Role of Lifestyle, Compliance and Dental care Habits in Causation of Periodontitis

Dr. Ankit Mohapatra
Department of Public Health Dentistry.
1

 Periodontal disease is a result of complex interaction
between subgingival microflora and non bacterial factors
(host and environmental factors)
 Bacteria alone in a compromised host or combined with
environmental factors increase the host susceptibility to
infection hence an increased risk of progressive periodontal
disease.
2

 Periodontitis is a chronic multifactorial inflammatory
disease caused by microorganisms and characterized by
progressive destruction of the tooth supporting apparatus
leading to tooth loss.
Tonetti MS, VanDyke TE and on behalf of working group 1 of the joint EFP/AAP
workshop and. Periodontitis and atherosclerotic cardiovascular disease: consensus
report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases. J
Clin Periodontol 40 (suppl. 14): S24–S29. 3

PERIODONTITIS
Subgingival microflora Non- bacterial factors
4

 Use of Tobacco.
 Low Socio-economic status.
 Poor Compliance and Irregular Dental Visits.
 Acquired Systemic and infectious diseases.
5

SE factors related to periodontal diseases are-
 Education
 Income
 Occupation
Worth to note that only Education factor remains stable across
the adult life hood, as it usually peaks earlier in life than the
other socio-economic indicators.
6
Fox CH et al. Periodontal disease among New England elders. J Periodontol.
1994 65:676-84

 Periodontal disease is more severe in individuals with poor
education level. Reasons to support-
 Smoking & Type 2 Diabetes associated with low education.
 Poorer cooping strategies
 High BMI
7

 Lower utilization of health services
 Low degree of health awareness
 Poor oral hygiene habits
8
Boillot A et al. (2011) Education as a Predictor of Chronic Periodontitis: A
Systematic Review with MetaAnalysis Population-Based Studies. PLoS ONE
6(7): e21508

 Moreover, low education level is likely to lead to low
prestige and low pay occupations, and residing in deprived
area.
 The impact of environmental conditions on periodontal
health is such that individuals living in a neighborhood in
the most socially marginalized areas experience twice the
risk of periodontitis relative to those in the most affluent.
9
Borrell LN et al. The role of individual and neighborhood social factors on
periodontitis: the third National Health and Nutrition Examination Survey. J
Periodontol. 2006;77:444–53.

 A study (2017) reviewed 7 longitudinal studies with a
follow-up period ranging from 2-28 years and
found evidence that demonstrated potential longitudinal
impact of earlier lower Socio Economic Position (SEP) on
later periodontal health.
10
Schuch HS, Peres KG, Singh A, Peres MA, and Do LG. Socioeconomic
position during life and periodontitis in adulthood: a systematic
review. Community Dent Oral Epidemiol. 2017;45:201–8.

Lifestyle is measured by means of-
 Tobacco-related habits,
 Physical activity,
 Dietary habits,
 Alcohol consumption.
11
Abel T. Measuring health lifestyles in a comparative analysis: theoretical issues and
empirical findings. Soc Sci Med. 1991;32(8):899-908.

 Periodontitis is a major oral disease that is strongly
influenced by obesity, over weight and level of exercise.
 Physical activity has shown to have a protective relationship
with several chronic diseases.*
12
*Mohammad S et al. Increased physical activity reduces prevalence of
periodontitis. Journal of Dentistry. 2005;33,(9): 703-710

 The adverse effect of obesity on the periodontium may be
mediated through pro-inflammatory cytokines like
interleukins (IL-1, IL-6 and TNF-α), adipokines (leptin,
adiponectin, resistin and plasminogen activator inhibitors-1)
and several other bioactive substances like reactive oxygen
species (ROS), which may affect the periodontal tissues
directly.
13

 Reactive oxygen species are products of normal cellular
metabolism but over-production of reactive oxygen species
induces damage by oxidizing DNA, lipids and proteins.
 Obesity increases the circulation of reactive oxygen species
which in turn causes gingival oxidative damage and
progression of periodontitis
14
Parveen Dahiya, Reet Kamal, and Rajan GuptaObesity, periodontal and
general health: Relationship and management.

 A systematic review (2010) reported a positive association
for obesity in the development of periodontal disease.
 There was a greater mean clinical attachment loss among
obese individuals, a higher mean body mass index (BMI)
among periodontal patients, and a trend of increasing odds
of prevalent periodontal disease with increasing BMI.*
15
*Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic Periodontal Disease and
Obesity: A Systematic Review and Meta-Analysis. J Periodontol.2010;81(12):1708-1724

 A Meta-analyses (2011) indicated statistically significant
associations between periodontitis and body mass index
(BMI) category obese OR 1.81, overweight OR 1.27 and
obese and overweight combined OR 2.13.
16
Jean Suvan et al. Association between overweight/obesity and periodontitis in adults.
A systematic review. Obesity reviews.2011;12:e381–e404

 A study (2017) reported that long working hours are
associated with periodontitis among Korean workers with
working group of >52 hours per week having 1.10 odds.*
17
*Wanhyung Lee et al. Relationship between long working hours and periodontitis among the
Korean workers. Scientific Reports 2017;7: 7967

 Nutritional intake has impact upon the levels of
inflammation seen in a number of diseases, and this is no
less the case in periodontitis.
 Studies using an experimental gingivitis model have shown
increased levels of bleeding on probing when participants
were fed with a diet high in carbohydrates when compared
to those on a low sugar diet.
18
Sidi A, Ashley F. Influence of frequent sugar intakes on experimental gingivitis. J
Periodontol 1984; 55: 419-423.

 Oxidative stress is a key driver of chronic inflammation and
as a result has a central role in the pathogenesis of a wide
range of chronic inflammatory diseases.
 In health a fine balance exists between, oxidants and on the
other antioxidants which are found in all tissues of the body
19

 A study (2013) reported the importance of total amounts of
simple sugars, carbohydrates and fat intake entering the
blood stream.
 Also frequency of intake is a key factor in generating
oxidative stress, the more frequent the intake the greater the
inflammation recorded in blood vessels
20
MR Milward, ILC Chapple. The Role Of Diet In Periodontal Disease. Dental
Health. 2013;52(3):18-21

 A study (2011) reported that overweight students, the
frequent consumption of fatty foods and infrequent
consumption of vegetables were associated with an
increased risk of periodontitis.
 In underweight and normal-weight students, eating habits
had little effect on the periodontal condition.
21
Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal Condition
in University Students. J Periodontol
2011;82,(12):1642-1649

 Periodontal disease progresses more rapidly in
undernourished population, the role of nutrition in
maintaining an adequate immune response explains this.
 Periodontitis is associated with an increased production of
reactive oxygen species which, if not buffered cause damage
to host cells and tisssue.
22

 Currently there is no strong evidence that supports the claim
of diet and nutrition as a causal factor for periodontitis.
 However studies are investigating the protective role of
antioxidants nutrients in periodontitis.
23
Moynihan PJ. The role of diet and nutrition in the etiology and prevention of
oral diseases. Bulletin of the World Health Organization. 2005 Sep; 83(9):694-9.

 A systematic review (2009) concluded that an association of
vitamin B complex, vitamin C, vitamin D, calcium and
magnesium deficiencies with periodontal disease in elderly
people is not evident.
24
Van der Putten Gj et al. Association of some specific nutrient deficiencies with
periodontal disease in elderly people: a systematic literature review. Nutrition 2009; 25:
717-722.

 A Systematic review (2014) reported that Vitamin E, zinc,
lycopene and vitamin B complex may have useful adjunct
benefits.
 However, there was inadequate evidence to link the
nutritional status of the host to periodontal inflammation.
25
Kulkarni V et al. The effect of nutrition on periodontal disease: a
systematic review. J Calif Dent Assoc. 2014 May;42(5):302-11.

 Vitamins are essential for general heath and normal
functioning. Similarly, they are required for maintaining
health oral and periodontal tissues. Nutritional deficiency of
vitamins results in oral manifestations such as scurvy and
rickets.
26
Shariq Najeeb et al. The Role of Nutrition in Periodontal Health: An Update.
Nutrients.2016;8:530

 Since epithelial tissues provide a primary barrier function to
protect against invading microorganisms, vitamin A plays an
important role in maintaining the epithelium.
 Periodontal changes have been reported in vitamin A-
deficient rats:
27

1. Hyperplasia and hyperkeratinisation of the gingival
epithelium with proliferation of the junctional epithelium.
2. Retardation of gingival wound healing
28
Dr. R.S. Pavithra et al. Vitamin Deficiency And Periodontal Disease – A Tie- in
Relationship. Sch. J. App. Med. Sci., Jan 2017; 5(1A):74-81

 Vitamin C (ascorbic acid) is primarily required for the
synthesis of collagen and it also prevents oxidative damage
by acting as a Reactive Oxidative Species (ROS) scavenger.
 Scurvy, first identified by Sir Thomas Barlow in 1883.
 In addition to malaise, lethargy, and spots on the skin,
periodontal hallmarks of scurvy are bleeding, inflamed, and
painful gums.
29
Shariq Najeeb et al. The Role of Nutrition in Periodontal Health: An Update. Nutrients
2016, 8, 530

 Ascorbic acid deficiency interferes with bone formation,
leading to loss of periodontal bone.
 Depletion of vitamin C may interfere with the ecologic
equilibrium of bacteria in plaque and thus increase its
pathogenicity.
 How ever there is no evidence to support the above
statement.
30
Dr. R.S. Pavithra et al. Vitamin Deficiency And Periodontal Disease – A Tie- in

 In humans, there are two important groups of vitamin D,
vitamins D2 (cholecalciferol) and D3 (ergocalciferol).
 Clinical studies have suggested that a deficiency of dietary
vitamin D leads to periodontal inflammation and a delay in
post-surgical periodontal healing
31

 However, clinical trials have found no significant link
between serum vitamin D levels and periodontal health.
 Nevertheless, when the correlation between serum vitamin
D levels and disease progression was studied in individuals
over 60 years of age, an inverse relationship was observed.
32
Shariq Najeeb et al. The Role of Nutrition in Periodontal Health: An Update. Nutrients
2016, 8, 530

 A longitudinal study (2011) reported that calcium and
vitamin D supplementation has a modest positive effect on
periodontal health, and consistent dental care improves
clinical parameters of periodontal disease regardless of such
supplements.
33
M. Nathalia Garcia One-year Effects of Vitamin D and Calcium Supplementation on
Chronic Periodontitis. J Periodontol. 2011 Jan; 82(1): 25–32.

 Vitamin E serves as an antioxidant to limit free-radical
reactions and to protect cells from lipid peroxidation.
 Cell membranes, which are high in polyunsaturated lipids,
are the major site of damage in vitamin E deficiency.
 Deficiency results in increased tendency for haemolysis
which affects cross linking of collagen
34
Klokkevold.P.R, Mealey.B.L, Carranza.F.A Influence of Systemic Disease and
Disorders on the Periodontium. Carranza’s Clinical Periodontology. 9th ed.
Philadelphia: Saunders Elsevier; 2002: 204-228

 A study (2014) investigated the levels of superoxide
dismutase (SOD) activity in serum and saliva of patients
with chronic periodontitis (CP).
 In addition, the outcome of scaling and root planing (SRP)
with and without vitamin E supplementation was evaluated
in terms of changes in periodontal parameters
35

 And they reported that adjunctive vitamin E
supplementation improves periodontal healing as well as
antioxidant defense.
36
Singh N, et al. Vitamin E supplementation, superoxide dismutase status, and outcome
of scaling and root planning in patients with chronic periodontitis: a randomized
clinical trial. J Periodontol. 2014 Feb; 85(2):242-9.

 But, Hideki Nagata (2014) contributed results of studies
published after 1980 to a book and described that the effects
of vitamin E on periodontal disease were unclear.
37
Nagata H. (2014) Role of Vitamin C and Vitamin E in Periodontal Disease. In: Ekuni
D., Battino M., Tomofuji T., Putnins E. (eds) Studies on Periodontal Disease. Oxidative
Stress in Applied Basic Research and Clinical Practice. Humana Press, New York, NY

 Folic acid deficiency is characterized by lesions in cells with
rapid rate of renewal, which demonstrates the importance of
this vitamin in the synthesis of DNA.
 Folic acid deficiency impairs immune responses and
resistance of the oral mucosa to penetration by pathogenic
organisms such as candida
38

 A study (1997) reported series of human trials and
concluded that there was a significant reduction of gingival
inflammation reported after systemic or local use of folic
acid, when compared with placebo.
39
Vogel RI, Fink RA, Frank O, Baker H. The effect of topical application of folic acid on
gingival health. Journal of oral medicine. 1977 Dec; 33(1):22

 Alcohol is considered as one of the independent modifiable
risk factors for periodontitis.
 Alcoholics are more prone to have a number of oral health
problems such as gingival infection, increased pocket depth
and loss of attachment, oropharynx cancer, caries, and tooth
loss
40

Several plausible mechanisms-
 Amaral et al. (2011) reported that alcoholics have higher
levels of periodontopathic species in the subgingival
microbiota than non-alcoholics.
41
Amaral CDSF, da Silva-Boghossian CM, Leão ATT, Colombo APV.
Evaluation of the subgingival microbiota of alcoholic and non-alcoholic
individuals. Journal of dentistry 2011; 39(11):729-738

 A recent study (2013) among African American males
reported that excessive alcohol use impairs the bactericidal
action of neutrophil and that periodontitis risk increases in
alcohol-dependent subjects with unimpaired neutrophil
function
42
Khocht A. Neutrophil function and periodontitis in alcohol-dependent males
without medical disorders. Journal of International Academy of
Periodontology 2013; 15(3):68-74

 A systematic review (2009) reported a positive association
between alcohol intake and periodontitis.
 Further concluding that alcohol consumption can be
considered a risk indicator for periodontitis.
43
S. Amaral Cda, M.V. Vettore, A. LeãoThe relationship of alcohol dependence
and alcohol consumption with periodontitis: a systematic review
J Dent, 37 (2009), pp. 643-651

 A meta-analysis conducted (2016) took 18 studies for
analysis and suggested that alcohol consumption was
associated with an increased risk of periodontitis.
44
Wang J, Lv J, Wang W, Jiang X. Alcohol consumption and risk of
periodontitis: a meta-analysis. J Clin Periodontol 2016;43(7):572-83

 Periodontal diseases are more prevalent in addicts than in
the general population also having more cervical plaque on
one or more teeth.
 A study (1996) found majority of addicts have a high rate of
plaque accumulation and calculus deposits resulting from
oral hygiene neglect, xerostomia and alteration in microbial
profile.
45
Molendijk B, Ter Horst G, Kasbergen M, Truin GJ, Mulder J. Dental health
in Dutch drug addicts. Community Dent Oral Epidemiol. 1996;24:117–9.

 Abused drugs such as opiates lead to suppression of pain
responses causing patient to ignore the signs of tooth decay,
periodontal diseases and limited access to dental care.*
 Dental caries and periodontal disease can be linked to the
hyposalivation due to the use of drugs.
46
*Carter EF. Dental implications of narcotic addiction. Aust Dent
J. 1978;23:308–10.

 Qat leaves are kept into muco-buccal fold and chewing it for
several hours with the release of psychoactive agents similar
to amphetamine inducing release of dopamine and is also
associated with periodontitis, oral leukoplakia and oral
cancer.
47
El-Wajeh YA, Thornhill MH. Qat and its health effects. Br Dent
J. 2009;206:17–21

 A study (2017) analysed results of 28 literatures to find an
association between poor oral health and substance abuse
and found that patients with substance abuse have greater
and more severe dental caries and periodontal disease than
the general population, and are less likely to have received
dental care.
48
Baghaie H et al. A systematic review and meta-analysis of the association
between poor oral health and substance abuse. Addiction. 2017
May;112(5):765-779

 Patient compliance may be defined as the extent to which a
person’s behaviour coincides with medical or oral health
related advice.
 It reflects a patient’s willingness to comply with preventive
or therapeutic strategies as set forth by his or her health care
provider.
49
Terezhalmy G, Florman M, Martin P, Barnard SC. Patient Compliance -
Strategies For Success : ADA CERP [Continuing Education Research
Programme]

 The most meticulous and conscientious periodontal therapy
by a dentist is many a times rendered by patients
noncompliance to the maintenance therapy.
 Stress full life events was the highly reported factor for non
compliance.*
50
*Becker, B. E., Karp, C. L., Becker, W. and Berg, L. Personality differences
and stressful life events. Differences between treated periodontal patients
with and without maintenance. Journal of Clinical Periodontology.1988;15:
49–52.

 A study (1991) reported that embarrassment, nervousness,
lack of time, practice location, beliefs/ideals, and personal
crises were not significant reasons for non-compliance
where as regular visit to dentist, cost and lack of perceived
need for periodontal therapy were the patients stated reasons
for non compliance.
51
Mendoza R et al. Compliance With Supportive Periodontal Therapy. J
Periodontol. 1991;62(12):731-736

 Younger patients and patients of higher SES are more
compliant to periodontal maintenance therapy.*
 Females are more compliant than males and it increases
with age.#
52
*Demetriou N et al, Compliance with supportive periodontal treatment in
private periodontal practice. A 14-year retrospective study. J
Periodontol.1995 Feb;66(2):145-9.
#Novaes AB Jr et al. Compliance with supportive periodontal therapy. Part 1.
Risk of non-compliance in the first 5-year period. J Periodontol. 1999
Jun;70(6):679-82.

 A study (2015) reported that the risk of tooth loss in the
Regular Compliance group was significantly lower than that
in the Erratic Compliance group.
 Further concluding that there is a less risk of tooth loss due
to periodontitis if the patient is more compliance to
periodontal therapy.
53
C.T. Lee, H.Y. Huang, T.C. Sun, N.Karimbux .Impact of Patient Compliance on Tooth Loss
during Supportive Periodontal Therapy: A Systematic Review and Meta-analysis. J Dent Res.
2015;94(6):777 - 786

 Dental visits
 Frequency and time of brushing
 Use of oral hygiene aids
54

 It is controversial to identify irregular dental visits as a risk
factor for periodontal disease.
55
Page RC, Beck JD. Risk assessment for periodontal diseases. International
dental journal. 1997 Apr 1;47(2):61-87.

 Regular dental attendance, along with other oral health
behavior, is an essential factor in the prevention of
periodontal disease progression and the maintenance of
good oral condition with functional tooth retention.
56
Yoriko Matsuoka et al. Dental attendance patterns of patients with non-
communicable diseases by six-year follow-up study. Health Science-
Healthcare.2011;11(1):4-8

 Inadequate control of dental biofilm may result in
recolonization of the subgingival area by periodontal
pathogenic microorganisms, which could compromise the
results of the periodontal treatment
 In periodontal maintenance, patients should participate
actively in the treatment and attending periodontal
maintenance appointments.
57
Carvalho et al. Compliance improvement in periodontal maintenance. J of
Appl Oral Sci. 2010;18(3):215-9.

 Patients who attend regular periodontal maintenance
programs have significant less attachment loss and tooth
loss when compared to those who do not receive periodontal
maintenance
58
Lindhe J, Nyman S. Long-term maintenance of patients treated for advanced
periodontal disease. J Clin Periodontol. 1984;11(8):504-14.

 Bacterial plaque is the primary etiologic factor associated
with periodontitis. Therefore effective plaque removal on
daily basis by an individual is critical.
 Many studies have demonstrated significant reductions in
probing pocket depths, attachment gains and, of course, in
gingival inflammation, with improvements in oral hygiene
alone.*
59
*Koshi E et al. Risk assessment for periodontal disease. J Indian Soc
Periodontol. 2012 Jul-Sep; 16(3): 324–328.

 Lack of oral hygiene encourages bacterial build-up and
biofilm plaque formation, and can also increase certain
species of pathogenic bacteria associated with more severe
forms of periodontal diseases.
60
American Academy of Periodontology statement on Risk Assessment. J
Periodontol. 2008;2:202.

 A study (2017) used pooled effect of fair OH versus good
OH and poor OH versus good OH on periodontitis found
odds ratios (ORs) of 2.04 and 5.01, respectively.
 They measured oral care habits according to toothbrushing
regularity and dental visit frequency; pooled ORs of 0.66
and 0.68, respectively.
61

 Further concluding that poor OH increases the risk of
periodontitis by approximately two- to five-fold compared
with good OH. Oral care habits, including regular brushing
and regular dental visits can decrease the risk of
periodontitis.
62
Lertpimonchai A et al. The association between oral hygiene and
periodontitis: a systematic review and meta-analysis.
Int Dent J.2017; 67: 332–343

Scottish Dental Clinical Effectiveness Programme
 Assess and explain risk factors for periodontal diseases to patients
 Carry out a full periodontal examination for patients with BASIC
PERIODONTAL EXAMINATION scoring 0-*
 Use the Oral Hygiene TIPPS (talk, instruct, practise, plan,
support) behaviour change strategy to address inadequate plaque
removal
63

 Raise the issue of smoking cessation where appropriate
 Encourage patients to modify other lifestyle factors that may
impact on their oral health
 Ensure the patient is able to perform optimal plaque removal
 Remove supra-gingival plaque, calculus and stain and sub-
gingival deposits
64

 Ensure that local plaque retentive factors are corrected
 Record the diagnosis, suggested treatment plan and details
of costs
65
Prevention And Treatment Of Periodontal Diseases In Primary Care Dental
Clinical Guidance. SDCEP. Dundee: Dundee Dental Education Centre. 2014

 Periodontal Diseases are unquestionably infectious.
 Apart from peripathogenic microflora, attachment loss is
influenced by many external modifying factors.
 External modifying factors such as Smoking, Low SES,
Compliance, Poor Oral Hygiene, Irregular dental visits and
Unhealthy lifestyle increase an individuals risk of
periodontal disease.
66

1. Per Axelsson. Diagnosis and Risk Prediction of Periodontal Diseases Vol 3.
2002. Quintessence Publishing Co. Inc. Illinios.
2. Carranza, F., Newman, M. and Takei, H. Carranza's Clinical Periodontology.
10th ed. 2006. St. Louis, Mo.: Elsevier Saunders.
3. Tonetti MS, VanDyke TE and on behalf of working group 1 of the joint
EFP/AAP workshop and. Periodontitis and atherosclerotic cardiovascular
disease: consensus report of the Joint EFP/AAP Workshop on Periodontitis
and Systemic Diseases. J Clin Periodontol 40 (suppl. 14): S24–S29.
67

4. Fox CH et al. Periodontal disease among New England elders. J Periodontol.
1994 65:676-84
5. Boillot A et al. (2011) Education as a Predictor of Chronic Periodontitis: A
Systematic Review with MetaAnalysis Population-Based Studies. PLoS ONE
6(7): e21508
6. Borrell LN et al. The role of individual and neighborhood social factors on
periodontitis: the third National Health and Nutrition Examination Survey. J
Periodontol. 2006;77:444–53.
68

7. Schuch HS, Peres KG, Singh A, Peres MA, and Do LG. Socioeconomic
position during life and periodontitis in adulthood: a systematic
review. Community Dent Oral Epidemiol. 2017;45:201–8.
8. Abel T. Measuring health lifestyles in a comparative analysis: theoretical
issues and empirical findings. Soc Sci Med. 1991;32(8):899-908.
9. Mohammad S et al. Increased physical activity reduces prevalence of
periodontitis. Journal of Dentistry. 2005;33,(9): 703-710
10. Parveen Dahiya, Reet Kamal, and Rajan GuptaObesity, periodontal and
general health: Relationship and management.
69

11. Jean Suvan et al. Association between overweight/obesity and periodontitis in
adults. A systematic review. Obesity reviews.2011;12:e381–e404
12. Wanhyung Lee et al. Relationship between long working hours and
periodontitis among the Korean workers. Scientific Reports 2017;7: 7967
13. Sidi A, Ashley F. Influence of frequent sugar intakes on experimental
gingivitis. J Periodontol 1984; 55: 419-423.
14. MR Milward, ILC Chapple. The Role Of Diet In Periodontal Disease. Dental
Health. 2013;52(3):18-21
70

15. Takaaki Tomofuji et al. Relationships Between Eating Habits and Periodontal
Condition in University Students. J Periodontol 2011;82,(12):1642-1649
16. Moynihan PJ. The role of diet and nutrition in the etiology and prevention of
oral diseases. Bulletin of the World Health Organization. 2005 Sep;
83(9):694-9.
17. Van der Putten Gj et al. Association of some specific nutrient deficiencies
with periodontal disease in elderly people: a systematic literature review.
Nutrition 2009; 25: 717-722.
18. Kulkarni V et al. The effect of nutrition on periodontal disease: a systematic
review. J Calif Dent Assoc. 2014 May;42(5):302-11. 71

19. Shariq Najeeb et al. The Role of Nutrition in Periodontal Health: An Update.
Nutrients.2016;8:530
20. Dr. R.S. Pavithra et al. Vitamin Deficiency And Periodontal Disease – A Tie- in
21. M. Nathalia Garcia One-year Effects of Vitamin D and Calcium Supplementation
on Chronic Periodontitis. J Periodontol. 2011 Jan; 82(1): 25–32.
22. Benjamin W. Chaffee and Scott J. Weston. Association Between Chronic
Periodontal Disease and Obesity: A Systematic Review and Meta-Analysis. J
Periodontol.2010;81(12):1708-1724
72

23. Klokkevold.P.R, Mealey.B.L, Carranza.F.A Influence of Systemic Disease and
Disorders on the Periodontium. Carranza’s Clinical Periodontology. 9th ed.
Philadelphia: Saunders Elsevier; 2002: 204-228
24. Singh N, et al. Vitamin E supplementation, superoxide dismutase status, and
outcome of scaling and root planning in patients with chronic periodontitis: a
randomized clinical trial. J Periodontol. 2014 Feb; 85(2):242-9.
25. Nagata H. (2014) Role of Vitamin C and Vitamin E in Periodontal Disease. In:
Ekuni D., Battino M., Tomofuji T., Putnins E. (eds) Studies on Periodontal
Disease. Oxidative Stress in Applied Basic Research and Clinical Practice.
Humana Press, New York, NY
73

26. Vogel RI, Fink RA, Frank O, Baker H. The effect of topical application of
folic acid on gingival health. Journal of oral medicine. 1977 Dec; 33(1):22
27. Amaral CDSF, da Silva-Boghossian CM, Leão ATT, Colombo APV.
Evaluation of the subgingival microbiota of alcoholic and non-alcoholic
individuals. Journal of dentistry 2011; 39(11):729-738
28. Szabo G. Consequences of alcohol consumption on host defence. Alcohol
and alcoholism 1999; 34(6): 830-841.
29. Khocht A. Neutrophil function and periodontitis in alcohol-dependent males
without medical disorders. Journal of International Academy of
Periodontology 2013; 15(3):68-74
74

30. S. Amaral Cda, M.V. Vettore, A. LeãoThe relationship of alcohol dependence
and alcohol consumption with periodontitis: a systematic review
J Dent, 37 (2009), pp. 643-651
31. Mishali Alsharief, Elizabeth KrallKaye Alcohol Consumption May Increase
the Risk for Periodontal Disease in Some Adult Populations. J Evid Based
Dent Pract. 2017;17(1):59-61
32. Wang J, Lv J, Wang W, Jiang X. Alcohol consumption and risk of
periodontitis: a meta-analysis. J Clin Periodontol 2016;43(7):572-83
33. Molendijk B, Ter Horst G, Kasbergen M, Truin GJ, Mulder J. Dental health
in Dutch drug addicts. Community Dent Oral Epidemiol. 1996;24:117–9. 75

34. Carter EF. Dental implications of narcotic addiction. Aust Dent
J. 1978;23:308–10.
35. El-Wajeh YA, Thornhill MH. Qat and its health effects. Br Dent
J. 2009;206:17–21
36. Baghaie H et al. A systematic review and meta-analysis of the association
between poor oral health and substance abuse. Addiction. 2017
May;112(5):765-779
37. Terezhalmy G, Florman M, Martin P, Barnard SC. Patient Compliance -
Strategies For Success : ADA CERP [Continuing Education Research
Programme] 76

38. Becker, B. E., Karp, C. L., Becker, W. and Berg, L. Personality differences and
stressful life events. Differences between treated periodontal patients with and
without maintenance. Journal of Clinical Periodontology.1988;15: 49–52.
39. Mendoza R et al. Compliance With Supportive Periodontal Therapy. J
Periodontol. 1991;62(12):731-736
40. Demetriou N et al, Compliance with supportive periodontal treatment in
private periodontal practice. A 14-year retrospective study. J Periodontol.1995
Feb;66(2):145-9
77

41. Novaes AB Jr et al. Compliance with supportive periodontal therapy. Part 1.
Risk of non-compliance in the first 5-year period. J Periodontol. 1999
Jun;70(6):679-82.
42. C.T. Lee, H.Y. Huang, T.C. Sun, N.Karimbux .Impact of Patient Compliance
on Tooth Loss during Supportive Periodontal Therapy: A Systematic Review
and Meta-analysis. J Dent Res. 2015;94(6):777 - 786
43. Page RC, Beck JD. Risk assessment for periodontal diseases. International
dental journal. 1997 Apr 1;47(2):61-87.
78

44. Yoriko Matsuoka et al. Dental attendance patterns of patients with non-
communicable diseases by six-year follow-up study. Health Science-
Healthcare.2011;11(1):4-8
45. Carvalho et al. Compliance improvement in periodontal maintenance. J of
Appl Oral Sci. 2010;18(3):215-9.
46. Lindhe J, Nyman S. Long-term maintenance of patients treated for advanced
periodontal disease. J Clin Periodontol. 1984;11(8):504-14.
47. Koshi E et al. Risk assessment for periodontal disease. J Indian Soc
Periodontol. 2012 Jul-Sep; 16(3): 324–328.
79

48. American Academy of Periodontology statement on Risk Assessment. J
Periodontol. 2008;2:202
49. Lertpimonchai A et al. The association between oral hygiene and
periodontitis: a systematic review and meta-analysis. Int Dent J.2017; 67:
332–343
50. Prevention And Treatment Of Periodontal Diseases In Primary Care Dental
Clinical Guidance. SDCEP. Dundee: Dundee Dental Education Centre. 2014
80

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