Influence of human evolution on susceptibility to chronic inflammatory oral diseases

Abstract

Periodontitis is a multifactorial chronic inflammatory disease resulting from the interaction among the oral microbiota, host immune response, genetic susceptibility, and environmental factors. Although traditionally associated with specific pathogenic microorganisms, growing evidence indicates that its pathogenesis is driven by ecological and evolutionary processes involving microbial dysbiosis and host adaptation to environmental changes. This narrative review aimed to analyze the influence of human evolution on susceptibility to chronic inflammatory oral diseases, with particular emphasis on periodontitis. A literature search was conducted in the PubMed, Scopus, and Google Scholar databases, including studies published between 2014 and 2025 addressing human evolution, the oral microbiome, host–microorganism coevolution, immune response, and periodontal inflammation. The analyzed evidence indicates that periodontal susceptibility results from the dynamic interaction among microbial adaptations, evolutionarily conserved immune mechanisms, and environmental changes associated with modern lifestyles. Mechanisms such as inflammophilic microbiota, bacterial phenotypic plasticity, and evolutionary mismatch contribute to the establishment of dysbiosis, the persistence of chronic inflammation, and the progression of periodontal disease. Overall, adopting an evolutionary perspective expands the traditional pathogen-centered model of periodontitis and provides a broader framework for understanding its biological mechanisms, with potential implications for future preventive, diagnostic, and therapeutic strategies.