Using risk assessment to customize periodontal treatment.

In recent years, understanding of the multifactorial nature of periodontal disease has taken great strides. Periodontal disease is initiated and sustained by the presence of bacteria, but disease progression is significantly modified by the body's response to the bacteria. This article highlights the emerging evidence regarding which risk factors are predominant in influencing the disease process and how the incorporation of prognostic risk factors in overall diagnosis can help facilitate treatment planning. These factors appear to be smoking, genetic susceptibility, compliance, and diabetes. The first three factors mentioned are the focus of this article. Each is discussed with regard to their role in amplifying the disease process and how this information can be used in clinical practice. By acknowledging the importance of these factors, dentists can consider their patients' risk to allow for more cost-effective planning and treatment. The opportunity to identify high-risk patients and treat them more proactively is significant; the challenge rests with dentists' willingness and ability to embrace the change before them.