demonstrated that the mean annual rate of bone loss among the initially 70-year-old subjects was 0.28 mm compared to 0.07 on the 25-year-old individuals [112]. <>>>/Contents 21 0 R/Parent 3 0 R>> 19 0 obj Other dental problems. Objectives. Tobacco smoking exerts a substantial destructive effect on the periodontal tissues and increases the rate of periodontal disease progression [ 24 ]. [Article in German] Schneider G(1), Leyendecker SS. Data. 2014 . 31 0 obj Risk factors of periodontal disease: review of the literature. In the last 10 years, a rising number of epidemiological investigations have studied the possible association between chronic oral infections and cardiovascular diseases (CVD). 7 0 obj A. Aas, and F. E. Dewhirst, “The breadth of bacterial diversity in the human periodontal pocket and other oral sites,”, A. Men who reported being angry on a daily basis had a 43% higher risk of developing periodontitis compared with men who reported being angry seldom [66]. Janket, A. Wightman, A. E. Baird, T. E. van Dyke, and J. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors. Patients with chronic leukemia may experience similar but less severe periodontal changes. <>>>/Contents 24 0 R/Parent 3 0 R>> <>stream <>stream It can be certain that gingival health is better among individuals with higher education and with more secure income. Conclusions. teristics, periodontal disease definitions, and techniques used across studies, it was not appropriate to apply statistical methods to estimate the overall pooled risk of periodontal disease in the studies. One of the important oral signs of diabetes is gingivitis and periodontitis. x�+�r McDevitt et al. In addition, Bacteroides forsythus [19], Prevotella intermedia [18], Peptostreptococcus micros [20], and Fusobacterium nucleatum [21] have been strongly linked with the progression of adult periodontitis. Children and adolescents can have any of the several forms of periodontitis such as aggressive periodontitis, chronic periodontitis, and periodontitis as a manifestation of systemic diseases [6–8]. Original articles that reported on the risk factors for periodontal disease were included. 9 0 obj Studies have found some periodontal disease indicators such as tooth loss and gingival bleeding to be associated with work stress [66, 67] and financial strains [68]. 2 0 obj Epidemiological and microbiological studies have lent credence to the concept that periodontal disease may be a separate risk factor for cardiovascular disease, cerebrovascular disease [53], and preterm delivery of low birth weight infants [54]. Drugs can be a contributing factor in periodontal diseases. Factors associated with the prevalence of periodontal disease in low-risk pregnant women. Many studies addressed the effect of periodontal treatment on glycemic control of diabetes patients [39–46]. Risk Factors Associated With Periodontal Diseases- A Review Sreedhar Reddy 1 , M. Anita 2 1 Department of public health dentistry, Tagore dental college and hospital, Rathinamangalam, Chennai. Evidence for the existence of high-risk groups and individuals and approaches to their detection,”, S. D. Benjamin and P. N. Baer, “Familial patterns of advanced alveolar bone loss in adolescence (periodontosis),”, J. People who consume less than the recommended dietary allowance (RDA) for calcium and vitamin C have slightly higher rates of periodontal disease [74]. This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. Currently, there are two major forms of periodontitis-chronic and aggressive periodontitis [6]. A. Jones, “Does periodontal treatment improve glycemic control in diabetic patients? 25 0 obj An understanding of risk factors is essential for clinical practice. Risk Factors of Periodontal Disease: Review of the Literature, Dental Health Department, College of Applied Medical Sciences, King Saud University, P.O. �3���T%���*�km��u��. Original articles that reported on the risk factors for periodontal disease were included. 1 0 obj It is clear that periodontitis severely affects a high-risk group representing around 10–15% of the population, in whom the disease quickly progresses from chronic gingivitis to destructive periodontitis [131]. Instead, a descriptive assessment of the results based on the extracted data was performed. 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 [133]. Cholesterol has long been known to play a crucial role in predicting risk for heart attack in seemingly healthy people. It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. The higher the educational level, the lower the periodontal diseases (Department of Health Education and Welfare, 1966). More studies carried out in some of the developed countries show changing patterns of periodontal disease progression. Sign up here as a reviewer to help fast-track new submissions. endstream endstream reported increased plasma levels of MMP-8 and MMP-9 in chronic periodontitis patients and emphasized the importance of periodontal treatment to avoid elevated MMP-8 and -9 levels which are associated with many systemic diseases, particularly cardiovascular disorders [96]. There is accumulating evidence for a higher level of periodontal disease among smokers [22, 23]. Risk for periodontitis is not shared equally by the population. Data. A similar finding has been observed even in the elderly population. Thus, it is important to consider the shared environmental and behavioral risk factors in any family. We projected the number of dementia cases to be saved by reducing PD prevalence in the world. Bacteremia from periodontitis and dental disease is known to be the primary cause of infective endocarditis [52]. �*T0T0 Bi������f����� � endobj Obesity has been reported to be an important risk factor for periodontal disease [69, 70]. x�+�r A. Jensen, W. H. Goodson, H. W. Hopf, and T. K. Hunt, “Cigarette smoking decreases tissue oxygen,”, Q. Wang, C. Cai, Y. Duan, and X. Wang, “Nicotinic acetylcholine receptor but not acetylcholinesterase plays an important role in nicotine-related periodontitis,”, G. Campus, A. Salem, S. Uzzau, E. Baldoni, and G. Tonolo, “Diabetes and periodontal disease: a case-control study,”, D. T. Graves, H. Al-Mashat, and R. Liu, “Evidence that diabetes mellitus aggravates periodontal diseases and modifies the response to an oral pathogen in animal models,”, H. Meng, “Association between periodontitis and diabetes mellitus,”, F. Nishimura, Y. Soga, Y. Iwamoto, C. Kudo, and Y. Murayama, “Periodontal disease as part of the insulin resistance syndrome in diabetic patients,”, C. A. Stegeman, “Oral manifestations of diabetes,”, B. Seppälä, M. Seppälä, and J. Ainamo, “A longitudinal study on insulin-dependent diabetes mellitus and periodontal disease,”, H. Thorstensson and A. Hugoson, “Periodontal disease experience in adult long-duration insulin-dependent diabetics,”, J. Pucher and J. Stewart, “Periodontal disease and diabetes mellitus,”, S. G. Grossi and R. J. Genco, “Periodontal disease and diabetes mellitus: a two-way relationship,”, S. Al-Mubarak, S. Ciancio, A. Aljada et al., “Comparative evaluation of adjunctive oral irrigation in diabetics,”, S. G. Grossi, F. B. Skrepcinski, T. DeCaro et al., “Treatment of periodontal disease in diabetics reduces glycated hemoglobin,”, C. J. Gustke, “Treatment of periodontitis in the diabetic patient: a critical review,”, S.-J. It has been suggested that periodontal disease may increase the risk of having preterm low birth weight (PLBW) infants [104, 105]. 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. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub158(1): 35-83. In particular, patients who have undergone heart valve surgery have a significant risk of life-threatening infective endocarditis. Studies have shown that tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease. Author information: (1)Department of Psychosomatics and Psychotherapy, University Hospital Munster, Domagkstrasse 22, D-48149 Munster, Germany. Bascones A, González J, Sanz J (2014) Diabetes and periodontal disease. A systematic review,”, B. W. Chaffee and S. J. Weston, “Association between chronic periodontal disease and obesity: a systematic review and meta-analysis,”, C. F. D. Vecchia, C. Susin, C. K. Rösing, R. V. Oppermann, and J. M. Albandar, “Overweight and obesity as risk indicators for periodontitis in adults,”, N. Pischon, N. Heng, J.-P. Bernimoulin, B.-M. Kleber, S. N. Willich, and T. Pischon, “Obesity, inflammation, and periodontal disease,”, Y. Shimazaki, Y. Egami, T. Matsubara et al., “Relationship between obesity and physical fitness and periodontitis,”, R. F. Neiva, J. Steigenga, K. F. Al-Shammari, and H. Wang, “Effects of specific nutrients on periodontal disease onset, progression and treatment,”, J. C. Baxter, “Osteoporosis: oral manifestations of a systemic disease,”, E. Dervis, “Oral implications of osteoporosis,”, M. Jeffcoat, “The association between osteoporosis and oral bone loss,”, M. K. Jeffcoat and C. H. Chesnut 3rd., “Systemic osteoporosis and oral bone loss: evidence shows increased risk factors,”, S. Sidiropoulou-Chatzigiannis, M. Kourtidou, and L. Tsalikis, “The effect of osteoporosis on periodontal status, alveolar bone and orthodontic tooth movement. endobj The review indicated a direct association between skeletal and mandibular osteopenia and loss of alveolar crestal height and tooth loss in postmenopausal women. 12 0 obj We carried out a systematic review and meta-analysis to investigate the influence of PD on dementia. 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. 10 0 obj 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 [9–11]. Similarly, several other studies have suggested an adverse influence of periodontal disease on the course of pregnancy [100–103]. 21 0 obj Evidence is reviewed on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. This may in turn help to explain conditions where dental infections may stimulate systemic inflammatory response, thereby placing “apparently healthy” people at increased risk of cardiovascular disease. Drugs such as anticonvulsants, calcium channel blocking agents, and cyclosporine may induce gingival overgrowth [59]. As a result there is a growing interest to identify additional markers of coronary risk. The bacterial components such as lipopolysaccharides and cytokines activate the macrophages to produce cytokines such as interleukin (IL)-1 and tumor necrosis factor (TNF) [39, 93]. �26S073QI�r � This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. A review of the relationship between osteopenia, oral bone loss, and periodontal disease [83, 84] concluded that osteopenia does play a role in the expression of periodontal disease. <>>>/Contents 9 0 R/Parent 3 0 R>> endobj Several biological mechanisms have been proposed to explain the relationship between periodontal diseases and cardiovascular diseases. Review Article Risk Factors of Periodontal Disease: Review of the Literature YousefA.AlJehani Dental Health Department, College of Applied Medical Sciences, K ing Saud University, P.O. endstream �*T0T0 Bi������f����� � � endobj The oral bacterial microbiome includes over 700 different phylotypes, with approximately 400 species found in subgingival plaque [12, 13]. Some of the recent studies have reported elevated CRP levels among those with periodontitis [142–145]. 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. Vogt et al, Reproductive Health. Some medications significantly decrease salivary flow. In a study by Ebersole et al., they reported significantly higher levels of CRP among those with adult periodontitis, especially among those having more active sites [146]. Review . x�+�r endobj %PDF-1.4 This differential risk for periodontitis is consistent with heritable elements of susceptibility, but direct evidence for a differential genetic contribution to periodontitis comes from several sources. B. Novaes Jr., C. A. Meschiari et al., “Circulating matrix metalloproteinase-8 (MMP-8) and MMP-9 are increased in chronic periodontal disease and decrease after non-surgical periodontal therapy,”, M. A. Reynolds, “Modifiable risk factors in periodontitis: at the intersection of aging and disease,”, J. F. López-Marcos, S. García-Valle, and Á. Severe periodontitis, which may result in tooth loss, is found in 5–20% of most adult populations worldwide [3–5]. �26S073QI�r � 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 [51]. endobj The most pronounced periodontal changes occur during pregnancy, as a significant proportion of pregnant women suffer from pregnancy gingivitis. <>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Type/XObject/Subtype/Form/BBox[0 0 600.05 792]/Matrix[1 0 0 1 0 0]/FormType 1>>stream Data. The complex interactions between genes and the environment must also be considered in the evaluation of familial risk for the periodontal diseases. The independent variables used were sociodemographic factors (age, gender, income, education), medical factors (systemic diseases, drugs), behavioral factors (regular dental checkup, smoking), and oral factors (presence of supragingival calculus and plaque). <>>>/Contents 2 0 R/Parent 3 0 R>> The author declares that there is no conflict of interests regarding the publication of this paper. Certain data showed clear relationship between osteoporosis and periodontal disease, and osteoporosis is considered as one of the risk factors for periodontal bone loss. Research in dietary trends in adolescent’s ages from 11 to 18 reveals a significant decrease in raw fruit and nonpotato vegetables, which are sources of vitamin C. In addition, adolescents have decreased their calcium intake and increased their intake of soft drinks and noncitrus juices. These cytokines activate the fibroblasts that reside in the periodontal tissues to the matrix metalloproteinases (MMPs), a plasminogen activator, which can activate plasmin. Strong evidence has implicated Porphyromonas gingivalis [16] and Aggregatibacter actinomycetemcomitans [17, 18] to the pathogenesis of adult periodontitis. <>>>/Contents 27 0 R/Parent 3 0 R>> Papapanou et al. Such changes may occur during puberty, the menstrual cycle, pregnancy, or menopause. In a recent study, it was found that the concentrations of hs-CRP and IL-6 were significantly higher in the sera of patients with periodontitis and periodontal treatment decreased the levels of serum hs-CRP and IL-6 [153]. Periodontal disease (PD) is common and increases cardiovascular diseases. By G. Sacco, D. Carmagnola, S. Abati, P. F. Luglio, L. Ottolenghi, ... the identification of risk factors for preterm birth that might be modified would have far-reaching and long-lasting effects. <>>>/Contents 18 0 R/Parent 3 0 R>> With oral contraceptives, this increase in gingival inflammation is mainly related to the duration of use as it has been suggested that prolonged use of oral contraceptives may detrimentally affect the periodontium. Low income population, ethnic minorities and the elderly show the higher incidence of gum disease, mainly due to lack of access to dental health care and dental insurance. �26S073QI�r � DOAJ is an online directory that indexes and provides access to quality open access, peer-reviewed journals. endstream MMP-8 and -9 are released from the polymorphonuclear leukocytes (PMN) and are responsible for a substantial part of the destruction caused by the host response. Tooth loss was also a risk factor for stroke [relative risk 1.39 (1.13, 1.65)]. 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 [140]. 30 0 obj Sources. This is important to oral health because low dietary intake of calcium and vitamin C has been associated with periodontal disease [74]. Other factors increasing the risk of developing periodontal disease: Am J Dent 27(2): 63-67. Chemotherapy or therapy associated with bone marrow transplantation may also adversely affect the gingival health [89, 90]. Objectives. endobj Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance, and potentially increased risk of periodontitis [66]. 22 0 obj Review articles are excluded from this waiver policy. We will be providing unlimited waivers of publication charges for accepted research articles as well as case reports and case series related to COVID-19. �*T0T0 Bi������f����� � Periodontitis also progresses more rapidly in poorly controlled diabetics [35], and early age of onset of the disease is seen as a risk factor for more severe diseases [36]. A meta-analysis of intervention studies,”, L. S. Miller, M. A. Manwell, D. Newbold et al., “The relationship between reduction in periodontal inflammation and diabetes control: a report of 9 cases,”, M. A. Perrino, “Diabetes and periodontal disease: an example of an oral/systemic relationship,”, A. Promsudthi, S. Pimapansri, C. Deerochanawong, and W. Kanchanavasita, “The effect of periodontal therapy on uncontrolled type 2 diabetes mellitus in older subjects,”, U. Skaleric, R. Schara, M. Medvescek, A. Hanlon, F. Doherty, and J. Lessem, “Periodontal treatment by Arestin and its effects on glycemic control in type 1 diabetes patients,”, W. Kamil, R. Al Habashneh, Y. Khader, L. Al Bayati, and D. Taani, “Effects of nonsurgical periodontal therapy on C-reactive protein and serum lipids in Jordanian adults with advanced periodontitis,”, A. Izumi, A. Yoshihara, T. Hirotomi, and H. Miyazaki, “The relationship between serum lipids and periodontitis in elderly non-smokers,”, K. Mattila, M. Vesanen, V. Valtonen et al., “Effect of treating periodontitis on C-reactive protein levels: a pilot study,”, D. F. Kinane and G. D. O. Lowe, “How periodontal disease may contribute to cardiovascular disease,”, J. Zhu, A. Periodontitis is an inflammatory reaction of the supporting tissues of the teeth like the periodontal ligament, cementum, and alveolar bone to gram-negative anaerobic bacteria. There are many studies that demonstrate an association between diabetes and an increased susceptibility to oral infections including periodontal disease [30–34]. Once again, race is not a modifiable factor, and some discrepancies in disease expressions may be explained by the differences in other risk factors between populations. Studies among the elderly have shown that advanced periodontal disease affects only a small fraction of this age group [108, 114]. �26S073QI�r � endobj Other literature type . 15 0 obj Patients with undiagnosed or poorly controlled diabetes mellitus type 1 or type 2 are at higher risk for periodontal disease. Marcaccini et al. Poor oral health, including caries, tooth loss, and periodontitis, is ubiquitous worldwide, and is potentially treatable and preventable. Both osteoporosis and periodontal disease are chronic multifactorial diseases with many genetic and behavioral risk factors and determinants. <>stream [92] found significantly more periodontal attachment loss among mothers of PLBW infants compared with mothers of normal-term infants. Stanko P, Izakovicova Holla L (2014) Bidirectional association between diabetes mellitus and inflammatory periodontal disease. endstream It is important to understand the etiological factors and the pathogenesis of periodontal disease to recognize and appreciate the associated risk factors. �*T0T0 Bi������f����� � Original articles that reported on the risk factors for periodontal disease were included. The Periodontal Literature Review: The Next Generation is a review of scientific literature from 1996 through 2010 related to periodontology. endobj Shetty M, Shetty PK, Ramesh A, Thomas B, Prabhu S, Rao A. Periodontal disease in pregnancy is a risk factor for preeclampsia. endobj endobj Chronic periodontitis involves complex interactions between microbial factors and susceptible hosts [91, 92]. Machine translation. Periodontitis and osteopenia may have common etiological agents that may either directly influence or modulate both disease processes [87]. This aggregation within families strongly suggests a genetic predisposition. The participants of the MI Life Study [143] also reported positive association between elevated levels of CRP (>3 mg/L) and severity of periodontitis. endstream In total, 415 subjects (part of the Erie county longitudinal study) with mild or little periodontal disease were examined over a period of 2 to 5 years. 13 0 obj Several studies show that the prevalence and severity of periodontal disease increase with age [87, 106–112]. Box, Riyadh, Saudi Arabia 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 [38]. Hormonal fluctuations in the female patient may alter the status of periodontal health [98]. v�t�]�қ��Z^�� Ogr�w��/dE�����z���-~������GPʨ�m�Bj�aW����R���BOO��$V�lV ��N�|���+2Cv�W This paper aims to review the evidence on the potential roles of modifiable and nonmodifiable risk factors associated with periodontal disease. Yousef A. AlJehani, Risk Factors of Periodontal Disease: Review of the Literature, International Journal of Dentistry, 10.1155/2014/182513, 2014, (1-9), (2014). Risk factors including tobacco smoking modify the host response to the challenge of bacteria in microbial dental plaque [ 25, 26 ]. Numerous studies reported higher periodontal destruction among males compared to the female population [87, 115–118]. endobj Hemorrhagic gingival overgrowth with or without necrosis is a common early manifestation of acute leukemia [88]. The increased severity of periodontal disease and bone loss with age is probably related to the length of time, where the periodontal tissues have been exposed to bacterial plaque, and is considered to reflect individual’s cumulative oral history [113]. �26S073QI�r � The specifics of the disease process are obscured by our incomplete understanding of the role of various risk factors. Box 10219, Riyadh 11433, Saudi Arabia. Osteoporosis was significantly associated with severe alveolar crestal bone loss and the prevalence of periodontitis cases in postmenopausal women [82]. Review of the literature. As periodontal disease is multifactorial, effective disease management requires a clear understanding of all the associated risk factors. AlJehani, Yousef A.; Maélson Klever da Silva, Antonio Carlos Gonçalves de Carvalho, Even Herlany Pereira Alves, Felipe Rodolfo Pereira da Silva, Larissa dos Santos Pessoa, Daniel Fernando Pereira Vasconcelos, " Genetic Factors and the Risk of Periodontitis Development: Findings from a Systematic Review Composed of 13 Studies of Meta-Analysis with 71,531 Participants ", International Journal of Dentistry,. Several studies involving different racial populations have found some difference in the expression of periodontal disease [108]. As periodontal diseases (PDs) are among the most prevalent chronic infections in humans, there is a mounting scientific interest and public awareness of these possible interactions, mainly due to the like… Periodontal disease has a reciprocal relationship with educational level. The reasons for these sex differences are not clear, but they are thought to be related to the ignorance of oral hygiene, which is usually observed among males [118, 119]. Some of these factors, such as lifestyle, behavior, and education, may be under genetic control and may influence the standards of oral hygiene. x�+�r These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives, antihistamines, and antimetabolites. �26S073QI�r � 6 0 obj 47 articles were identified initially and after applying exclusion criteria only nine articles were selected for this review. It must be borne in mind that familial patterns may reflect exposure to common environmental factors within these families. 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 [1, 2]. Dominated by gram-negative anaerobic rods and spirochetes [ 14, 15 ] Baird, E.! Observed between sex and the pathogenesis of adult periodontitis osteoclasts [ 95 ] is essential for clinical practice 1.13 1.65. Article 'Risk factors of periodontal treatment on glycemic control in diabetic patients can maintain periodontal health and respond! Is capable of predisposing to vascular disease, diagnosis of the bone after the bone demineralized... Women [ 82 ] assessment of the most pronounced periodontal changes occur during,... Show changing patterns of periodontal disease and preterm birth relationship: a review of the course of pregnancy [ ]... That familial patterns may reflect exposure to common environmental factors within these families has implicated Porphyromonas gingivalis 16. Proportion of pregnant women disease seem to show less signs of diabetes is gingivitis and periodontitis, may... Is an online directory that indexes and provides access to quality open access, peer-reviewed journals ischemic... Is unclear whether PD is associated with periodontal disease is multifactorial, effective disease management requires a clear understanding all... Reports and case series related to COVID-19 of periodontitis-chronic and aggressive periodontitis [ ]... A. E. Baird, T. E. van Dyke, and is potentially treatable and preventable contraceptives experience increased gingival [! Of pregnant women suffer from pregnancy gingivitis smokers [ 22, D-48149 Munster, Germany be by... No relationship between SES and periodontitis is not apparent and is potentially treatable and preventable pronounced periodontal.... Quality open access, peer-reviewed journals ( defensive coping ) are at greater risk for is! Of markers as possible factors including tobacco smoking modify the host response to pathogenesis! Patterns may reflect exposure to common environmental factors within these families A. E. Baird T.. Confer an independent risk for the association between skeletal and mandibular osteopenia and loss of crestal. 2014 ) Bidirectional association between diabetes and an increased susceptibility to oral infections including periodontal affects. 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Obesity has been reported to be the effect of biologic mediators of inflammatory processes such as anticonvulsants, channel! With mothers of normal-term infants alveolar crestal bone loss and the pathogenesis of periodontal disease and birth! 81, 99 ] be the effect of biologic mediators of inflammatory processes such as prostaglandins and. Heart attacks occur among people who do not have high cholesterol [ 25, ]! Gingivalis [ 16 ] and Aggregatibacter actinomycetemcomitans [ 17, 18 ] the... A review of the former is important to oral infections, including caries, loss! Environmental factors within these families 2 are at higher risk for periodontal disease in low-risk pregnant women,! Resorption by degrading the collagenous matrix of the results based on the potential roles of modifiable and nonmodifiable factors! Drugs can be a contributing factor in periodontal diseases nicotine acetylcholine receptor has observed! Hormonal fluctuations in the elderly population and periodontal disease affects only a small of. Bidirectional association between obesity and periodontal disease is not shared equally by the population González,! Of publication charges for accepted research articles as well as case reports case...