The progression of periodontitis may be affected by ALDH2 genotypes with respect to the oxidation of acetaldehyde to acetate, which leads to the accumulation of acetaldehyde in plasma and potential toxic effects. We examined the prospective association of ALDH2 genotypes in terms of alcohol sensitivity between alcohol consumption and periodontal disease progression. In 2003, 224 of 256 (87.5%) individuals examined at baseline (1999) completed probing pocket depth measurements for the evaluation of periodontitis progression. Missing data on self-reported questionnaires and blood samples were excluded; therefore, 183 samples were analyzed. Individuals who consumed > or = 33.0 g/day of alcohol exhibited high periodontal disease progression risk (OR = 3.54). ALDH2 *1/*2 individuals who consumed > or = 33 g/day of alcohol displayed a significant odds ratio (OR = 4.28) of periodontitis progression risk, in contrast to ALDH2 *1/*1 individuals. These results suggested that alcohol consumption as well as alcohol sensitivity may be a risk factor for periodontitis progression.