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It is usually characterized by progressive destruction of the periodontal soft and hard tissues, clinically manifested as gingival inflammation combined with attachment loss (CAL), radiographically detectable alveolar bone resorption, periodontal pockets, and bleeding on probing, as well as tooth mobility and potential tooth loss in advanced stages. These processes are moderated by the interplay between a dysbiotic microbiota and aberrant immune reactions within the gingival and periodontal tissues and can be modified by numerous internal or external influences. A number of studies discovered the importance of a variety of these impacting factors in periodontitis, including systemic, lifestyle, and environmental factors. Regarding the evidence level, these factors can be classified as predisposing factors, risk indicators, or risk factors. Predisposing factors include age, physical activity, dietary habits, alcohol consumption, and socioeconomic status. As risk indicators, obesity, osteoporosis, cardiovascular diseases, mental health disorders, poor diet, stress, and sleep disorders can be regarded Well\u2010known risk factors for periodontitis are smoking\/tobacco use and diabetes mellitus. This review highlights the manifold mechanistic aspects of the link between the pathogenesis of periodontitis, addressing these numerous factors to supplement the long\u2010standing knowledge of the progression of the disease.<\/jats:p>","DOI":"10.1111\/jre.70003","type":"journal-article","created":{"date-parts":[[2025,6,13]],"date-time":"2025-06-13T08:15:51Z","timestamp":1749802551000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Systemic, Lifestyle and Environmental Modifying Factors in the Pathogenesis of Periodontitis"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7508-2616","authenticated-orcid":false,"given":"Sabine","family":"Elisabeth Groeger","sequence":"first","affiliation":[{"name":"Department of Periodontology, Dental School Justus\u2010Liebig\u2010University of Giessen  Giessen Germany"},{"name":"Department of Orthodontics Dental School, Justus\u2010Liebig\u2010University of Giessen  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9496-975X","authenticated-orcid":false,"given":"Yuxi","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Periodontology Affiliated Stomatology Hospital of Guangzhou Medical University  Guangzhou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiawen","family":"Yong","sequence":"additional","affiliation":[{"name":"Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Key Laboratory of Oral Biomedical Research of Zhejiang Province, Cancer Center of Zhejiang University Engineering Research Center of Oral Biomaterials and Devices of Zhejiang Province  Hangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthodontics Dental School, Justus\u2010Liebig\u2010University of Giessen  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"Ruf","sequence":"additional","affiliation":[{"name":"Department of Orthodontics Dental School, Justus\u2010Liebig\u2010University of Giessen  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joerg","family":"Meyle","sequence":"additional","affiliation":[{"name":"Department of Periodontology, Dental School Justus\u2010Liebig\u2010University of Giessen  Giessen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,13]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0022034514552491"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)67728-8"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.12650"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k601"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-024-61002-9"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cell.2022.11.001"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12380"},{"issue":"3","key":"e_1_2_8_9_1","first-page":"79","article-title":"Periodontal Implications of Immunodeficient States: Manifestations and Management","volume":"2","author":"Pattni R.","year":"2000","journal-title":"Journal of the International Academy of Periodontology"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nrl.2016.07.013"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1177\/00220345211037220"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jconrel.2017.05.001"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/geronj\/48.5.M207"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1189\/jlb.70.6.881"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1023286831246"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/acel.12222"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.job.2013.09.001"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.it.2018.12.007"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/prd.12032"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0765.2009.01245.x"},{"issue":"2","key":"e_1_2_8_21_1","first-page":"497","article-title":"Involution Patterns of the Human Thymus. 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