Periodontal Disease and Overall Health: A Clinician's Guide

CHAPTER 2 Overview of Periodontal Disease:CHAPTER 2 Causes, Pathogenesis, and Characteristics 11Risk FactorsThere are a number of risk factors associatedwith periodontal diseases. 29-34 Determiningrisk is helpful in developing recommendationsfor prevention and indetermining strategies for the overall managementof periodontitis. It has been recognizedthat the severity and progression ofperiodontal disease varies from individualto individual. Bacteria are essential for theinitiation of the disease, but it is the host responseto the bacterial challenge that determinesthe severity and rate of progression ofthe periodontitis. Therefore, it is the host’simmunologic reaction that determines susceptibilityto the disease.General categories of risk factors associatedwith the development of periodontitisinclude genetic, environmental (e.g., tobaccouse), and acquired risk factors (e.g., systemicdisease). Risk factors (Table 2) and riskreduction strategies (Table 3) should be consideredwhen assessing each patient. 35 Somerisk factors can be modified to reduce apatient’s susceptibility. Environmental factorssuch as tobacco use and stress can bemanaged with smoking cessation and stressmanagement; for acquired factors such assystemic diseases, medications usuallyprescribed by the physician can be used tohelp in the management and control ofchronic disorders (Table 3). The use ofchemotherapeutic agents specifically designedto improve the clinical outcomes ofmechanical treatments for periodontal diseasesmay be particularly useful in the managementof those individuals with single ormultiple risk factors. Risk assessment canTable 2. Risk Assessment for Periodontitis1. Heredity as determined by genetic testing and family history2. Smoking, including frequency, current use, and history3. Hormonal variations such as those seen in:a. Pregnancy, in which there are increased levels of estradiol and progesterone that may change theenvironment and permit virulent organisms to become more destructiveb. Menopause, in which the reduction in estrogen levels leads to osteopenia and eventually osteoporosis4. Systemic diseases such as:a. Diabetes (the duration and level of control are important)b. Osteoporosisc. Immune system disorders such as HIVd. Hematologic disorders such as neutropeniase. Connective tissue disorders such as Marfan’s and Ehlers-Danlos syndromes5. Stress as reported by the patient6. Nutritional deficiencies and obesity that may require a dietary analysis7. Medications such as:a. Calcium channel blockersb. Immunomodulatory agentsc. Anticonvulsantsd. Those known to cause dry mouth or xerostomia8. Faulty dentistry such as overhangs and subgingival margins9. Poor oral hygiene resulting in excessive plaque and calculus10. History of periodontal diseaseSources: J Periodontol 1994;65:260–267. 29 J Periodontol 1995;66:23–29. 30 J Periodontol 1999;70:711–723. 31J Periodontol 2000;71:1057–1066. 32 J Periodontol 2000;71:1215–1223. 33 J Periodontol 2000;71:1492–1498. 34