strains that do not normally occur in the healthy
sulcus and oral cavity. Their colonization strictly correlates with the occurrence and
progression of disease.
4. Systemic Immune Status
In general, individuals with systematically healthy immune system can tolerate and
neutralize the majority of the side effects of the inflammation protecting the
periodontium against plaque bacteria.
But this is not the case for immunocomprised patients and Debilitating systemic illness
can alter the hosts ability to cope with infections and may exacerbate existing
infections.
For example: those who are HIV positive; are diabetic; or have osteoporosis.
5. Smoking
It has been shown that cigarette smokers have more bone loss, attachment loss, deeper
periodontal pockets, and less gingival bleeding than non-smokers.
They also have a different bacterial colonization pattern, which the reason is unknown.
The smoking targets several mechanisms in the gingiva that determine the balance
between dental plaque and periodontal defensive factors
6. Puberty, Pregnancy, and menopause
Periods of hormonal flux are known to occur during puberty, menstruation, pregnancy,
and the menopause, FSH and LH in particular. The gingiva is a target tissue for the
actions of steroid hormones.
Clinical changes in the tissues of the periodontium have been identified during periods of
hormonal fluctuation.
7. Ethnicity
The effect of race has been studied in the USA. The periodontal attachment loss is
significantly higher in American blacks than in age than in Caucasians.

8. Age
The average attachment loss is increasing parallel with the ages
Due to the gerophysiological changes occurring in the periodontium the aged periodontal
tissue is more susceptible to plaque effect and inflammatory tissue damages than that of
the younger tissue.
The regenerative potential of the periodontium is decreasing with ages.
9. Diet
Certain dietary factors, in particular fruit juices, yoghurt, and wines, have been
implicated in the causation of root dentin hypersensitivity. By their acidity and ability to
etch dentin these substances may dissolve the occlusions of the dentinal tubules or
prevent them from forming.
10. Genetics
Any kind of gene combination that might have effect on the development of periodontal
tissues or influence the innate or specific immune reactions can be a major susceptibility
risk factor in the etiology of periodontal disease,
11. Psychological state/stress
In depression, some patients have lost their motivation and neglect their oral hygiene.
Antidepressants cause xerostomia, promote plaque accumulation and periodontal
disease.
12. Socio-economic factors
Epidemiological studies show a positive correlation between the socio-economic status
and the prevalence and severity of periodontal disease
The social status also determine some other behavioral risk factors (smoking, diet, oral
hygiene, systemic diseases, stress)