Risk factors for periodontitis
Definitions & Key takeaways
Periodontal disease refers to a group of inflammatory conditions that affect the supporting tissues around the teeth. The mildest form of periodontal disease is gingivitis and if left untreated, it can progress to periodontitis.
Risk factors for periodontitis include dental plaque, dental caries, trauma, and systemic factors that may impair the host's immune defense like HIV infection, poor oral hygiene, smoking, and stress. By being aware of these risk factors, individuals can take steps to reduce their risk of developing periodontitis, such as practicing good oral hygiene, quitting tobacco, and seeking treatment for any underlying medical conditions. Regular dental check-ups are also important for detecting and treating periodontal diseases in their early stages.
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.
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.
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.
Moreover, caries along the gingival margin can cause dental plaque retention, thereby increasing the risk of periodontal disease.
The next local factor is the tooth position. Overcrowded teeth, or dental crowding, occurs when there’s an insufficient amount of space for all teeth to properly erupt.
The last one is tipping. When a tooth is extracted, the tooth distal to it will often tip mesially into the space and create a difficult area to access.
All three factors can cause dental plaque-retentive areas and therefore increased risk of periodontitis. Let’s move on to anatomical factors that make biofilm difficult to remove.
Now, furcation involvement refers to a bone loss in the furcation area, which is the place where the roots of multi-rooted teeth diverge.
In some individuals, these depressions can extend to the root and this is especially common in maxillary lateral and central incisors.
Finally, we have concavities which are linear depressions of the root surface that are typically located on the mesial surface of maxillary first premolars.
On the other hand, there are also anatomical features of the soft tissue that can increase the risk of periodontitis, such as inadequate attached gingiva, gingival clefts, enlargements, and craters.
These deformities create a favorable environment for bacterial growth and eventual plaque formation. Moving on to iatrogenic factors.
These contributing factors occur due to inadequate dental procedures and restorations. Open margins of restorations occur when the restoration material, such as a crown, does not reach the natural tooth margin, leaving a small gap where dental plaque can accumulate.
On the other hand, overhanging margins of restorations occur when the material extends beyond the tooth structure, creating an overhang.
In addition to being extremely hard to clean, the newly formed environment also promotes the growth of Gram negative bacteria that can eventually cause periodontal disease.
Finally, we have open contacts or spaces between adjacent teeth that are commonly associated with food impaction. Food impaction can lead to direct trauma to the interdental tissue and it also creates a favorable environment for bacterial growth and the formation of dental plaque.
The last main local factor associated with increased risk of periodontitis are traumas, such as occlusal trauma or soft tissue trauma.
Occlusal trauma occurs when the maxillary and mandibular teeth exert force on each other, resulting in the injury of the periodontium.
In combination with inflammation, occlusal trauma can result in periodontal damage. On the other hand, soft tissue trauma is typically associated with inappropriate oral hygiene techniques such as vigorous brushing and flossing.
Now, moving on to systemic conditions associated with periodontal disease. First, let’s focus on endocrine disorders, starting with diabetes mellitus.
Uncontrolled blood glucose levels can decrease resistance to infection by impairing the chemotaxis of neutrophils, which are the first-line of defense against the bacteria.
Another possible risk factor is obesity. Finally, we have conditions associated with hormonal changes, such as puberty, pregnancy, estrogen deficiency, and oral contraceptives.
Puberty gingivitis is common in individuals between 11 and 13 years of age and it can affect both males and females. Alternatively, during pregnancy, there’s an increased concentration of estrogen and progesterone in the gingival crevicular fluid.
On the other hand, low levels of estrogen are also associated with an increased risk of periodontitis. This is common for individuals with estrogen deficiency and osteoporosis.
Finally, oral contraceptives can cause gingival enlargement and decrease host response to dental plaque. Next, conditions that compromise the host’s immune system also increase the risk of periodontitis.
For example, HIV positive individuals can develop necrotizing gingivitis, and the more severe necrotizing periodontitis which is characterized by rapid bone loss.
Moreover, periodontitis can occur in individuals with leukemia and neutrophil disorders, both of which compromise the effectiveness of the immune system.
Genetic disorders that affect the immune system or connective tissue development can also increase the risk of periodontitis.
These include severe congenital neutropenia, Chediak-Higashi syndrome, and Down syndrome. Medications that can cause gingival overgrowth can also increase the risk of periodontal disease.
For example, individuals on phenytoin, a seizure medication, develop gingival hyperplasia in about 50% of cases. Next, we have calcium channel blockers, such as nifedipine which causes a gingival enlargement in 20% of cases.
Another medication that is associated with this side effect is cyclosporine, an immunosuppressive medication typically used to prevent organ rejection after transplantation.
If combined, nifedipine and cyclosporine can cause a severe overgrowth of the gingiva! Now, it’s important to note that stress can also increase the risk of periodontal disease because it’s associated with poorer oral hygiene and an altered immune response.
This is because stress can alter the protective response of neutrophils, which is further followed by the upregulation of macrophages.
Macrophages produce chemical mediators that eventually damage the surrounding connective and bone tissue. Another important risk factor is smoking, which is associated with an increased incidence and severity of periodontitis.
It has been shown that smoking can impair neutrophil function and reduce gingival microcirculation. Impaired gingival microcirculation is related to decreased bleeding on probing which can mask periodontal disease.
It’s important to note that smokers are more prone to a painful infection of the gingiva called necrotizing gingivitis, or NG for short, which is characterized by bleeding and ulcerations of the gingiva.
Finally, we have poor nutrition, which can directly influence the resistance and healing process of the periodontium. Studies have suggested that low dietary intake of calcium and vitamin D may decrease the resistance of the periodontium and slow healing.
Now, we have one last thing to cover and that’s the periodontal risk assessment, or PRA. The goal of this assessment is to identify individuals who are more likely to develop periodontal disease.
This is important because even if two individuals both have the same periodontal condition, the individuals with higher risk may require different case management than the person with lower risk.
Periodontal risk assessment covers four categories of risk elements and they include risk factors, risk indicators, risk determinants, and risk markers.
Risk factors increase the chance of developing periodontitis and they include tobacco smoking, diabetes mellitus, pathogenic bacteria, and accumulation of dental plaque.
Risk indicators are defined as possible risk factors for periodontal disease. Risk indicators include HIV infection, osteoporosis, obesity, poor nutrition, and infrequent dental visits.
Risk determinants are individual characteristics that cannot be modified, such as genetic factors, age, gender, stress, and socioeconomic status.
Finally, risk markers are associated with an increased risk of developing the disease. Important risk markers include the previous history of periodontal disease, bleeding on probing, and gingival biomarkers.
##Summary All right, as a quick recap. Periodontal disease refers to a group of inflammatory conditions that affect the supporting tissues around the teeth.
The mildest form of periodontal disease is gingivitis and if left untreated, it can progress to periodontitis. The primary etiologic factor of periodontitis is dental plaque; while secondary etiologic factors include local factors, such as calculus, caries, tooth position, anatomical features of teeth, iatrogenic factors, and trauma; and systemic factors, which include systemic conditions that may impair the host’s immune defense and increase the risk of periodontitis.
These include endocrine, hematologic, and immunocompromised conditions; medications, smoking and stress. Periodontal risk assessment is used to identify individuals who are more likely to develop periodontal disease.
No notes for this video yet
Try adding a note below