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Risk determinant: A risk factor that cannot be modified (eg, genetic factors, sex, age).²

Risk factor: Environmental, behavioral, or biologic factors that increase the likelihood of developing the disease; identified through longitudinal studies and confirmed to be present before the onset of the disease (eg, smoking, diabetes, pathogenic bacteria).

Risk indicator: A putative risk factor that is correctly identified through cross-sectional study designs.

Risk marker or risk predictor: Characteristics or factors that have the ability to predict individuals at high risk for disease, but are not part of the causal chain.³

Risk assessment is an essential component of periodontal patient management due to a number of local and systemic factors that can potentially affect the manifestation and progression of the disease. Accounting for these factors is an important step toward the delivery of optimal periodontal care.¹ In this chapter, the main risk factors, risk determinants, risk indicators, and risk markers are reviewed. The association between them and the onset and progression of periodontal disease is discussed, as well as the impact on treatment outcomes. It should be highlighted that this chapter is based on the current knowledge, and if new evidence emerges in the future, some of these factors may be classified under a different category.

Box 4-1 lists examples of risk factors, risk determinants, risk indicators, and risk markers or predictors for periodontal disease.

BOX 4-1 Classification of the main risk factors, risk determinants, risk indicators, and risk markers for periodontal disease

Risk factors	Risk determinants	Risk indicators	Risk markers
SmokingDiabetesPathogenic bacteria	GeneticsAgeSexRace	ObesityOsteoporosisStressAlcohol useRheumatoid arthritis	Bleeding on probingProbing depthFurcation involvement