Risk factors
Smoking, glycaemic control, plaque and local factors influence disease and response. Discuss modifiable factors with the patient.
Understand
Biofilm is necessary but host susceptibility and exposure modify disease. Smoking and glycaemic control influence both progression and response to treatment.
Assess
Discuss pack-year or current smoking, diabetes history and control, plaque retention and medication effects. Ask about practical barriers to daily cleaning.
Apply
Support smoking cessation and coordinated diabetes care alongside mechanical therapy. Avoid promising that instrumentation alone can overcome continued high-risk exposure.
Key distinctions
Smoking can mask bleeding while worsening progression, so a low bleeding score is not always reassuring. Diabetes and periodontal inflammation have a two-way association in clinical management, though an individual patient's course varies. Risk-factor conversations should be practical and non-stigmatising; referral to cessation or medical support can complement dental treatment.
Think through a case
A patient improves after instrumentation but continues smoking and has poor glycaemic control. Discuss why recurrence risk remains and coordinate support.
The distinction to remember
Do not treat smoking or diabetes as a reason to withhold all periodontal care; integrate risk modification with treatment.
Test your recall
Why ask about diabetes control in periodontitis?
Show answer
Poor control can worsen periodontal inflammation and outcomes.