Many believe that periodontal disease is a disease that is solely based on genetics. My grandparents had dentures, my parents had dentures, so will I. The truth is, that genetics plays a role, but is not a sentence for dentures. There are risks and limitations in the progression of periodontal disease… Can each patient limit the risks of developing full blown progressive periodontal disease?….The answer is a resounding…YES! It takes a good oral hygiene regimen, knowledge of the current state of your condition, and frequent professional cleaning to keep our mouths in a healthy, disease-free state.

Risk Factors Of Periodontal Disease

Patient Caused Risk Factors

Poor Oral Hygiene – This is an obvious one that each individual can control. Brushing, flossing, rinsing, and seeking regular dental care are essential steps to remain periodontal disease free and avoid progression beyond gingivitis.

Age – Research has shown that older people have the highest rates of periodontal disease. The research shows that over 70% of Americans 65 and older have periodontitis.

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

Poor nutrition– Eating an unhealthy diet will not supply you with the essential vitamins and minerals necessary for tissue healing and repair.

Anatomy – The local anatomic risk factors for periodontal disease include:,

1. Furcation anatomy. These are the spaces between roots of molars.  In many instances, the entrance of  such furcations are restricted enough to limit access for proper hygiene maintenance. Risk factors for periodontal disease are classified according to their involvement in tooth furcations. A Grade I CEP presents with minimal projection of enamel toward the entrance of the furaction. A Grade II CEP approximates the entrance of the furcation, and the tip of a Grade Ill CEP is well within the furcation.

2. Common anatomic deformities. These interfere with a patient’s ability to effectively remove plaque biofilm which are one of the risk factors for periodontal disease. An example are Cervical enamel projections (CEP). CEPs are tooth developmental deformities of the CEJ found on molars.

4. Palato-gingival grooves (PGG). POGs are tooth developmental deformities of maxillary central and lateral incisors. They begin in lingual pits and extend vertically onto root surfaces. PGGs could, on rare occasions, extend to the root apex. PGGs are commonly associated risk factors for periodontal disease with increased gingival inflammation, plaque accumulation, and probing depth.

5. Open contacts, loss of interdental papilla, and food impaction. Open contacts between teeth may allow for easy food impaction. Food impaction is defined as the forceful wedging of food between teeth. Loss of the pointed papilla between teeth leaves another area for food impaction.

Medications – Some drugs, such as oral contraceptives, anti-depressants, and certain heart medicines, can have an affect on your oral health, causing dry mouth, inflammation and gum tissue overgrowth. It is important to tell your dentist the medications you might be on so they can tailor a treatment schedule for your needs.

Other Disease – These include cardiovascular disease, diabetes, and rheumatoid arthritis.  These diseases can interfere with the inflammatory process, causing healing problems, and may worsen the condition of the gums.

Poor Nutrition – A diet without all the essential nutrients for our bodies to function can compromise our immune systems, decrease healing ability, and make tissue weaker and easier to breakdown. This will make it harder to fight off infection. Since, periodontal disease essentially begins as an infection, this lack of nutrition can make the periodontal disease develop and progress faster than it normally would. Studies have also linked obesity with an increased risk of periodontal disease.

Dentist Caused Risk Factors

Overhanging dental restorations – A poorly completed dental restoration typically has dental material overhanging the tooth. This creates an issue keeping the area clean and also creates an area for food and bacteria to build up. These overhangs can be irritating to the tissues and retain plaque and food more easily.

Violation of the “biologic width” –  is the height between the deepest point of the gum pocket and the bone. This distance is important to consider when fabricating any dental restorations, because they must respect the natural architecture of the gingival attachment if harmful consequences are to be avoided. These consequences include bone and tissue recession.

Open contacts and food impaction – If a dentist places a new dental restoration and does not create the proper tight contact between adjacent teeth, that area becomes a food and plaque trap. It will necessitate improved dental hygiene in that area to keep it clean. More often than not, food and debris will accumulate creating a localized area of periodontal disease.

Occlusal trauma – If a new restoration is not properly set in alignment with the other teeth, a patient can create damage to the tooth as well as the surrounding tissue just from the act of chewing. The bite should always be checked and adjusted after dental work to prevent trauma to an individual tooth.

Periodontal Disease Conclusion

Luckily, with the exception of the anatomy we are born with, all of these periodontal disease risk factors can be overcome. The first step is to practice good oral hygiene by brushing, flossing, and using an antibacterial mouthrinse. The second step is to choose a well qualified dentist and keep a regular schedule to help give you the best fighting chance at preventing,  treating and stabilizing periodontal disease.