As dental professionals, we spend our professional lives encouraging patients to adopt healthy behaviours for improved health outcomes. Our advice and tailored recommendations, though always based on science and experience, often require patients to introduce additional steps into their oral health routine or restrict unhealthy habits. The result is lower compliance than we would like. But how much difference do our patients’ actions really have on their oral health? What is genetic and what is behavioural?
In the genes
Geneticists have been studying the genome for the past century, attempting to unlock the secrets contained within each individual’s DNA. Consequently, we know that genes play an important role in a person’s predisposition to certain health concerns. Conditions such as cancer, cardiovascular disease, diabetes, autoimmune disorders and psychiatric illnesses are all more likely where a family history of the disease is identified. This is especially relevant given that family members will typically have been exposed to similar geonomics and environmental factors, providing insight into aetiologic heterogeneity of certain diseases as well.[i]
Interestingly, this is a field of study in which artificial intelligence (AI) is increasingly involved. The technology has already shown promising results in helping to combat the many challenges of genome-wide association studies and the complex data associated with them.[ii]
With regards to oral health, genetics have been shown to influence the development of some conditions far more than others. For instance, tooth agenesis has a genetic component,[iii] as does tooth position and therefore malalignment.[iv]
In most cases, a combination of genetic and environmental factors contributes to dental disease. For example, research confirms that a person’s genetic compound can affect their susceptibility to inflammation and, therefore, periodontal disease.[v] There is also evidence to suggest that genetics influence the development of dental caries.[vi] However, in both cases, environmental and lifestyle factors are thought to have a greater impact on disease progression than genetic programming.[vii]
Environmental, social and lifestyle factors
This is true of almost all oral health-related conditions, which are caused or worsened by environmental determinants. These involve aspects such as equality, livelihood, access to health care and a social support network, as well as broader issues like climate change and the future evolution of pathogens.[viii]
Beyond these, there are various sociological factors that affect all areas of health, including oral health, like food security and housing stability.[ix] These can often influence a person’s diet, for example, which directly affects nutrition, as well as systemic and dental health.[x] Further lifestyle factors associated with periodontal disease, dental caries and other oral health conditions include smoking tobacco, alcohol consumption, weight and quality of sleep.[xi]
Of course, one of the largest – if not the largest – social determinant of oral health is the patient’s daily oral health routine. As we know, patients’ habits and behaviours regarding oral hygiene are crucial in minimising the risk of developing dental diseases. At the very least, basic principles must be consistently followed, including twice daily brushing, use of fluoride toothpaste, daily interdental cleaning and regular dental check-ups. Their approach to oral hygiene should also adapt as their age or personal needs change in order to remain as effective as possible.[xii] Missing any one of these steps will negatively impact oral health, no matter what their genetics indicate.
Improving the odds
While genetics can’t be changed, being aware of a predisposition to disease can help guide preventive measures. This means the dental team can more accurately advise patients on how to reduce their risk of oral health concerns and educate them on the signs to look out for to ensure early detection.
Behaviours, on the other hand, can be modified. A change in attitude and approach to dental hygiene, as well as broader elements such as diet, can do wonders for patients’ health. However, this is always a lot easier said than done, as adopting new behaviours can be a difficult process for many individuals.
Dental professionals can facilitate behaviour change in a number of ways. Motivational interviewing is one tool that has been identified as useful in encouraging behaviour change in patients. As a long-term solution, it must be delivered over a number of sessions. For the greatest success, it should also be utilised for patients who are identified as open to and ready for change.[xiii] Signposting patients to reliable resources is also beneficial, allowing them to continue educating themselves on how they can drive risk down for a healthier dental future.
Simple questions, complex answers
The complex nature of dentistry means that few questions can be answered in a clear-cut way for the majority of patients. When it comes to whether genetics or behaviours have most impact oral health, in reality, it is a combination of both. Dental professionals are perfectly placed to tailor information and advice for patients according to their inherited risks and personal habits to help them achieve the best outcomes.
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[i] Institute of Medicine (US) Committee on Assessing Interactions Among Social, Behavioral, and Genetic Factors in Health; Hernandez LM, Blazer DG, editors. Genes, Behavior, and the Social Environment: Moving Beyond the Nature/Nurture Debate. Washington (DC): National Academies Press (US); 2006. 3, Genetics and Health. Available from: https://www.ncbi.nlm.nih.gov/books/NBK19932/
[ii] Long E, Wan P, Chen Q, Lu Z, Choi J. From function to translation: decoding genetic susceptibility to human diseases via artificial intelligence. Cell Genomics. June 2023; 3(6); 100320
[iii] Cakan DG, Ulkur F, Taner T. The genetic basis of dental anomalies and its relation to orthodontics. Eur J Dent. 2013 Sep;7(Suppl 1):S143-S147. doi: 10.4103/1305-7456.119092. PMID: 24966722; PMCID: PMC4054073.
[iv] Humans inherit the traits of their teeth. Br Dent J 228, 665–666 (2020). https://doi.org/10.1038/s41415-020-1605-8
[v] Tettamanti L, Gaudio RM, Iapichino A, Mucchi D, Tagliabue A. Genetic susceptibility and periodontal disease: a retrospective study on a large italian sample. Oral Implantol (Rome). 2017 Apr 10;10(1):20-27. doi: 10.11138/orl/2017.10.1.020. PMID: 28757932; PMCID: PMC5516423.
[vi] Shaffer JR, Wang X, McNeil DW, Weyant RJ, Crout R, Marazita ML. Genetic susceptibility to dental caries differs between the sexes: a family-based study. Caries Res. 2015;49(2):133-40. doi: 10.1159/000369103. Epub 2015 Jan 22. PMID: 25612913; PMCID: PMC4449725.
[vii] American Dental Association. Genetics and Oral Health. https://www.ada.org/resources/ada-library/oral-health-topics/genetics-and-oral-health#:~:text=Twin%20studies%20have%20suggested%20partial,to%20as%20high%20as%2085%25.&text=The%20wide%20range%20of%20heritability,level%20genetic%20or%20environmental%20differences. [Accessed March 2025]
[viii] de Abreu MHNG, Cruz AJS, Borges-Oliveira AC, Martins RC, Mattos FF. Perspectives on Social and Environmental Determinants of Oral Health. Int J Environ Res Public Health. 2021 Dec 20;18(24):13429. doi: 10.3390/ijerph182413429. PMID: 34949037; PMCID: PMC8708013.
[ix] Obeidat, R., Heaton, L.J., Tranby, E.P. et al. Social determinants of health linked with oral health in a representative sample of U.S. adults. BMC Oral Health 24, 1518 (2024). https://doi.org/10.1186/s12903-024-05257-8
[x] Tohary IA, et al. The Impact Of Diet And Nutrition On Oral Health: A Systematic Review. Migration Letters. Volume: 19, No: S5 (2022), pp. 338-346. ISSN: 1741-8984 (Print) ISSN: 1741-8992 (Online)
[xi] Xu, J., Huang, Y., Wang, J. et al. Association between healthy lifestyle combinations and periodontitis in NHANES. BMC Oral Health 24, 182 (2024). https://doi.org/10.1186/s12903-024-03937-z
[xii] Gallione, C., Bassi, E., Cattaneo, A., Busca, E., Basso, I. and Dal Molin, A. (2025), Oral Health Care: A Systematic Review of Clinical Practice Guidelines. Nurs Health Sci., 27: e70027. https://doi.org/10.1111/nhs.70027
[xiii] Manoranjitha, B. & Mallikarjuna, Shwetha & Krishnappa, Pushpanjali. (2017). A systematic review of health education theories and approaches in improving the oral health behaviour among adults. International Journal Of Community Medicine And Public Health. 4. 286. 10.18203/2394-6040.ijcmph20170251.
