1. Environmental, Acquired, and Behavioral Factors
1.1. Specific Bacteria
1.1.1. Common Bacteria: Red group
1.1.1.1. P. Gingivalis B. forsythus T. denticola
1.1.2. Plaque is main etiological factor
1.1.3. But isn't sufficient alone to explain why pt. has periodontal disease.
1.2. Smoking
1.2.1. Major Risk Factor in periodontitis
1.2.2. Smoking causes changes, mainly immunological.
1.2.3. Smokers do respond to tx, but less so than non-smokers.
1.2.4. Ex-smokers do have improved response to tx.
1.3. Diabetes
1.3.1. Host produces:
1.3.1.1. Additional Collagenase
1.3.1.2. Additional Inflammatory cytokines
1.3.1.3. Advanced Glycation End Products
1.3.2. Major Risk Factor in periodontitis
1.3.3. Prevelance between Type 1 and 2 isn't determined. Most studies have been with type 2
1.3.4. There are changes in oral flora.
1.4. Not yet established as risk factors
1.4.1. Obesity
1.4.1.1. Chronic inflammatory response
1.4.2. Stress
1.4.2.1. Lower socioeconomic status has greater prevelance. These studies haven't controlled other factors such as hygiene.
1.4.3. Osteoporosis
2. Conclusion
2.1. Specific bacteria, cigarette smoking and diabetes mellitus are the major established risk factors for periodontitis
3. Risk Factor
3.1. Aspect of personal behavior or life-style, an enviornmental exposure, or an inborn or inherited characteristic which, on the basis of epidemiologic evidence, is known to be associated with disease-related condition.
3.2. Compare to etiological factor = causes disease
4. Non-modifiable factors
4.1. Not significant risk factors
4.1.1. Age
4.1.1.1. Prevalence and severity of periodontitis increase with older age
4.1.1.2. However , the concept of periodontitis as an inevitable cause of age has been challenged
4.1.1.3. Other factors - such as oral hygiene - must be removed in order to consider only age.
4.1.2. Gender
4.1.2.1. Women have lower prevelance bc they traditionally take better care of teeth, more likely to not fail a hygiene appt.
4.1.2.2. No established inherent difference between men and women
4.1.2.3. No difference in susceptibility to periodontal disease.
4.1.3. Race
4.1.3.1. Differences in the prevalence of periodontitis between countries and across continents.
4.1.3.2. But no consistent patterns after accounting for co-variates such as oral hygiene
4.2. Significant risk factor
4.2.1. Genetics
4.2.1.1. Significant modifiers of the periodontitis phenotype
4.2.1.2. Aggressive periodontitis seems to have more connection to genetics.