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72]

Review Article

Role of Genetic in Periodontal Disease

Anand Narayanrao Wankhede, Sayli Anand Wankhede1, Shilpa Prashant Wasu2

Department of Genetics is the study and understanding of the phenomena of heredity and
Periodontology, Swargiya

Abstract
Dadasaheb Kalmegh Smruti
variation. A  large number of genes are associated with many systemic conditions.
Dental College and Hospital, Periodontitis is inflammatory condition of periodontium. Periodontium consists of
Nagpur, 2Department of gingiva, periodontal ligament, cementum, and alveolar bone. It is considered being
Periodontology, V.Y.W.S a multifactorial disease. Studies of animals and humans support the concept that
Dental College and a large number of genes’ factor may be associated with periodontitis and clearly
Hospital, Amravati, 1Private play a role in the predisposition and progression of periodontal diseases. It has
Practitioner, Wardha,
Maharashtra, India
been proven that genetic factors impair inflammatory and immune responses during
periodontal diseases. Research on identifying specific genes causing periodontitis
may improve and prevent the disease progression. The aim of this article is to focus
on genetic risk factors and its influence for the various forms of periodontal disease.

Received: April, 2017.

Keywords: Aggressive, chronic, genetic, gingivitis, periodontitis, polymorphism,
Accepted: October 2017. single nucleotide, syndrome

Introduction Gingivitis and Periodontitis

P eriodontitis is a complex disease. It is one of the

most common oral diseases and is characterized
by gingival inflammation and alveolar bone
Oral cavity is a mirror of human body. More than
800 different bacterial species are found in oral cavity.[4‑6]
W. D. Miller was one of the important individuals who
resorption.[1] According to the World Health Organization worked greatly on oral microbiology. In 1890, he
report, severe periodontitis can lead to tooth loss in published a book titled Microorganisms of the Human
5%–15% of most world populations. Hence, it can be Mouth.[7] Specific group of microorganism or specific
considered among the prevalent and important global microorganism leads to the destruction of periodontium by
health problem in terms of quality of life. synthesizing products such as collagenase, hyaluronidase,
protease, and endotoxin that causes damage to epithelium,
Periodontitis is initiated by microorganisms and perhaps
connective tissue, and to intercellular constituents. These
viruses in the subgingival biofilm and further affected
products initiate the inflammatory process and activate
by lifestyle factors such as smoking, stress, diet, and
monocytes/macrophages which produce substances
environment. It can also be influenced by acquired
such as prostaglandin E2, interferon, tumor necrosis
systemic diseases which reduce or hamper an optimal
factor (TNF), and interleukin (IL)‑1.
host response. Apart from this, some modifying disease
genes can also be responsible for susceptibility to Inflammatory process transforms the healthy gingiva
periodontitis. Aggressive periodontitis is inherited as into gingivitis and the severity of the gingivitis further
Mendelian traits, and they are good models to identify affected by smoking, lifestyle, stress, diet, genetic
genetic risk factors in periodontitis.[2] However other
genetic risk factors, i.e., gene–gene interactions,
Address for correspondence: Dr. Anand Narayanrao Wankhede,
gene‑environmental, and environment–gene‑life style Department of Periodontology, Swargiya Dadasaheb Kalmegh
interaction also need to be present simultaneously for Smruti Dental College and Hospital, Nagpur, Maharashtra, India.
the phenotype to develop in periodontal disease.[3,4] E‑mail: wankhedeanand@yahoo.co.in

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DOI: 10.4103/jicdro.jicdro_10_17 How to cite this article: Wankhede AN, Wankhede SA, Wasu SP. Role of
genetic in periodontal disease. J Int Clin Dent Res Organ 2017;9:53-8.

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Wankhede, et al.: Genetics and periodontal diseases

makeup of the individual, and host–response and if Among chronic and aggressive periodontitis, aggressive
any underlying systemic diseases which can lead to periodontitis showed genetic predisposition in the
increase in progression of periodontitis.[8] Risk factors affected person. Various investigators conducted
for periodontal diseases include microbiologic factors, a familial study based on the hypothesis that it
immunologic factors, environmental factors, and genetic is inherited. Saxén concluded that the juvenile
factor. periodontitis  (aggressive periodontitis) is inherited in
an autosomal recessive mode.[11] Shapira et  al. showed
Gingivitis is the inflammation of gingiva. Gingivitis is a
family pedigree is consistent with an autosomal dominant
reversible condition whereas periodontitis is irreversible
mode of transmission in aggressive periodontitis.[12]
condition, in which along with inflammation of gingiva,
Michalowicz et  al. analyzed periodontal finding which
destruction of tooth‑supporting structure occurs. Not all
included probing depth, clinical attachment level,
cases of gingivitis become periodontitis; however, other
and plaque score in 110 adult twins who were both
cases go through a brief phase of gingivitis and rapidly
reared together and reared apart. A  significant genetic
develop into periodontitis that means periodontitis
component was identified for gingivitis, probing depth,
is always preceded by gingivitis but not all cases of
attachment loss, and plaque score.[13] Heritability studies
gingivitis progress to periodontitis.
indicate that 38%–82% of population variance for these
periodontal measures of disease may be attributed to a
Aggressive Periodontitis and Chronic
genetic factor, whereas there is general agreement that
Periodontitis bacteria are important in pathogenesis of periodontal
Periodontitis is an inflammatory condition of the disease. Approximately half of variance in disease in the
periodontium which affects gingiva, periodontal ligament, population is attributed to genetic variance, the basis for
cementum, and alveolar bone. Periodontitis is further heritability of periodontitis appears to be biological not
classified into chronic periodontitis and aggressive behavioral in nature.[14]
periodontitis.
Aggressive periodontitis differs from the chronic
Method of Genetic Analyses in

periodontitis by the rapid rate of disease progression Periodontics

seen in an otherwise healthy individual, absence of large Methods that are generally used to find the mode
accumulations of plaque and calculus, and family history of inheritance in periodontitis is done by familial
suggestive of a genetic trait in aggressive periodontitis.[9] aggregation, twin studies, segregation analysis, linkage
Chronic Periodontitis is as an infectious disease resulting analysis, and association studies. There have been
in inflammation within the supporting tissues of the many clinical reports suggesting a familial aggregation
teeth, progressive attachment loss, and bone loss.[10] of periodontitis, but until recently, the research tools to
It is the most common form of periodontitis. Chronic pursue these reports were lacking.[15]
periodontitis is more prevalent in adults but can occur
in children too. Amount of destruction consistent with Polymorphism
the subgingival calculus, variable microbial pattern, Human shares 99.9% of their genetic information.
and possibly modified by and/or associated with the The 0.1% differs from one person to the other. There
systemic diseases. Untreated chronic periodontitis may are a number of differences in the DNA sequences of
lead gingival inflammation, pocket formation, clinical two individuals and not all differences in the DNA
attachment loss, resorption of alveolar bone, and sequences cause disease; such differences are known as
occasional suppuration which are consider to be a clinical polymorphism. Polymorphism differs from the mutation
sign of chronic periodontitis. in such way that mutation causes the heritable alteration
or change in the genetic material. Single nucleotide
Role of Genetics in Etiopathogenesis of polymorphisms are variations of single base pairs spread
Periodontal Diseases all over the genome.[16]
Periodontal disease is a polymicrobial in origin which is
highly governed by host response, environmental factors,
Polymorphism in Relation to

and genetic factors. Scientists had done the research Periodontal Diseases
to find the role of genes and pattern of inheritance in Research on new methods for investigation of
periodontal disease. There are chromosome regions that disease condition at molecular level put the light to
potentially harbor susceptibility genes for periodontal the study interaction between host and parasite. In
diseases. periodontal disease, researcher has done worked on

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cellular and molecular level, especially on IL‑1,[17‑19] the action of neutrophil are seen. Some of syndromes are
IL‑4,[20] IL‑6,[21‑23] TNF‑α,[24‑26] Vitamin‑D receptor,[27‑29] associated with gingival enlargement, gingival bleeding,
Fc‑gamma receptor,[30‑32] IL‑10,[33,34] and matrix gingival fibromatosis, periodontitis, alveolar bone loss,
metalloproteinase. [35‑39]
and tooth loss.[50]
Studies had analyzed IL1 genetic association with
Genetics Test for Diagnosis and
periodontitis in clinical practice. The studies demonstrated
that composite IL‑1 genotype is significantly associated Therapeutic Treatment
with severity of periodontitis both in chronic and Genetic counseling
aggressive periodontitis. It also confirmed that both IL1 Genetic counseling is defined as a communication
genotyping and smoking history provide objective risk process involved in human problems associated with
factors for periodontal disease.[40‑43] However, there is the occurrence and recurrence of a genetic disorder in a
variation has been found between the different ethnic family. This process involves the expertise of a trained
groups of IL‑1 on periodontitis. Armitage et al. concluded counselor to guide individuals, family to the medical
that prevalence of both IL‑1A and IL‑1B polymorphism facts related to diagnosis, prognosis, and management of
dramatically lower in Chinese than Europeans.[44] a disorder, the role of heredity in genetic disorder, the
probable impact on the other members of the family,
An interaction of IL‑1 positive genotype with age,
and preventive measures for further recurrence of such
smoking, and Porphyromonas gingivalis which suggests
disorders in the family.[51]
that IL1 genotype is a contributory but nonessential
risk factor for periodontal disease progression in this Steps in genetic counseling:[52]
population.[45] Diehl et al. analyzed linkage disequilibrium a. Family history
of IL‑1 genetic polymorphism with aggressive • To construct and analysis pedigree
periodontitis. They selected 28 African‑American families b. Clinical Examination
and seven Caucasian American families with two or more c. Investigation*
affected members. IL‑1A and IL‑1B polymorphism were • Chromosomal analysis
in strong disequilibrium with each other in Caucasians • Enzyme assays
but not in African‑Americans. Results showed that • Metabolite measurements
aggressive periodontitis as a complex, oligogenic • DNA analysis.
disorder, with IL‑1 genetic variation contributing an *These are specialized tests which may be essential to
important but not exclusive influence on disease risk.[46] arrive at the final diagnosis
Papapanou et al. analyzed a IL‑1 gene polymorphism and d. Disease managements.
periodontal disease in a case–control study. No relation Genetic tests for periodontitis
between genotype positive and subgingival microbial At present, it is possible to perform genetic testing to
profile was observed. Genotype positive patients revealed identify individuals carrying gene mutations responsible
both overall lower serum antibody level and specific titers for several syndromic forms of periodontitis including
against selected bacteria. Thus, composite genotype failed LAD types 1 and 2, Papillon‑Lefèvre syndrome,
to distinguish between periodontitis patients and controls Haim‑Munk syndrome, Chédiak‑Higashi syndrome,
but correlated in patients with the severity of disease and and some forms of Ehlers‑Danlos syndrome. To
antibody responses to periodontal microbiota.[47] date, there is no evidence that mutations in the genes
responsible for these conditions are responsible for
Syndromes and Periodontitis the more prevalent forms of aggressive or chronic
Periodontitis has a common and interlink relation periodontitis. Genetic testing for mutations of specific
with syndromes which may or may not be present genes is not currently utilized for genetic testing for
with syndromes but when present, syndromes bring aggressive periodontitis and chronic periodontitis is
up structural and functional changes on periodontium. unknown. In the field of periodontics, most work in
Syndromes such as Chèdiak–Higashi syndrome,[48] evaluating genetic polymorphisms and their relationship
lazy leukocyte syndrome,[48,49] leukocyte adhesion to periodontitis has been performed for several IL‑1
deficiency  (LAD),[48] Papillon‑Lefèvre syndrome,[48] and genetic polymorphisms, and these tests show promise,
Down syndrome[49] showed the features of periodontitis. especially among certain preselected populations,
Neutrophil is the first line of defence in periodontitis. but for reasons stated previously, more genotypic
Abnormality in the action of neutrophil aggregates information that identifies additional genomic risk
periodontal disease condition. Conditions such as LAD, markers would likely provide even better diagnostic and
lazy leukocytes, Down syndrome in which abnormality in prognostic tools in the future.[53]

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Human Genome project Conclusion

It is an international scientific research project with the Despite tremendous efforts and published papers in
goal of determining identification of a large number the field of genetic association with periodontitis over
of disease‑causing genes. It opened the floodgate the past decade, the causative gene polymorphisms
of DNA diagnostic tests which have found a firm of periodontitis and their pathophysiological effect
place in clinical management of various diseases by are still very controversial. Association studies have
way of genetic counselling, carrier detection, and limited power to detect the rare genetic risk factors.
presymptomatic.[51] Knowledge of the hereditary influence of disease is not
a new finding, and it seems that the oral cavity is not
Candidate gene approach
excluded from genetic factors. Genes do not work in a
Gene mapping is a test which is used to find whether one
vacuum, nor does it appear that one gene is responsible
allele of a gene occurs more often in patients with the for this disease. At present, current dental treatment
disease than in participant without a disease. Gene, i.e., and/or periodontal treatment does not commonly use
candidate gene is chosen on the basis of their presumed the available knowledge of genetic factor for treatment.
or known function.[54] There will be need of a proper approach  (protocol)
Syndrome diagnosis for patient treatment which will incorporate genetic
Syndrome brings up structural and functional changes in knowledge on a regular basis.
patients. Most of time, it is very difficult to do accurate Financial support and sponsorship
diagnosis. Various computerized database, namely, Nil.
Pictures of Selected Syndromes and Undiagnosed
Conflicts of interest
Malformation and London Dysmorphology Database
greatly helped for diagnostic approaches which give There are no conflicts of interest.
detailed descriptions of syndromes.[52]
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