10 Risk and periodontal diseases

Figure 10.1 Pack years of cigarette smoking and clinical attachment loss.

Figure 10.2 Periodontal disease and glycaemic control: cause or effect?

Figure 10.3 Interaction of periodontal microflora, the inflammatory response and risk factors.

Table 10.1 Levels of evidence for risk determinants in chronic diseases and characteristics of these studies which make the factors more convincing, and not likely to be spurious associations.

Type of study	Study characteristics
Cross-sectional or case–control studies	Confounding factors are eliminated or adjusted for in the analysis
Longitudinal epidemiological studies (establish temporality and evidence for effects in causal pathway)	Dose–response effects
Mechanism studies	Study results are consistent among various independent studies
Intervention studies	Effects are clinically meaningful Relationship is biologically plausible

Table 10.2 Systemic risk determinants for periodontal disease.

Systemic risk factors	Systemic risk indicators
Smoking	Low dietary calcium
Diabetes mellitus type 1 and 2	Postmenopausal osteoporosis and osteopenia
Race	Visceral obesity
Genetics Male gender Polymorphonuclear leukocyte (neutrophil) function Socioeconomic status (low educational level) Acquired systemic infections (e.g. human immunodeficiency virus (HIV)) Severe malnutrition (cancrum oris)	Stress and inadequate coping