RISK FACTORS

Consider your risk factors for gum disease

Smoking

Smokers have a seven times greater chance of losing their teeth than nonsmokers. A patient who smokes and who is also genetically susceptible (see Genetics) has a 20-fold increased chance of losing his/her teeth. This is one of the few host factors that can be altered, and every effort should be made to stop smoking completely for periodontal and general health reasons.

Genetics

It has been found that about one person in four carries a genotype that makes them more susceptible to periodontal disease. Because a periodontist sees advanced cases, he may be reasonably certain that a patient is susceptible and treat accordingly. Being susceptible does not mean teeth will be lost, but rather that plaque control must be ideal and that pockets must be eradicated as completely as possible so daily oral hygiene will access all areas.

If a case is not severe, genetic testing is available and may be useful to evaluate the patient’s resistance. If he or she is not susceptible, less surgery may be needed, with minor pockets being treated with scaling and root planing and maintained with periodontal cleanings. If the test is positive, more aggressive treatment and pocket elimination is needed.

Genetic testing is done by taking a sample of saliva, which is then submitted for analysis. It is a one-time expense and, in certain cases, can help formulate the best treatment plan.

Stress

When under stress, our bodies produce a variety of chemicals that negatively influence our resistance, thereby specifically contributing to the progression of periodontal disease. At times, under severe stress, an acute and painful infection of the gums can occur.

Your Spouse/Partner

Studies have demonstrated the transmission of bacteria associated with periodontal disease from person to person. Therefore, screening of spouses or partners of patients diagnosed or treated for periodontal disease is recommended.

Medications

A number of medications affect the gums. The classic example is Dilantin which produces a severe overgrowth of gum tissue in some patients. This makes cleaning the teeth difficult, if not impossible, resulting in periodontal breakdown. Surgically trimming the gum back to the normal shape is often the only solution, but unless the medication can be changed, re-growth almost always occurs. Similar gum overgrowth is seen in some patients taking calcium channel blockers and ACE inhibitors, drugs commonly used for heart conditions. These medications, including Cardizem, Procardia, Verapamil, Vasotec, Prinivil, Altace, Zestril and several others, can result in overgrown gums which adversely affect periodontal health and must be closely monitored.

Diabetes

Diabetics are at increased risk for periodontal breakdown. Smokers with diabetes increase their risk of tooth loss by twenty fold. This disease can contribute to bacterial overgrowth. People with type II diabetes are three times as likely to develop periodontal disease as non-diabetics. Those with poorly-controlled blood sugar levels develop periodontal disease more frequently and demonstrate greater destruction.  Untreated or inadequately-controlled periodontal disease makes control of blood sugar difficult.  Fortunately, periodontal treatment is generally successful with the controlled diabetic. Increased diligence with plaque control and preventive care is key.

Hormones

Women are at higher risk for gum inflammation when there are increased levels of estrogen and other sex hormones such as during puberty, menstruation, the second and third trimester of pregnancy, and breastfeeding. Some women notice that their gums bleed easily and that they are red and puffy. Normally these symptoms disappear when the levels of circulating hormones decrease, and with good plaque control, no permanent damage occurs. Women taking oral contraceptives may also experience these changes in their gums.

Puberty

During puberty, there is increased production of sex hormones. These higher hormone levels increase gum sensitivity and lead to greater irritation from plaque and food particles. The gums can become swollen, turn red, and feel tender.

Menstruation

Similar symptoms as described above under Puberty, occasionally appear several days before menstruation. Bleeding of the gums, bright red swelling between the teeth and gum, or sores on the inside of the cheek may occur. These symptoms generally clear up once the period has started.

Pregnancy

Pregnant mothers with periodontal disease expose their unborn children to a variety of risks and possible complications.  Pregnancy causes many hormonal changes in women, which increase the likelihood of developing periodontal disease such as gingivitis, or gum inflammation. These oral problems have been linked to preeclampsia, or low birth weight of the baby, as well as premature birth. Fortunately, halting the progression of periodontal disease through practicing high standards of oral hygiene and treating existing problems can help reduce the risk of periodontal disease-related complications by up to 50%.

Gums and teeth are also affected during pregnancy. Between the second and eighth month, gums may also swell, bleed, and become red or tender. Large lumps may appear as a reaction to local irritants. However, these growths are generally painless and not cancerous. They may require professional removal but usually disappear sometime after delivery. Periodontal health practices should be part of your prenatal care. Any infections during pregnancy, including periodontal infections, can place a baby’s health at risk.

Organ Transplant Recipient

Patients who have received organ transplants take a variety of medications that can contribute to the onset or exacerbation of periodontal disease. Medications used to suppress organ rejection can result in gum overgrowth and progression of periodontal infection. All patients being considered for organ transplants should have a comprehensive dental evaluation prior to transplant surgery to insure that no infection is present. If periodontal infection is present, it should be treated prior to transplant surgery. Following the receipt of an organ, a continuous effort to control and prevent the onset of periodontal disease is necessary for the transplant to be successful.