Periodontitis is one of the most ubiquitous diseases and is characterized by the destruction of connective tissue and dental bone support following an inflammatory host response secondary to infection by periodontal bacteria [
It is now generally agreed that almost all forms of periodontal disease occur as a result of mixed microbial infections within which specific groups of pathogenic bacteria coexist [
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 by hand-searching in peer-reviewed journals and cross-referenced with the articles accessed.
The oral bacterial microbiome includes over 700 different phylotypes, with approximately 400 species found in subgingival plaque [
There is accumulating evidence for a higher level of periodontal disease among smokers [
One of the important oral signs of diabetes is gingivitis and periodontitis. Patients with undiagnosed or poorly controlled diabetes mellitus type 1 or type 2 are at higher risk for periodontal disease. There are many studies that demonstrate an association between diabetes and an increased susceptibility to oral infections including periodontal disease [
Despite discrepancy regarding this issue in the scientific literature, it seems that the effect of glycemic control is related to the mode of periodontal therapy [
The biological plausibility of the association between periodontal diseases and cardiovascular diseases is well studied and it includes some of the following possible mechanisms: high concentrations of cholesterol and the action of oral bacteria in the process of atherosclerosis or the participation of acute-phase proteins that may increase in chronic periodontitis [
Periodontal disease is capable of predisposing to vascular disease due to the rich source of subgingival microbial species and host’s response. Furthermore, we must be aware that these diseases share many risk factors and there are evident similarities to the basic pathogenic mechanisms [
Periodontitis is associated with the increase in the level of C-reactive protein and fibrinogen, irrespective of coronary diseases. Furthermore, there is evidence that suggests that the increase in the levels of systemic markers of inflammation, such as the C-reactive protein (CRP) and interleukin-6 (IL-6), is associated with cardiovascular diseases [
Bacteremia from periodontitis and dental disease is known to be the primary cause of infective endocarditis [
Wu et al. [
Some medications significantly decrease salivary flow. These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives, antihistamines, and antimetabolites. Other drugs, particularly those in liquid or chewable form that contain added sugar, alter the pH and composition of plaque, making it more able to adhere to tooth surfaces [
Drugs can be a contributing factor in periodontal diseases. Drugs such as anticonvulsants, calcium channel blocking agents, and cyclosporine may induce gingival overgrowth [
Patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease [
Obesity has been reported to be an important risk factor for periodontal disease [
Many of the studies conducted to date suggest there is a relationship between skeletal osteoporosis and bone loss [
Hemorrhagic gingival overgrowth with or without necrosis is a common early manifestation of acute leukemia [
Chronic periodontitis involves complex interactions between microbial factors and susceptible hosts [
Hormonal fluctuations in the female patient may alter the status of periodontal health [
Offenbacher et al. [
Similarly, several other studies have suggested an adverse influence of periodontal disease on the course of pregnancy [
Several studies show that the prevalence and severity of periodontal disease increase with age [
Numerous studies reported higher periodontal destruction among males compared to the female population [
The possible relationship between periodontal disease and socioeconomic status was found in several studies [
Periodontal disease has a reciprocal relationship with educational level. The higher the educational level, the lower the periodontal diseases (Department of Health Education and Welfare, 1966). Several studies involving different racial populations have found some difference in the expression of periodontal disease [
Studies show genetic risk factors associated with periodontitis [
Many works of the literature report familial aggregation of periodontal diseases, but due to different terminology, classification systems, and lack of standardized methods of clinical examination, it is difficult to compare reports directly. Although periodontal disease nosology has changed many times over the timeframe of these reports, most familial reports for periodontitis are for early-onset forms now called aggressive periodontitis [
In chronic periodontitis, the phenotype or disease characteristics do not present significantly until the third decade of life, whereas, in the aggressive forms of periodontal disease, the presentation can occur in the first, second, third, and fourth decades. This variability in presentation of significant signs of disease makes diagnosis difficult, not only in declaring if a patient suffers from the disease but also in detecting patients who do not suffer from the disease and differentiating between adult and aggressive forms of periodontitis. The problems associated with the clinical differentiation of periodontal disease are not uncommon in medical genetics, since similar problems arise in the study of other delayed-onset hereditary traits [
Cholesterol has long been known to play a crucial role in predicting risk for heart attack in seemingly healthy people. But half of all heart attacks occur among people who do not have high cholesterol. Also, the classical risk factors of CVD cannot account for all the variation in the incidence of CVD cases [
Many works in the literature report familial aggregation of periodontal diseases, but due to different terminology, classification systems, and lack of standardized methods of clinical examination, it is difficult to compare reports directly. Reports of the familial nature of chronic forms of periodontitis are less frequent, although German studies of the familial nature of chronic forms of periodontitis from the early 20th century have been reviewed by [
It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors.
The author declares that there is no conflict of interests regarding the publication of this paper.