title: Interaction of lifestyle, behaviour or systemic diseases with dental caries and periodontal diseases: consensus report of group 2 of the joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases.
abstract: Periodontal diseases and dental caries are the most common diseases of humans and the main cause of tooth loss. Both diseases can lead to nutritional compromise and negative impacts upon self-esteem and quality of life. As complex chronic diseases, they share common risk factors, such as a requirement for a pathogenic plaque biofilm, yet they exhibit distinct pathophysiologies. Multiple exposures contribute to their causal pathways, and susceptibility involves risk factors that are inherited (e.g. genetic variants), and those that are acquired (e.g. socio-economic factors, biofilm load or composition, smoking, carbohydrate intake). Identification of these factors is crucial in the prevention of both diseases as well as in their management.
  
  
  OBJECTIVE
  To systematically appraise the scientific literature to identify potential risk factors for caries and periodontal diseases.
  
  
  METHODS
  One systematic review (genetic risk factors), one narrative review (role of diet and nutrition) and reference documentation for modifiable acquired risk factors common to both disease groups, formed the basis of the report.
  
  
  CONCLUSIONS
  There is moderately strong evidence for a genetic contribution to periodontal diseases and caries susceptibility, with an attributable risk estimated to be up to 50%. The genetics literature for periodontal disease is more substantial than for caries and genes associated with chronic periodontitis are the vitamin D receptor (VDR), Fc gamma receptor IIA (Fc-γRIIA) and Interleukin 10 (IL10) genes. For caries, genes involved in enamel formation (AMELX, AMBN, ENAM, TUFT, MMP20, and KLK4), salivary characteristics (AQP5), immune regulation and dietary preferences had the largest impact. No common genetic variants were found. Fermentable carbohydrates (sugars and starches) were the most relevant common dietary risk factor for both diseases, but associated mechanisms differed. In caries, the fermentation process leads to acid production and the generation of biofilm components such as Glucans. In periodontitis, glycaemia drives oxidative stress and advanced glycation end-products may also trigger a hyper inflammatory state. Micronutrient deficiencies, such as for vitamin C, vitamin D or vitamin B12, may be related to the onset and progression of both diseases. Functional foods or probiotics could be helpful in caries prevention and periodontal disease management, although evidence is limited and biological mechanisms not fully elucidated. Hyposalivation, rheumatoid arthritis, smoking/tobacco use, undiagnosed or sub-optimally controlled diabetes and obesity are common acquired risk factors for both caries and periodontal diseases.
authors.affiliation: Periodontal Research Group, The University of Birmingham, Birmingham, UK.
authors.forename: Iain L C
authors.identifier: http://orcid.org/0000-0003-2697-7082
authors.initials: IL
authors.lastname: Chapple
authors.affiliation: Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France.|EA 2496, Paris 5-Descartes University, U.F.R. of Odontology, Paris, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Bouchard
authors.affiliation: WHO Collaboration Centre for Epidemiology and Community Dentistry, Milan, Italy.
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Cagetti
authors.affiliation: WHO Collaboration Centre for Epidemiology and Community Dentistry, Milan, Italy.|Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, Universita degli Studi di Sassari, Sassari, Italy.
authors.forename: Guglielmo
authors.identifier: http://orcid.org/0000-0002-8573-485X
authors.initials: G
authors.lastname: Campus
authors.affiliation: Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France.|INSERM, U1018, Villejuif, France.
authors.forename: Maria-Clotilde
authors.initials: MC
authors.lastname: Carra
authors.affiliation: Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, Universita degli Studi di Sassari, Sassari, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Cocco
authors.affiliation: Centre for Oral Clinical Research, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University London (QMUL), London, UK.
authors.forename: Luigi
authors.initials: L
authors.lastname: Nibali
authors.affiliation: Public Health Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Philippe
authors.initials: P
authors.lastname: Hujoel
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry in Amsterdam, Amsterdam, the Netherlands.
authors.forename: Marja L
authors.initials: ML
authors.lastname: Laine
authors.affiliation: Department of Cariology, Institute of Odontology, Gothenburg, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Lingstrom
authors.affiliation: Melbourne Dental School, University of Melbourne, Parkville, Vic., Australia.
authors.forename: David J
authors.identifier: http://orcid.org/0000-0002-4570-0620
authors.initials: DJ
authors.lastname: Manton
authors.affiliation: Faculty of Dentistry, Universidad Complutense de Madrid, Madrid, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Montero
authors.affiliation: Dental Innovation and Translation Centre, Dental Institute, Kings College London, London, UK.
authors.forename: Nigel
authors.initials: N
authors.lastname: Pitts
authors.affiliation: Department of Periodontology, Service of Odontology, Rothschild Hospital, AP-HP, Paris 7-Denis Diderot University, U.F.R. of Odontology, Paris, France.|EA 2496, Paris 5-Descartes University, U.F.R. of Odontology, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Rangé
authors.affiliation: Division for Cariology, Department of Operative Dentistry and Periodontology, Center for Dental Medicine, University Medical Center, Albert-Ludwig-University, Freiburg, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Schlueter
authors.affiliation: Periodontology, K. U. Leuven, Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Teughels
authors.affiliation: Faculty of Health and Medical Sciences, School of Dentistry, Section of Cariology and Endodontics, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Svante
authors.initials: S
authors.lastname: Twetman
authors.affiliation: Department of Cariology, Academic Centre for Dentistry Amsterdam, Amsterdam, the Netherlands.
authors.forename: Cor
authors.initials: C
authors.lastname: Van Loveren
authors.affiliation: Department of Periodontology, Academic Centre for Dentistry in Amsterdam, Amsterdam, the Netherlands.
authors.forename: Fridus
authors.initials: F
authors.lastname: Van der Weijden
authors.affiliation: Oral Biology, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Alexandre R
authors.initials: AR
authors.lastname: Vieira
authors.affiliation: Department of Special Care Dentistry, Dental School, Witten/Herdecke University, Witten, Germany.
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Schulte
mesh_terms: D003731:Dental Caries / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D015438:Health Behavior; D006801:Humans; D008019:Life Style; D010510:Periodontal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D012307:Risk Factors
keywords: Fc gamma receptor IIA (FcγRIIA) gene; Interleukin 10 (IL10) gene; acquired risk factors; amelogenin (AMELX) gene; aquaporin (AQP5) gene; candidate gene study (CGS); carbohydrate; caries; diabetes; diet; fluoride; genetics; genome wide association study (GWAS); gingival bleeding; gingivitis; hyposalivation; macronutrient; malnutrition; micronutrient; nutrition; oral hygiene frequency; periodontal diseases; periodontitis; polyunsaturated fatty acid (PUFA); prediction factor; prognostic factor; protein; risk factor; saliva; single nucleotide polymorphism (SNP); smoking; starch; sugars; vitamin B12; vitamin C; vitamin D; vitamin D receptor (VDR) gene