Systemic, Lifestyle and Environmental Modifying Factors in the Pathogenesis of Periodontitis

Periodontitis, a chronic inflammatory condition, affects approximately 20%-50% of the world's population. It is usually characterized by progressive destruction of the periodontal soft and hard tissues, clinically manifested as gingival inflammation combined with attachment loss (CAL), radiographically detectable alveolar bone resorption, periodontal pockets, and bleeding on probing, as well as tooth mobility and potential tooth loss in advanced stages. These processes are moderated by the interplay between a dysbiotic microbiota and aberrant immune reactions within the gingival and periodontal tissues and can be modified by numerous internal or external influences. A number of studies discovered the importance of a variety of these impacting factors in periodontitis, including systemic, lifestyle, and environmental factors. Regarding the evidence level, these factors can be classified as predisposing factors, risk indicators, or risk factors. Predisposing factors include age, physical activity, dietary habits, alcohol consumption, and socioeconomic status. As risk indicators, obesity, osteoporosis, cardiovascular diseases, mental health disorders, poor diet, stress, and sleep disorders can be regarded Well-known risk factors for periodontitis are smoking/tobacco use and diabetes mellitus. This review highlights the manifold mechanistic aspects of the link between the pathogenesis of periodontitis, addressing these numerous factors to supplement the long-standing knowledge of the progression of the disease.