Public Health Implications of Chronic Periodontal Infections in Adults

Population Aspects, Smoking and Other Modifiable Risk Factors for Periodontal Disease
Brian Burt, BDS, MPH, PhD, Professor, Department of Epidemiology, and Director, Program in Dental Public Health, University of Michigan School of Public Health, Ann Arbor, Michigan

This review considers the distribution of gingivitis and chronic periodontitis in the U.S. population and the effects of oral hygiene and smoking as risk factors for those conditions. Gingivitis is widely prevalent in its milder forms, but only a few gingivitis sites progress to periodontitis. A majority of any adult population in the United States has periodontitis to some degree, though only 5% to 15% of any population suffers from severe, generalized periodontitis.

Two important incidence studies have confirmed both the episodic nature of periodontal destruction and how susceptibility varies in a population. The apparent increase in the severity of periodontitis with age, noted in cross-sectional studies, is considered to come from the long-term cumulative effects of bacterial plaque rather than from increasing susceptibility with age. While it is clear that plaque deposits are the prime cause of gingivitis, the relationship of oral hygiene to periodontitis is less straightforward. Oral hygiene can favorably influence the ecology of the microbial flora in shallow-to-moderate pockets. But oral hygiene alone has little effect on established periodontitis because it does not affect host response. There is evidence, however, that frequent professional supragingival cleaning, when added to good oral hygiene, inhibits the proliferation of subgingival microbiota in moderately deep pockets.

Smoking is clearly a risk factor for periodontal diseases, with the relative risk of periodontitis attributable to tobacco, compared to non-smokers of 2.5 to 6.0 or higher. Smoking promotes periodontitis progression and slows healing after treatment. Widespread tobacco use in past decades may have contributed to periodontitis in the population. Cessation of smoking is basic to any periodontitis treatment.

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Page last reviewed: February 2, 2005
Content source: Division of Oral Health, National Center for Chronic Disease Prevention and Health Promotion