How Genetics Affect Periodontal Disease

The other four risk factors are explored in other articles. They include:

1. The presence of subgingival bacterial biofilm on tooth root surfaces and the epithelial lining
2. Lifestyle-related risk factors such as smoking and poor oral hygiene
3. Systemic diseases
4. Miscellaneous factors, including both tooth and dentition-related and random (stochastic) factors, occlusal/functional programs, iatrogenic aspects, etc.

The relative contribution of each of these five factors, genetics included, varies based on the individual patient and situation.

Generally, however, because periodontitis is relatively uncommon in patients under 35, the younger the patient experiencing periodontitis, the more likely it is that their disease can be linked (at least to a greater extent) to genetic factors.

On the other hand, the older the patient is when the disease first manifests itself, the more likely it is that genetic contribution plays a less prominent role in the development and progression of periodontitis.

People with a genetic predisposition toward developing periodontitis have gene expressions that affect how quickly and severely their body’s immune system reacts to the presence of potentially harmful bacteria on soft tissues in the gums and arteries. The more reactionary the inflammatory response, the more quickly the symptoms and damaging consequences of periodontal disease may occur.

If your patients have questions about how their own genetic predispositions may affect their risk of developing periodontal disease, this is what you can tell them, based on the latest scientific evidence available.

How genetics affect periodontal disease

Though scientific research is inconclusive and ongoing, so far 65 different genes have been suggested to be associated with periodontitis, based on genome-wide association studies and candidate gene case control studies.

These studies also found pleiotropy (when one gene influences two or more apparently unrelated phenotypic traits) between periodontal disease and other chronic inflammatory diseases, such as atherosclerotic cardiovascular disease.

According to the latest research, four genetic loci have been confirmed to be shared between atherosclerotic cardiovascular diseases and periodontitis so far:

• CDKN2B-AS1 (ANRIL)
• A noncoding element within CAMTA1 upstream of VAMP3
• PLG
• A haplotype block at the VAMP8 locus

The fact that these are the only loci shared between atherosclerotic cardiovascular diseases and periodontitis suggests – albeit inconclusively – that periodontal disease is not necessarily, explicitly causally related to atherosclerotic disease and diabetes. The commonality does suggest, however, that both conditions are sequelae of similar or even (potentially) the same aberrant inflammatory pathways.

This may suggest that a patient with a familial genetic history of cardiovascular disease or diabetes may also have a higher risk of developing periodontal disease, as they are more likely to exhibit the aberrant inflammatory response associated with both conditions.

This aberrant response affects how quickly and severely the person’s inflammation response to bacteria occurs within the body – whether the affected site is in the gums or in the arteries. The more severe the inflammatory response to bacteria, the more likely periodontal disease is to develop.

Besides genetics, epigenetics – meaning the modification of genes by the environment – most likely also plays a role.

For example, epigenetic changes can be induced by aging, systemic disease, microbial composition, lifestyle habits, etc. These changes can result in increased susceptibility to periodontal diseases. There is also a hypothesis that the composition of the subgingival microbiome – and thereby potential susceptibility for periodontal diseases – is partly determined by genetics, though this requires further research. 

Patients with a genetic predisposition to experience quick or severe inflammation responses to bacteria, therefore, may be at a greater risk of periodontal disease and various other atherosclerotic diseases.

What this means for your patients

The younger the patient who develops periodontitis is, the more likely genetics played a significant role in their contraction. Even for these patients, however, it’s important to note that genetics is only one of five major risk factors dictating susceptibility to periodontal disease. The greatest determinant of anyone’s risk of periodontal disease that can be influenced the easiest continues to be their adherence to healthy oral hygiene practices.

Not only should all patients consider the maintenance of good oral hygiene practises the best way they can prevent periodontal disease, but patients who believe they may have a genetic predisposition to develop periodontal diseases should prioritise oral hygiene even more.

For any patients who believe they may have a genetic predisposition toward periodontitis, it is important to stress that developing periodontal diseases is never a “foregone” conclusion, regardless of susceptibility.

Everyone has the ability to drastically reduce their risk of periodontal disease by practising regular, effective oral health rituals.

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