Modifiable systemic factors for periodontal disease prevention and management

In addition to local factors such as bacterial profile, oral hygiene and scaling and root planning, several systemic factors also play a key role in periodontal disease. Periodontal disease shares several common modifiable factors with major cardiometabolic diseases, and may also be an independent risk factor for some systemic disease. Accordingly, periodontists can think more broadly in motivating and enabling reduction of common risk factors for periodontitis, which would help prevent periodontal disease as well as cardiometabolic health. Smoking is a major risk factor for periodontal disease (acting locally andsystemically) and for many chronic diseases; motivating and enabling smoking cessation can be an important means for improving oral and systemic health. Inflammation has a bi-directional association with periodontal disease. Obesity is an important risk factor for local and systemic inflammation and is associated with increased periodontitis. In addition, various nutritional factors play a role in preventing cardiometabolic disease and some of these same factors may also improve periodontal disease status. Dentists can promote healthy lifestyle factors including improving diet, physical activity and weight. Diabetes and its precursors such as insulin resistance and pre-diabetes could lead to complications including periodontitis. Psychosocial factors, such as anger and stress, may also affect periodontal status. This chapter will review nutritional and systemic risk factors for periodontitis, focusing on modifiable common risk factors that also impact cardiometabolic disease, which can be targeted through oral and medical health professionals for improving periodontal and cardiometabolic health.