Not all patients are the same: systemic risk factors for adult periodontitis.

Periodontal diseases are viewed today as multifactoral problems that are initiated and sustained by bacteria but significantly modified by the body's response to bacterial plaque. Local and systemic risk factors are involved in the disease process and both should be included when prognosis and treatment plans are developed. The most significant systemic modifying factors appear to be smoking, diabetes, and a recently discovered genetic marker. Slight changes in genes that produce an important inflammatory mediator, found in one-third of those studied, can lead to major negative outcomes in the way the body responds to bacteria.