Risk Factors for Periodontal Disease

By Brian J. Gray, DDS, MAGD, FICOI

It is well established that the main cause of periodontal diseases is bacterial plaque. But not everyone responds the same to the same bacterial infection. There are many factors that can contribute to making someone more or less susceptible to the progression of periodontal disease. These factors are called risk factors. They can increase the risk, severity, and speed at which periodontal disease develops. Some risk factors can be modified. If they are, periodontal disease and tissue destruction can be controlled and maybe even prevented.

There are several factors that can put individuals at greater risk for periodontal disease.

1. Poor Oral Hygiene: The bacterial plaque that continuously forms on the teeth is the main cause of periodontal infections. Without bacterial plaque there cannot be periodontal disease. But as the amount of plaque increases, so does the risk for periodontal disease. There is a shift in the bacterial population of plaque from one that is compatible with health, to one that is responsible for periodontal disease. The best way to help control or prevent the progression of periodontal diseases is to follow a diligent plaque control program that includes daily brushing and flossing.
2. Crowded Teeth: Crowded teeth can contribute to plaque retention and interfere with oral hygiene. If this becomes a problem, it may be necessary to reshape the teeth or move them to a better position with the use of dental appliances or braces.
3. Poor Fitting Dental Appliances or Restorations (dentures, fillings, or crowns): These factors also may contribute to plaque retention and interfere with oral hygiene methods. If this is the case, the restorations may need to be reshaped, polished, or even replaced.
4. Occlusion (the way the teeth bite or come together): The excess forces created by an unbalanced bite, by clenching, or by grinding of the teeth, can accelerate the progression of bone destruction and periodontal disease. These forces can also contribute to excessive wear of the teeth, fractures, temporomandibular joint (TMJ) problems, or root canal problems. People that clench or grind their teeth may not be conscious of it, but may experience sore jaw muscles, TMJ problems, headaches, and neck or shoulder pain. Most people are more susceptible to clenching or grinding during periods of high stress. These habits can be controlled and treated with specially made dental appliances (nightguards), braces, reshaping of the biting surfaces of the teeth, exercises, medications, or a combination of the above.
5. Tobacco: People who smoke or chew tobacco are more likely to have periodontal disease. They also are more likely to have a poorer and slower response to periodontal treatment. The risk of acquiring periodontal disease decreases after smoking cessation and former smokers and non-smokers respond the same to periodontal treatment. Smoking cessation is beneficial to periodontal and overall health.
6. Poor Nutrition: Although periodontal disease is not caused by nutritional deficiency, a diet low in nutrients can diminish the effectiveness of the body's immune system. This reduces the resistance to infections such as periodontal disease. To aid in the body's capacity to fight infections, maintain a well-balanced diet and avoid fad diets that exclude entire food groups and limit nutrients.
7. Stress: Stress reduces the immune response and makes it hard for the body to fight infection. A study has shown that people that are under financial stress and have poor coping ability have a two-fold increase in the incidence of periodontal disease.
8. Pregnancy and Female Hormonal Changes: The hormonal changes that occur during pregnancy, puberty, and menstruation can make the gums more sensitive to bacterial plaque and increase the risk for periodontal disease. Pre-existing periodontal problems can become more severe if plaque is not controlled. So an efficient and consistent plaque control program is essential in maintaining periodontal health through pregnancy and all stages of life.
9. Systemic Diseases: Certain systemic (general body) diseases, such as AIDS and diabetes, may decrease the body's ability to fight infection and can result in more severe periodontal disease. Always keep the dental care provider informed of changes in medical status.
10. Medication: Several drugs such as birth control pills, immunosuppressants, anti-depressants, and some heart medications can also increase the risk for periodontal disease. Patients should inform their dental care provider of any changes in the medications that they may be taking.
11. Genetics: Up to 30% of the population may have a gene that is linked with an increased susceptibility to periodontal disease. Although genetics is not modifiable, knowing one's genetic profile puts individuals in a proactive position regarding dental health. Through proper home care, periodontal maintenance visits, modification of known risk factors, and early intervention, individuals have an excellent chance of keeping their teeth for a lifetime.