Risk Factors

A risk factor is an environmental exposure, aspect of behavior, or an inherent characteristic which is associated with a disease.  The association may or may not be causal, though the use of the term often implies causality.

Plaque, Bacteria, and Oral Hygiene

       The main cause of gum disease is bacterial plaque, a sticky colorless film that constantly forms on the teeth.  Daily removal of plaque is essential to a healthy mouth. If plaque is not removed, it hardens into a rough, porous deposit called calculus, or tartar.  Toxins (or poisons) produced by bacteria in the plaque irritate the gums.  These toxins destroy supporting tissues around the teeth.  The gums begins to pull away from the teeth, forming pockets that fill with  more plaque.  As the disease progresses, the pockets grow deeper.  Plaque moves further down the roots of the teeth.  Bone that supports the teeth may be permanently damaged.  Unless treated, the affected teeth can become loose and eventually lost.

Although, plaque is the primary cause of periodontal disease, other factors may also play a role in the health of your gums.  These include the following:

Lifestyle Decisions

• Diet - lacking in rich nutrients can diminish the body's efforts to fight infection

• Stress - According to the researcher in a study published in The Journal of Periodontology, high levels of financial stress and poor coping skills can the double the likelihood of developing periodontal disease.  Those who are under high stress  had higher attachment loss and alveolar bone loss than those who are under low stress.  They stated that high level stress and lack of adequate coping skills could lead to altered habits, such as reduced oral hygiene, teeth grinding, salivary changes, and a weakening of the body's ability to fight infection. 

• Tobacco Use-is linked with many serious illnesses such as cancer, lung disease and heart disease, as well as numerous other health problems.  Studies now also have proven that tobacco users also are at increased risk for periodontal disease.  Tobacco use may be one of the most significant risk factors in the development and progression of periodontal disease.
  

• Smokers are more likely than nonsmokers to have calculus (tartar) formed on their teeth, have deeper pockets between teeth and gums, and lose more of the bone and tissue that support teeth.  If calculus is not removed during a professional cleaning, and it remains below your gum-line, the bacteria in the calculus can destroy the gum tissue and cause the gums to pull away from the teeth.   When this happens, periodontal pockets form and fill with disease-causing bacteria.  If left untreated, periodontal disease will progress.  The pockets between the teeth and gums will grow deeper, allowing more bacteria to destroy tissue and supporting bone tissue.  As a result the gums may shrink away from the teeth making them look longer.  Without support, teeth may become loose, painful and even fall out.
  
•     Users of smokeless tobacco will more likely experience gum recession and will have a greater chance of losing the bone and fibers that hold teeth.  If gums recede to the point where the tooth roots are exposed, teeth may become susceptible to root cavities or sensitive to cold and touch.  Users of smokeless tobacco also increases the chance of developing oral cancer.
  
•     Chemicals in tobacco including nicotine and tar causes all these problems of tobacco use.  These harmful substances cause an increase in the accumulation of plaque and calculus that can irritate the gums and lead to infection.  Following periodontal treatment or any type of oral surgery, the chemicals in tobacco can also slow down the healing process and make the treatment results less predictable.

Problems that result due to tobacco use:

•     Oral cancer
•     Bad breath
•     Stained teeth
•     Tooth loss
•     Bone loss
•     Loss of taste and smell
•     Less success with periodontal treatment
•     Less success with dental implants
•     Gum recession
•     Mouth sores

Occlusion

• Clenching and grinding is a strong risk factor for periodontal disease and must be stabilized if treatment is to be successful.   Some people are aware of this habit but most are not.  This habit if not detected can also damage the jaw joint and teeth and also make you more susceptible to periodontal disease.

• To help correct this and to prevent further damage, a bite or night guard is recommended.  This hard plastic retainer evenly distributes the forces created through clenching and grinding.  

Diabetes

• Diabetes and periodontal disease affect each other.  Individuals who are diabetic and cannot control their diabetes are at higher risk for periodontal disease and those who develop periodontal disease, are not able to control their diabetes.  Uncontrolled diabetics may experience delayed wound healing, decreased salivary flow, increased susceptibility to tooth decay, and burning sensation in mouth or tongue.

Women and Periodontal Disease

       Being a woman requires unique health care needs which also changes the body.  Events including puberty, pregnancy, or menopause require a women to take special care of themselves.  It is important to know that as these health changes occur, there is also evident change that happen in a woman's oral care needs.  It  now has been proven that ones oral health and overall health are connected and can affect each other.  Hormonal changes throughout a woman's life can affect many tissues including her gums, which may increase her susceptibility to periodontal disease. 

• Puberty and Menstruation

        During puberty, a young woman's system matures and the production of sex hormones including progesterone and possibly estrogen increase.  The elevation of these hormones may cause an increase in the gums' sensitivity and lead to a greater reaction to any irritation, including food particles and plaque.  The gums at this time  becomes swollen, red and may feel tender.  Some women experience similar symptoms three to four days before their period.  This also occurs due to the increased levels of progesterone in their system.

        Menstruation gingivitis is also experienced by some women right before her period and usually clears up when her period has started.  Symptoms include gingival (gum) bleeding, redness, swelling, or sores on the inside of cheek.

        These symptoms tend to lessen as the amount of hormones decrease. However, it is very important to keep good oral homecare during these hormonal changes.  Regular dental checkups are  necessary to be sure that the dental bone and supporting tissues are not damaged.

• Pregnancy and Oral Contraceptives

          A woman's teeth and gums are affected by pregnancy, just as other tissues in her body.   Most women experience increased gingivitis or pregnancy gingivitis which usually occurs during the beginning of the second or third month through the eight month.  It is at this time that some women notice swelling, bleeding, redness or tenderness in the gum tissue.

          In some cases, swollen gums due to pregnancy gingivitis can react strongly to local irritants and form large lumps.  These are called pregnancy tumors.  These are not  cancerous and are generally painless.  These usually disappear after pregnancy but on certain occasion, may need to be removed professionally.

          It is very important for a pregnant woman to have a healthy mouth because periodontal health can affect the health of the baby.  Studies have shown any infection during pregnancy, including periodontal infection, is cause for concern and may put a pregnant woman at significant risk for delivering a premature, low birth weight baby.  Why take the chance?  Include periodontal health in your dental care.  A healthy mouth will give you, and your baby, something to smile about!

        If you're taking any oral contraceptives (birth control pills), you may be susceptible to oral health conditions that affect pregnant women.  Synthetic hormones in oral contraceptives are designed to mimic pregnancy and may cause your gums to turn red, bleed, and swell.

        If you are taking oral contraceptives,  careful periodontal monitoring and excellent oral hygiene,  including personal and professional care,  are essential to ensure the health of your gum tissue and bone supporting your teeth.  As always, it's important to mention any prescriptions that you are taking, including oral contraceptives,  to your medical and dental care providers.  This will help to eliminate the risk of harmful drug interactions caused by popular medications,  such as antibiotics, that can lessen the effect of an oral contraceptive.

• Menopause

     If you're menopausal or post-menopausal, you may have noticed a change in the way your mouth looks or feels.  These symptoms may be related to changes occurring in your body,  but a clear understanding of why this happens is not yet established.

        You may experience discomfort in your mouth,  including pain and burning sensations in the gum tissue and altered taste,  especially salty , peppery or sour.  Most women find that estrogen supplements,  either in pill form or a solution applied directly to the affected tissue, help to relieve these symptoms.  Additionally, saliva substitutes are available to lessen the effects of a "dry" mouth.

        On rare occasions,  a woman may experience  menopausal gingivostomatitis. This condition is marked by gums that may look dry or shiny,  bleed easily,  and range from abnormally pale to deep red.

        During this period of a woman's life,  professional cleanings and diligent at-home oral hygiene are essential.  If you experience any symptoms associated with menopause or post-menopause, it's important to immediately notify your dentist or periodontist.  He or she will tailor a treatment plan to help manage your condition.