Most American adults have some form of gum disease but are unaware of it. The main risk factors for periodontal disease include:
- Smoking or tobacco use
- Female hormonal changes
- Illnesses such as diabetes or HIV/AIDS, and the medications used to treat some conditions
- Genetic factors
Periodontitis typically occurs as people get older and is most common after age 35.
Smoking. Smoking is the major preventable risk factor for periodontal disease. Smoking can cause bone loss and gum recession even in the absence of periodontal disease. The risk of periodontal disease increases with the number of cigarettes smoked per day. Smoking cigars and pipes carries the same risks as smoking cigarettes.
Substance Abuse. Long-term abuse of alcohol and certain types of illegal drugs (amphetamines) can damage gums and teeth.
Diet. A healthy diet, including eating fruits and vegetables rich in vitamin C, is important for good oral health. Malnutrition is a risk factor for periodontal disease.
Stress. Psychological stress can cause the body to release inflammatory hormones that may trigger or worsen periodontal disease.
Female hormones affect the gums, and women are particularly susceptible to periodontal problems. Hormone-influenced gingivitis appears in some adolescents, in some pregnant women, and is occasionally a side effect of birth control medication.
Menstruation. Gingivitis may flare up in some women a few days before they menstruate, when progesterone levels are high. Gum inflammation may also occur during ovulation. The female hormone progesterone dilates blood vessels, which causes inflammation and blocks the repair of collagen, the structural protein that supports the gums.
Pregnancy. Hormonal changes during pregnancy can aggravate existing gingivitis, which typically worsens around the second month and reaches a peak in the eighth month. Any pregnancy-related gingivitis usually resolves within a few months of delivery. Because periodontal disease may increase the risk for low-weight infants and cause other complications, it is important for pregnant women to see a dentist.
Menopause. Estrogen deficiency after menopause reduces bone mineral density, which can lead to bone loss. Bone loss is associated with both periodontal disease and osteoporosis (loss of bone density). The hormonal changes associated with menopause can cause dry mouth, which can lead to tooth and gum problems.
Periodontal disease often occurs in members of the same family. Genetic factors play a role in making some people more susceptible to periodontal disease.
Medical Conditions Associated with Periodontal Disease
Diabetes. There is a strong two-way association between diabetes (both type 1 and 2) and periodontal disease. Periodontal disease is a common complication of poorly controlled diabetes. People with diabetes who have poorly controlled blood sugar (glucose) levels are at high risk for developing many kinds of infections, including periodontal disease. There is also evidence that periodontal disease may adversely affect blood sugar (glycemic) control, which can increase the risk for other health complications.
Heart Disease. Periodontal disease and heart disease share common risk factors (smoking, older age, diabetes) but it is not yet clear if having one condition increases the risk for developing the other (see Complications section of this report).
Other Medical Conditions. A number of medical conditions can increase the risk of developing gingivitis and periodontal disease. They include conditions that affect the immune system such as HIV/AIDS, leukemia, Down syndrome, and autoimmune disorders (Crohn's disease, multiple sclerosis, systemic lupus erythematosus). There is also evidence that severe periodontal disease may increase the risk for developing certain autoimmune disorders, such as rheumatoid arthritis.
Prescription Medications. Gingival overgrowth can be a side effect of many drugs including certain types of oral contraceptives, antidepressants, and heart medications. Any drug that has a side effect of dry mouth can increase the risk for gum disease.
If you take a bisphosphonate drug such as alendronate (Fosamax, generic) discuss with your dentist any potential risks from dental procedures (such as extractions and implants) that involve the jawbone. Oral bisphosphanates, which are used to treat osteoporosis, have in rare cases caused osteonecrosis (bone destruction) of the jaw. (Intravenous bisphosphantes, which are used in cancer treatment, are more likely to cause osteonecrosis.) Your dentist or oral surgeon may need to take special precautions when performing dental surgery. In any case, be sure to inform your dentist of all medications you are taking.
Oral Health Risk Factors
Oral Hygiene. Lack of oral hygiene, such as not brushing or flossing regularly, encourages bacterial buildup and plaque formation.
Poorly Contoured Restorations. Poorly contoured restorations (fillings or crowns) that provide traps for debris and plaque can also contribute to periodontitis.
Tooth Structure. Abnormal tooth structure can increase the risk of periodontal disease.
Wisdom Teeth. Wisdom teeth, also called third molars, can be a major breeding ground for the bacteria that cause periodontal disease. Periodontitis can occur in wisdom teeth that have broken through the gum as well as teeth that are impacted (buried). Adolescents and young adults with wisdom teeth should have a dentist check for signs of periodontal disease.