Risk Factors For Periodontitis

periodontitis-riskWhat are the Causes and Risk Factors For Periodontitis?

In the majority of cases periodontitis occurs because of poor dental hygiene. Periodontitis begins with the development of plaque. Plaque is a sticky film that forms on teeth when the sugars and starches present in foods interact with the normal bacteria in the mouth. Brushing removes plaque but plaque quickly reforms, typically within 24 hours. Plaque that remains on teeth for longer than a couple of days can harden under the gums, becoming tartar. Tartar makes plaque harder to remove and can create a reservoir for bacteria. Tartar cannot be removed by brushing and flossing alone and requires removal by a dentist or dental hygienist. When tartar is left on teeth, it can cause early stage periodontitis, also called gingivitis, which is an irritation and inflammation in the gums around the base of your teeth. Ongoing inflammation in the gums eventually creates pockets between the gums and teeth which collect plaque, tartar and bacteria. Over time these pockets deepen, more bacteria accumulate and eventually tissue and bone loss occurs. If bone loss is significant, one or more teeth may be lost.

Risk factors for developing periodontitis include:

  • Poor oral hygiene1
  • Gingivitis1
  • Smoking2
  • Diabetes3
  • Older age1
  • Poor diet1
  • Stress4
  • Reduced immunity-due to HIV/AIDs, chemotherapy or other immunosuppressive treatment1
  • Medications that reduce the output of saliva1
  • Hormonal changes due to pregnancy, oral contraceptive use or menopause1
  • Crooked teeth5
  • Poorly fitting bridges5
  • Defective fillings5
  • Genetics6

Genetic vs. Environmental Causes

Periodontitis is caused by a combination of genes and the environment. It is estimated that approximately 42% of the risk is due to genetic factors while the remaining 58% is due to lifestyle and environmental factors7.

Page References

1. Periodontal (gum) disease: Causes, symptoms and treatments. National Institute of Dental and Craniofacial Research. http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm
2. Tomar, SL and Asma, T. (2000). Smoking – Attributable Periodontitis in the United States: Findings From NHANES III. J Periondontal. 71(5): 743-751.

3. Chapple IL et al. (2013). Diabetes and periodontal diseases: consensus report of the Joint EFP/AAP Workshop on Periodontitis and Systemic Diseases.J Periodontol. Apr;84(4 Suppl):S106-12.
4. Peruzzo et al. (2007). A systematic review of stress and psychological factors as possible risk factors for periodontal disease. J Periodontol. Aug; 78(8):1491-504.
5. Centers for Disease Control, Division of Oral Health Periodontal Disease. http://www.cdc.gov/oralhealth/topics/periodontal_disease.htm
6. Nikolopoulos, GK et al. (2008). Cytokine gene polymorphisms in periodontal disease: a meta-analysis of 53 studies including 4,178 cases and 4,590 controls. J Clin Periodontol. 35(9):754-67.

7. Mucci LA, et al. (2009). Do genetic factors explain the association between poor oral health and cardiovascular disease? A prospective study among Swedish twins. Am J Epidemiol. 170:615-621.