Risk factors

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Refer to Section 2 of the full guidance.

  • Explain to patients who have known risk factors (e.g. smoking, diabetes) that they are at risk of developing periodontal disease and the steps they can take to reduce their risk.
  • Ensure that patients who are pregnant are aware of their increased risk of developing pregnancy gingivitis. Highlight the need for more frequent visits for dental prophylaxis or, if required, supportive periodontal therapy during pregnancy.

This flowchart provides more information on assigning a risk level.

More on risk factors

Although for most patients periodontal diseases are preventable with good oral hygiene, there are many factors which increase the probability of a patient developing periodontal disease. 

  • Smoking is thought to reduce gingival blood flow (thereby suppressing the signs and symptoms of gingivitis), impair wound healing and increase production of inflammation-mediating cytokines;
  • Poorly controlled diabetes enhances the signs and symptoms of gingivitis and periodontitis and has an adverse effect on wound healing, making treatment of these patients more difficult; 
  • There is a body of evidence indicating an association between periodontitis and cardiovascular disease but there is currently no evidence that treatment of periodontal disease can improve cardiovascular outcomes;
  • A family history may predispose a patient to developing periodontitis; 
  • Stress, diet, obesity, osteoporosis and rheumatoid arthritis may increase the severity of periodontitis but currently the scientific evidence for these factors is weak;
  • Patients taking certain medications, such as calcium channel blockers, phenytoin and ciclosporin, may be at risk of gingival enlargement;
  • The hormonal changes associated with adolescence and pregnancy have been implicated in the development of gingivitis and gingival enlargement;
  • Local risk factors, such as calculus, malpositioned teeth, overhanging restorations and partial dentures may also increase the risk of periodontal diseases.