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   Aprofileofthepatientwithperiodontaldisease? T erry   D. R ees  Almost 30 years ago, a small group of clinical period-ontists conducted a brief but intense meeting todetermine if it was possible to develop a profile of patients at increased risk of advanced periodontaldisease. We had become intrigued with the early efforts of our medical colleagues to use evidenced-based data to determine environmental and physio-logic risk factors that placed one at greater risk fordeveloping specific systemic diseases. Heart diseasesusceptibility was at the forefront of this effort. Accu-mulated data indicated that risk factors could beidentified and that many of these factors could becontrolled to prevent and/or treat some cardiovas-cular disorders (7, 18, 20). Could this same thing bedone for periodontal diseases? A review of the periodontal literature indicated thatmuch had been written regarding the etiology of periodontitis but there was little hard evidence toidentify specific predisposing factors. Consequently,using what we thought was common sense and ourclinical experiences, we developed a list of factorsthat we believed were characteristic of individualsaffected by periodontal disease. This list includedthe following:   Inadequate oral hygiene/increased plaque accu-mulation   Presence of local factors predisposing to plaqueaccumulation   Poor motivation regarding oral health   Non-compliance with maintenance protocols   Presence of parafunctional occlusal habits   Disease prone   Smoker   Emotionally stressed   Possibly malnourished   Family history of periodontitisIt is of interest to note that this profile of thepatient with periodontitis seems realistic eventoday, and may help to explain why some indivi-duals develop severe disease while others do not.Evidence-based data has identified some of thosefeatures as risk factors for periodontal diseases(1–4, 10, 14–16, 21). However, the modern perio-dontal practitioner may still be perplexed regarding the differentiation of etiologic factors from risk factors and regarding the difference between a risk factor, a risk indicator and a background factor. Thisdilemma is compounded by the fact that some puta-tive periodontal risk factors are also implicated in a variety of systemic diseases.In this volume of   Periodontology 2000   an effort hasbeen made to evaluate current understanding regarding the factors that may place an individualat increased risk for developing periodontal diseaseor at increased risk for advanced disease. Theopening chapter of the text, written by Dr. Martha Nunn (13), provides a review of terminology relative to risks and an overview of factors that aresuspected to predispose one to periodontal diseaseactivity.Other authors have reviewed available evidenceregarding specific periodontal risk factors/indicatorsand offered their interpretation of the data associat-ing these factors with increased susceptibility to per-iodontal destruction. Drs. Paul Ezzo and ChristopherCutler (6) have described the potential for specificoral microbiota to increase the risk for periodontaldiseases. Dr. Francisco Rivera-Hidalgo (17) has pro-vided current information regarding smoking as anexternal periodontal risk factor, while Dr. SalvadorNares (12) has discussed the impact of the humangenome study and the role of genetics in determining periodontal risk susceptibility and host response tothe challenge of bacterial plaque and other etiologicfactors. Dr. Stephen Harrel (9) addresses the contro-versy regarding the role of trauma from occlusion as 9  Periodontology 2000, Vol. 32, 2003, 9–10 Copyright   #  Blackwell Munksgaard 2003Printed in Denmark. All rights reserved   PERIODONTOLOGY 2000 ISSN 0906-6713  a risk factor for increased periodontal destructionand altered response to periodontal therapy. Various systemic risk factors are discussed indetail. The in fl uences of diabetes mellitus and endo-genous female sex hormones are discussed by Drs.Brian Mealey and Alan Moritz (11) and the role of neutrophil dysfunction is addressed by Drs. DavidDeas, Scott Mackey and Howard McDonnell (5).Drs. Nico Geurs, Cora Lewis and Marjorie Jeffcoat(8) have provided updated information regarding the relationship between osteopenia/osteoporosisand the risk for periodontal diseases. Finally, Drs.Thomas Stanford and Terry Rees (19) have discussedthe degree of risk for periodontal disease generatedby acquired immune suppression, emotional stress,malnutrition, obesity, alcohol abuse and aging.Much is yet to be learned in order to explain why some individuals develop severe periodontal disease while others are relatively resistant to disease pro-gression beyond marginal gingivitis. It is hoped,however, that this text will help to shed light onthe riddle of periodontal disease. References 1. Albander JM. Global risk factors and risk indicators forperiodontal diseases.  Periodontol 2000   2002:  29 : 177 – 206.2. Albander JM, Rams TE. Risk factors for periodontitis inchildren and young persons.  Periodontol 2000   2002:  29 :207 – 222.3. Amarasena H, Ekanayaka AN, Herath L, Miyazaki H. Tobac-co use and oral hygiene as risk indicators for periodontitis. Community Dent Oral Epidemiol   2002:  30 : 115 – 123.4. Beck JD, Lainson PA, Field HM, Hawkins BF. Risk factorsfor various levels of periodontal disease and treatmentneeds in Iowa.  Community Dent Oral Epidemiol   1984:  12 :17 – 22.5. Deas DE, Mackey SA, McDonnell HT. Systemic disease andperiodontitis: manifestations of neutrophil dysfunction. Periodontol 2000   2003:  32 : 82 – 104.6. Ezzo PJ, Cutler CW. Microorganisms as risk indicators forperiodontal disease.  Periodontol 2000   2003:  32 : 24 – 35.7. Fejfar Z.  ‘‘ Risk factors ’’  in ischaemic heart disease.  ActaCardiol   1972:  Suppl 15 : 7 – 35.8. Geurs NC, Lewis CE, Jeffcoat MK. Osteoporosis and perio-dontal disease progression.  Periodontol 2000   2003:  32 :105 – 110.9. Harrel SK. Occlusal forces as a risk factor for periodontaldisease.  Periodontol 2000   2003:  32 : 111 – 117.10. Jansson LE, Hagstrom KE. Relationship between com-pliance and periodontal treatment outcomes in smokers.  J Periodontol   2002:  73 : 602 – 607.11. Mealey BL, Moritz AJ. Hormonal influence: effects of dia-betes mellitus and endogenous female sex steroid hor-mones on the periodontium.  Periodontol 2000   2003:  32 :59 – 81.12. Nares S. The genetic relationship to periodontal diease. Periodontol 2000   2003:  32 : 36 – 49.13. Nunn ME. Understanding the etiology of periodontitis: anoverview of periodontal risk factors.  Periodontol 2000   2003: 32 : 11 – 23.14. Ogawa H, Yoshihara A, Hirotomi T, Ando Y, Miyazaki H.Risk factors for periodontal disease progression among elderly people.  J Clin Periodontol   2002:  29 : 592 – 597.15. Page RC, Krall EA, Martin J, Manci L, Garcia RI. Validity andaccuracy of a risk calculator in predicting periodontal dis-ease.  J Am Dent Assoc   2002:  133 : 569 – 576.16. Ritchie CS, Hoshipura K, Hung HC, Douglass CW. Nutritionas a mediator in the relation between oral and systemicdisease: associations between specific measures of adultoral health and nutrition outcomes.  Crit Rev Oral Biol  Med   2002:  13 : 291 – 300.17. Rivera-Hidalgo F. Smoking and periodontal disease.  Perio-dontol 2000   2003:  32 : 50 – 58.18. Stamler J, Epstein FH. Coronary heart disease: risk factors asguides to preventive action.  Prev Med   1972:  1 : 27 – 48.19. Stanford TW, Rees TD. Acquired immune suppression andother risk factors/indicators for periodontal disease pro-gression.  Periodontol 2000   2003:  32 : 118 – 135.20. Taylor CB, Hass GM, Ho KJ, Liu LB. Risk factors in thepathogenesis of atherosclerotic heart disease and general-ized atherosclerosis.  Ann Clin Lab Sci   1972:  2 : 239 – 243.21. Thomson WM, Williams SM. Partial- or full-mouth ap-proaches to assessing the prevalence of and risk factorsfor periodontal disease in young adults.  J Periodontol  2002:  73 : 1010 – 1014. Rees  10 
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