Adolescent and young adult periodontitis: modifiable inflammatory pathways and risk stratification

This review summarizes current evidence on modifiable risk factors for periodontitis in adolescents and young adults, with a focus on their underlying inflammatory pathways and mechanisms in early disease progression.

A structured literature search was performed in PubMed/MEDLINE and Web of Science for human studies published from 2000 to 2025, examining gingival and periodontal outcomes in relation to four major modifiable exposure clusters: tobacco use, obesity and metabolic health, diet and related behaviors, and plaque-retentive or iatrogenic factors.

Available evidence indicates that early inflammatory indicators of periodontal risk, particularly bleeding on probing and calculus, are highly prevalent in young populations and closely associated with these modifiable exposures. These factors drive periodontal pathogenesis by increasing inflammatory burden, promoting microbial dysbiosis, impairing host immune and metabolic responses, and accelerating the transition from gingivitis to periodontitis. Importantly, modifiable risks and early periodontal burden are not uniformly distributed across the population, but cluster within distinct high-risk subgroups.

These findings indicates that early periodontitis in youth arises from concentrated risk exposure rather than a population-wide downward shift in age at onset. Targeted, multi-level preventive strategies for high-risk subgroups that address underlying modifiable inflammatory pathways may effectively delay the onset and progression of periodontitis and exert beneficial effects on long-term periodontitis-related systemic health outcomes.