Periodontology 2000, Vol.

32, 2003, 910

Printed in Denmark. All rights reserved

Copyright # Blackwell Munksgaard 2003

PERIODONTOLOGY 2000
ISSN 0906-6713

A profile of the patient with

periodontal disease?
Terry D. Rees

Almost 30 years ago, a small group of clinical periodontists conducted a brief but intense meeting to
determine if it was possible to develop a profile of
patients at increased risk of advanced periodontal
disease. We had become intrigued with the early
efforts of our medical colleagues to use evidencedbased data to determine environmental and physiologic risk factors that placed one at greater risk for
developing specific systemic diseases. Heart disease
susceptibility was at the forefront of this effort. Accumulated data indicated that risk factors could be
identified and that many of these factors could be
controlled to prevent and/or treat some cardiovascular disorders (7, 18, 20). Could this same thing be
done for periodontal diseases?
A review of the periodontal literature indicated that
much had been written regarding the etiology of
periodontitis but there was little hard evidence to
identify specific predisposing factors. Consequently,
using what we thought was common sense and our
clinical experiences, we developed a list of factors
that we believed were characteristic of individuals
affected by periodontal disease. This list included
the following:
 Inadequate oral hygiene/increased plaque accumulation
 Presence of local factors predisposing to plaque
accumulation
 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 periodontitis
It is of interest to note that this profile of the
patient with periodontitis seems realistic even

today, and may help to explain why some individuals develop severe disease while others do not.
Evidence-based data has identified some of those
features as risk factors for periodontal diseases
(14, 10, 1416, 21). However, the modern periodontal 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. This
dilemma is compounded by the fact that some putative periodontal risk factors are also implicated in a
variety of systemic diseases.
In this volume of Periodontology 2000 an effort has
been made to evaluate current understanding
regarding the factors that may place an individual
at increased risk for developing periodontal disease
or at increased risk for advanced disease. The
opening chapter of the text, written by Dr. Martha
Nunn (13), provides a review of terminology
relative to risks and an overview of factors that are
suspected to predispose one to periodontal disease
activity.
Other authors have reviewed available evidence
regarding specific periodontal risk factors/indicators
and offered their interpretation of the data associating these factors with increased susceptibility to periodontal destruction. Drs. Paul Ezzo and Christopher
Cutler (6) have described the potential for specific
oral microbiota to increase the risk for periodontal
diseases. Dr. Francisco Rivera-Hidalgo (17) has provided current information regarding smoking as an
external periodontal risk factor, while Dr. Salvador
Nares (12) has discussed the impact of the human
genome study and the role of genetics in determining
periodontal risk susceptibility and host response to
the challenge of bacterial plaque and other etiologic
factors. Dr. Stephen Harrel (9) addresses the controversy regarding the role of trauma from occlusion as

Rees

a risk factor for increased periodontal destruction

and altered response to periodontal therapy.
Various systemic risk factors are discussed in
detail. The influences of diabetes mellitus and endogenous female sex hormones are discussed by Drs.
Brian Mealey and Alan Moritz (11) and the role of
neutrophil dysfunction is addressed by Drs. David
Deas, Scott Mackey and Howard McDonnell (5).
Drs. Nico Geurs, Cora Lewis and Marjorie Jeffcoat
(8) have provided updated information regarding
the relationship between osteopenia/osteoporosis
and the risk for periodontal diseases. Finally, Drs.
Thomas Stanford and Terry Rees (19) have discussed
the degree of risk for periodontal disease generated
by 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 progression beyond marginal gingivitis. It is hoped,
however, that this text will help to shed light on
the riddle of periodontal disease.

References
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2. Albander JM, Rams TE. Risk factors for periodontitis in
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10

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