Risk Factors for Periodontal Disease Heredity Family history, PST-test Smoking Frequency, Current, Past Diabetes Duration, Control Stress Reported by patient Medications Calcium channel blockers Dilantin Cyclosporin Known to cause dry mouth Nutrition Obesity Poor oral hygiene Plaque and calculus Faulty dentistry Overhangs, Subgingival margins Hormonal variations Pregnancy Increased estradiol & progesterone Menopause Decreased estrogen, osteoporosis Immunocompromise HIV Neutropenia Connective tissue diseases Previous history of periodontitis

Important Factors to Consider in Assessing the Periodontal Status of Patients with Diabetes Degree of Metabolic Control Duration of Disease Presence of Other Long-term Complications Retinopathy Angiopathy Nephropathy Neuropathy Delayed Wound Healing Concurrent Risk Factors Plaque Smoking Stress Medications Hormonal Variations Adolescence Pregnancy Menopause

This schematic depicts the etiologic factors and cascade of events contributing to chronic adult periodontitis. The periodontal breakdown cascade consists of both a bacterial component and a host component, which combine to result in the clinical sequelae of periodontitis including pocket formation, loss of attachment, tooth mobility, and tooth loss. Notes:

Obesity An independent risk factor for periodontal disease After statistical adjustment for other periodontal risk factors such as Age Gender Socioeconomic status Smoking Diabetes Plaque Genco et al., Bissada et al.