Smoking is recognized as an established risk factor for periodontitis with harmful effects on the periodontium. A large percentage of patients seeking treatment are heavy smokers, consuming more than 15-20 cigarettes per day. Smokers show fewer signs of bleeding gums, and thus they usually fail to realize that they suffer from periodontitis.
Smoking aggravates the periodontitis symptoms and undermines the results of surgical and non-surgical periodontal therapy. Moreover, smokers are more likely to relapse after periodontal treatment and they also show compromised results in implant therapy.
Various potential mechanisms have been discussed in the literature, including effects on the oral microbiota, the gingival tissues, the inflammatory and immune response, and the healing capacity of the periodontium.
Nevertheless, there is evidence that smoking cessation may have beneficial effects on periodontal status and enhance the result of periodontal therapy.
Diabetes mellitus is a common, chronic condition with serious health implications. It represents a group of metabolic disorders characterized by defects in insulin production, insulin action, or both, leading to abnormal glucose metabolism. The diabetes patient may present various symptoms, like dry or burning mouth and tongue, caries and stomatitis.
Periodontitis is highly associated with diabetes mellitus. Convincing evidence exists to support the fact that a poorly-controlled periodontal patient is at a higher risk for presenting with severe periodontitis and may present with or experience recurrent periodontal abscesses, gingival overgrowth, rapid bone loss, and impaired healing. Conversely, advanced periodontitis seems to affect the state of diabetes.
Periodontal and implant therapy in patients with well-controlled diabetes is equally successful as in healthy or not diabetic patients. Patients with undiagnosed or poorly controlled diabetes are recommended to receive dental treatment only in emergency cases and strictly under antibiotic prophylaxis.
During the past few years, evidence has indicated an association between adverse pregnancy outcomes such as preterm birth, low birth weight and pre-eclampsia and periodontal disease.
Oral bacteria may reach amniotic fluids and influence maternal fetal tissues via a hematogenous spread resulting in a chorioamniotic challenge and thus providing the inflammatory impetus for labor induction.
On the other hand, periodontal treatment has been proven to be safe and beneficial when provided during the second trimester of pregnancy.
According to epidemiologic studies, there is a positive link between cardiovascular and cerebrovascular disease and periodontitis. Periodontopathic bacteria originating from gum pockets can enter the circulation and cause bacteremia triggering a a systemic inflammatory response involving the endothelium and immune cells.
Patients with periodontitis should be advised that there is a higher risk for cardiovascular diseases, such as myocardial infarction or stroke, and as such, they should actively manage all their cardiovascular risk factors (smoking, exercise, excess weight, blood pressure, lipid and glucose management, and sufficient periodontal therapy and periodontal maintenance).
Stress and psychosomatic disorders most likely affect periodontal health through interactions among the nervous, endocrine and immune systems. Stress has been reported as an important risk factor for necrotizing ulcerative gingivitis for many decades.
The effects of stress on periodontium may be described as indirect or direct. Indirect effects are those associated with compromised oral hygiene, inattention to dental visits for prevention/care, deterioration of metabolic control in diabetes, increase in smoking, and inability to maintain healthy eating habits. Direct effects may be mediated both via modification of the composition of the subgingival biofilm and exaggeration of the host inflammatory response.
Stress is part of human life and its potential effect on incidence of periodontal disease and the response to therapy should not be underestimated. Patients that are able to limit stress factors are less likely to suffer from periodontitis.
Recently, research has been focused on the possible link between osteoporosis and periodontitis, as both conditions involve bone loss and may potentially share common risk factors and pathogenic mechanisms.
Results from several studies indicate that women with estrogen insufficiency have a reduced alveolar bone, although a cause-and-effect relationship has yet to be proved. Additionally, postmenopausal women receiving estrogen substitution treatment show improved levels of bone density.
