Review Ranks Evidence Behind Local and Systemic Gingivitis Risk Factors

Edited by Dentaltown staff

Fixed orthodontic appliances consistently increase gingival inflammation while the evidence on overweight and obesity remains too thin to draw a conclusion, according to a systematic review of local and systemic risk factors for dental biofilm-induced gingivitis published Sept. 17 in the Journal of Clinical Periodontology.

Investigators screened 11,529 records and included 71 papers, restricting eligibility to longitudinal studies of at least three months or studies using the experimental gingivitis protocol. Fifty-five papers addressed risk factors and indicators, and 16 addressed interventions.

Among local factors, fixed appliances were the most studied, acting through plaque retention. Removal of the appliances consistently produced a significant reduction in inflammation. Evidence on whether orthodontic correction of malalignment or severe crowding changes gingival inflammation was limited. Some studies found higher gingival index scores at sites with defective, overhanging, or subgingival restorative margins.

Among systemic factors, adherence to a pro-inflammatory or high-sugar diet increased risk, while an anti-inflammatory or low-sugar diet and dietary counseling could reduce it.

In patients with pre-existing gingivitis, menstrual cycle hormone fluctuations and gonadotropin-induced ovarian stimulation were associated with increased inflammation independent of plaque levels.

The review found no convincing evidence that overweight or obesity increases gingivitis risk, attributing that to a lack of studies rather than to negative findings.

Researchers at Université Paris Cité and Sorbonne Paris Nord led the review, with colleagues at the University of Bonn, the University of Marburg, and the University of Medicine and Pharmacy Iuliu Ha?ieganu in Cluj-Napoca. The protocol was registered with PROSPERO and the review followed PRISMA guidelines.

The authors concluded that certainty of evidence varies across the factors examined, and that oral hygiene instruction and professional mechanical plaque removal should be intensified in affected patients, with dietary advice considered as an adjunct.

Sources:
Journal of Clinical Periodontology, “Local and Systemic Risk Factors of Dental Biofilm-Induced Gingivitis and Their Control: A Systematic Review,” published online Sept. 17, 2026: doi.org/10.1111/jcpe.70189
PubMed record, PMID 42751832: pubmed.ncbi.nlm.nih.gov/42751832