Local and Systemic Risk Factors of Dental Biofilm‐Induced Gingivitis and Their Control: A Systematic Review

Abstract

ABSTRACT Objectives To identify local and systemic risk factors/indicators for dental biofilm‐induced gingivitis (DB‐GI) and to summarize evidence for their control. Methods A systematic review was undertaken following Preferred Reporting Items for Systematic Review and Meta‐Analyses (PRISMA) guidelines and divided into PECOTS and PICOTS questions, respectively, related to risk factors/indicators and intervention studies. Only longitudinal studies with at least 3 months duration or studies using the experimental gingivitis protocol were included. Literature search was performed on electronic databases PubMed in Medline, Ovid in EMBASE and SCOPUS. The protocol was registered in PROSPERO. Results From an initial screening of 11,529 entries, 71 papers were eventually included, 55 for PECOTS (39 for local factors, 16 for systemic factors) and 16 for PICOTS (11 for local factors, 5 for systemic factors). Local factors: most studies addressed fixed orthodontic appliances as a factor in plaque retention, whereas only a few studies investigated the effects of tooth malalignment/severe crowding on DB‐GI. Some studies found higher GI at sites with defective, overhanging or subgingival margins. The removal of fixed orthodontic appliances led consistently to a significant reduction of DB‐GI, whereas the evidence for an effect of orthodontic tooth correction on DB‐GI in patients with malalignment/severe crowding was rather limited. Systemic factors: adherence to a pro‐inflammatory or high‐sugar diet increased the risk of DB‐GI, whereas an anti‐inflammatory/low‐sugar diet and dietary advice could reduce it. In patients with pre‐existing gingivitis, menstrual cycle hormone fluctuations and gonadotropin‐induced ovarian stimulation were associated with increased DB‐GI independent of plaque levels. No convincing evidence was found that overweight/obesity increases the risk for DB‐GI due to a lack of studies. Conclusions DB‐GI may be influenced by local and systemic factors, although the certainty of the evidence varies. Fixed orthodontic appliances consistently increase gingival inflammation through plaque retention, an effect that is generally reversible after appliance removal. Evidence regarding the impact of orthodontic correction of malalignment or severe crowding remains limited. Dietary patterns may influence gingival inflammation, with some preliminary evidence suggesting benefits of anti‐inflammatory or low‐sugar diets. Hormonal fluctuations and exogenous sex steroid use may increase gingival inflammation in patients with pre‐existing gingivitis. Evidence is currently insufficient to support overweight or obesity as risk factors for gingival inflammation. Clinical Significance Dental biofilm‐induced gingivitis is increased by some predisposing local factors and modifying local and systemic factors. Oral hygiene instructions and professional mechanical plaque removal should be intensified in these patients and dietary advice may be considered.

The authors' abstract, as published at the source. Journal Of Clinical Periodontology, 2026 · DOI ↗