Risk factors for periodontitis

Periodontal disease refers to a group of inflammatory conditions that affect the tissues around the teeth.

The mildest form of periodontal disease is gingivitis.

If left untreated, gingivitis can progress to periodontitis, which can lead to destruction of the supporting structures around the teeth.

Now, etiologic factors in periodontal disease are subdivided into two main groups, primary and secondary etiologic factors.

The primary, or initiating etiologic factor is the dental plaque or dental biofilm, which is a sticky collection of bacteria, salivary proteins, and dead cells from the oral mucosa.

On the other hand, secondary, also known as contributing etiologic factors, enhance the ability of dental plaque to cause periodontitis.

Secondary etiologic factors are further subdivided into local factors, which make the dental plaque more resistant and difficult to remove; and systemic factors, which include conditions like diabetes that could impair the host’s immune response and increase the risk of periodontitis.

Local factors include calculus, caries, tooth position, anatomical features, iatrogenic factors, and trauma.

First, let’s focus on calculus, which is defined as a calcified dental plaque.

Supragingival calculus is located above the gingiva while subgingival is below the gingiva.

Supragingival calculus is visible upon oral examination and it’s composed of organic and inorganic components.

Organic components include bacterial cells, salivary proteins, and lipids.

The inorganic component mainly consists of calcium phosphate.

In contrast to supragingival calculus, subgingival calculus is not visible upon oral examination and it’s harder to remove.

Additionally, subgingival calculus is associated with a higher calcium to phosphate ratio and more serum derived proteins.

Next up is dental caries, also known as tooth decay, which is caused by acid-producing bacteria that can eventually cause tooth demineralization.