Dental crowding as a potential risk factor for periodontal disease progression: a systematic review

Relevance. Dental crowding is one of the most common forms of malocclusion, with a reported global prevalence of 30%–60% that continues to increase. In addition to causing functional problems and esthetic concerns, dental crowding may represent an important risk factor for gingivitis and periodontitis. However, the mechanisms underlying this association and the extent of its impact on periodontal health remain unclear, highlighting the need to systematically synthesize the available evidence. Objective. To systematically review the available evidence on the association between dental crowding and periodontal diseases and to examine the pathogenetic mechanisms through which the identified etiologic factors may affect periodontal tissues.

Materials and methods. This systematic review was conducted in accordance with the PRISMA guidelines. A literature search was performed in eLIBRARY.RU, PubMed, Google Scholar, and CyberLeninka for studies published between 2010 and 2024. The search strategy included the terms “crowded teeth,” “periodontal diseases,” and “periodontal disease in patients with crowded teeth,” as well as their Russian-language equivalents. Of the 875 records initially identified, nine studies were included in the final analysis after duplicate removal and multistage screening based on relevance and quality criteria.

Results. The included studies consistently indicated an association between dental crowding and poorer periodontal health. Individuals with dental crowding were more likely to have poor oral hygiene and greater plaque accumulation, which may contribute to the development of gingivitis and periodontitis. The identified factors were classified as mechanical, including limited access for oral hygiene and plaque retention; morphologic, including a higher prevalence of a thin periodontal phenotype and reduced width of attached gingiva; and functional, including occlusal trauma and premature occlusal contacts. These factors were associated with hemodynamic alterations characterized by persistent vasoconstriction, reduced vascular elasticity, and lower blood flow velocity, potentially predisposing periodontal tissues to ischemia. The available evidence also indicated that impedance plethysmography of the periodontium (rheoperiodontography) and laser Doppler flowmetry may be useful for detecting subclinical alterations in regional periodontal blood flow and microcirculation.

Conclusion. Dental crowding was associated with poorer periodontal health and may contribute to the development and progression of gingivitis and periodontitis. The periodontal changes associated with crowding appear to result from multiple mechanical, morphologic, functional, and hemodynamic factors. These findings support an interdisciplinary approach to the management of patients with dental crowding. Orthodontic correction of crowding should be considered not only a means of correcting malocclusion but also part of a preventive strategy that may improve conditions for maintaining long-term periodontal health, including regional periodontal blood flow and microcirculation. Integrated periodontal and orthodontic care may therefore be important for achieving stable long-term outcomes.

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