iDentistry The Journal identistry_may_aug2019 | Page 15

The Journal
periodontitis in blacks than in whites with a
Periodontal Index score of 1.28 and 0.76 in the
4
two groups, respectively.
Genetic factors
For instance, the intrafamiliar occurrence of
Papillon–Lefevre syndrome was described
decades ago. Increased susceptibility to the
early onset prepubertal forms of periodontal
diseases typically has an interfamilial pattern
the disease has been attributed to various
defects in the host response to microbial
infections. Generalized prepupertal
periodontitis has been shown to be associated
with leukocyte adhesion deficiency and other
leukocyte abnormalities which causes
abnormal local recruitment of neutrophils and
monocytes and inadequate host immune
response. 5
Family studies show that aggressive
periodontitis occurs in families, and this
suggests that genetic factors are partly
responsible for the increased susceptibility to
this aggressive form of periodontal diseases.
There is evidence of interindividual differences
in the rate of production of the inflammatory
cytokines interleukin-1 (IL-1), tumor necrosis
factor-a (TNFa), and prostaglandin E2 following
endotoxine stimulation of monocytes.6 In
addition, it has been shown that certain gene
polymorphisms are associated with stable
interindividual differences in IL-1 and TNF
production.
Tanerrella forsythus, in the subgingival flora is
associated with increased risks of periodontal
tissue loss. They estimated that the risk (odds
ratio) of clinical attachment loss attributed to P.
gingivalis was 1.6, and to T. forsythus was 2.5.
Viruses
Studies show a higher occurrence of human
cytomegalovirus and other herpes viruses
infections in periodontitis than in gingivitis
lesions, higher detection frequency in deep
than in shallow periodontal pockets and that
active cytomegalovirus replication may occur in
periodontal defects.
Osteopenia and osteoporosis
NHANES III data found that in women with high
dental calculus scores, the mean clinical
attachment loss per person was higher in
women with low compared to normal femoral
bone mineral density; whereas no difference
was found when a corresponding comparison
was made in women with low or moderate
calculus scores.
Psychological factors
A few early studies have reported a higher
prevalence of chronic destructive periodontal
diseases in persons with certain psychological
disorders and several studies have suggested
that psychological stress may be associated
with more acute forms of disease particularly
acute necrotizing periodontal diseases.
Bacterial specificity
Local factors
Haubek et al. (105) showed that a highly toxic
clone of A.actinomycetemcomitans is prevalent
in aggressive periodontitis patients from certain
geographic regions, particularly those of African
origin. There is a large body of evidence
showing that P.gingivalis is strongly associated
9
8
with chronic periodontitis . Grossi et al.
concluded that the presence of P. gingivalis and
15
Within-person variability in the level of
periodontal tissue loss may be attributed to
several local factors including tooth morphology
and alignment, form and location of tooth
furcation, level and quality of dental
restorations, dental calculus formation, dental
caries lesions near gingival tissue, trauma from
Vol. 15
No. 2
May-Aug 2019