Risk Factors For Gingivitis and Periodontitis
It is well established that the main cause of gingivitis, or periodontal disease, is bacterial plaque. But not everyone responds the same to the same bacterial infection. There are many factors that can contribute to making someone more or less susceptible to the progression of periodontitis. These factors are called risk factors. They can increase the risk, severity, and speed at which the disease develops. Some risk factors can be modified. If they are, gum disease and tissue destruction can be controlled and maybe even prevented with periodontal treatment.
There are several factors that can put individuals at greater risk for gingivitis or periodontal disease.
1. Poor Oral Hygiene: The bacterial plaque that continuously forms on the teeth is the main cause of periodontal infections. Without bacterial plaque there cannot be periodontitis. But as the amount of plaque increases, so does the risk for the disease. There is a shift in the bacterial population of plaque from one that is compatible with health, to one that is responsible for the disease. The best way to help control or prevent the progression of periodontal diseases is to follow a diligent plaque control program that includes daily brushing and flossing.
2. Crowded Teeth: Crowded teeth can contribute to plaque retention and interfere with oral hygiene. If this becomes a problem, it may be necessary to reshape the teeth or move them to a better position with the use of dental appliances or braces.
3. Poor Fitting Dentures, Fillings, or Crowns: These factors also may contribute to plaque retention and interfere with oral hygiene methods. If this is the case, the restorations may need to be reshaped, polished, or even replaced.
4. Occlusion (the way the teeth bite or come together): The forces created by an unbalanced bite, by clenching, or by grinding of the teeth, can accelerate the progression of bone destruction and periodontal disease. These forces can also contribute to excessive wear of the teeth, fractures, temporomandibular joint (TMJ) problems, or root canal problems. People who clench or grind their teeth may not be conscious of it, but may experience sore jaw muscles, TMJ problems, headaches, and neck or shoulder pain. Most people are more susceptible to clenching or grinding during periods of high stress. These habits can be controlled and treated with specially made dental appliances (night guards), braces, reshaping of the biting surfaces of the teeth, exercises, medications, or a combination of the above.
5. Tobacco: People who smoke or chew tobacco are more likely to have periodontitis. They also are more likely to have a poorer and slower response to periodontal treatment. The risk of acquiring periodontal disease decreases after smoking cessation and former smokers and non-smokers respond the same to treatment from a periodontist. Smoking cessation is beneficial to periodontal and overall health.
6. Poor Nutrition: Although periodontal disease is not caused by nutritional deficiency, a diet low in nutrients can diminish the effectiveness of the body's immune system. This reduces the resistance to infections such as periodontitis. To aid in the body's capacity to fight infections, maintain a well-balanced diet and avoid fad diets that exclude entire food groups and limit nutrients.
7. Stress: Stress reduces the immune response and makes it hard for the body to fight infection. A study has shown that people who are under financial stress and have poor coping ability have a two-fold increase in the incidence of periodontal disease.
8. Pregnancy and Female Hormonal Changes: The hormonal changes that occur during pregnancy, puberty, and menstruation can make the gums more sensitive to bacterial plaque and increase the risk for periodontal disease. Pre-existing periodontal problems can become more severe if plaque is not controlled. So an efficient and consistent plaque control program is essential in maintaining periodontal health through pregnancy and all stages of life.
9. Systemic Diseases: Certain systemic (general body) diseases, such as AIDS and diabetes, may decrease the body's ability to fight infection and can result in more severe periodontal disease. Always keep your dental care provider informed of changes in medical status.
10. Medication: Drugs such as birth control pills, immunosuppressants, anti-depressants, and some heart medications can also increase the risk for periodontal disease. Patients should inform their dental care provider of any changes in the medications that they may be taking.
11. Genetics: Up to 30% of the population may have a gene that is linked with an increased susceptibility to periodontal disease. Although genetics is not modifiable, knowing one's genetic profile puts individuals in a proactive position regarding dental health. Through proper home care, periodontal maintenance visits, modification of known risk factors, and early intervention, individuals have an excellent chance of keeping their teeth for a lifetime.
By Laura Minsk, DMD
Receding Gums Fixed With Periodontal Procedures
Not even the most beautiful teeth can look attractive if healthy and pleasing-looking gums do not surround them. That's because the gums frame the teeth like a picture frame frames a picture. To have a pleasing smile, the shape, color, and texture of the gums are just as important as that of the teeth they frame. Although tooth development, periodontal disease, trauma, or tooth loss can create esthetic gum deformities like receding gums, modern periodontal procedures can give individuals a smile to smile about.
Common Cosmetic Gum Problems
Unhealthy Gums
As a result of periodontal disease, a person may have red, shiny, or swollen gums. If an individual has gingivitis or periodontitis, the gums have to be periodontally treated prior to cosmetic dental procedures.
"Gummy Smile"
Teeth that appear too short may be normal-sized teeth hiding under too much gum. This can be the result of normal tooth development, or the use of certain medications that may cause gums to overgrow. Either way, a crown lengthening (see article "Crown Lengthening") procedure can help reveal the normal tooth structure.
Recession
If the teeth appear to be too long or if the root surfaces are exposed, it may be due to receding gums (see article "Recession"). Soft tissue grafting (see article "Soft Tissue Grafts") is very successful in correcting this problem.
Uneven Gum Margins
If the gum margins appear to be higher on some teeth and lower on others, this may be due to receding gums, altered eruption, or gum defects that resulted from tooth loss. The treatment of uneven gum margins may require crown lengthening, soft tissue grafting, ridge augmentation or a combination of these procedures.
Gum Indentations
After a tooth is lost, the bone that encased it disintegrates and the gum around it may collapse, creating an indentation where the tooth used to be. Ridge augmentation procedures can help correct this problem.
Uneven Pigmentation
Changes in the color of the gums may be part of normal gum development, or the result of scarring. Soft tissue grafts can predictably correct this problem.
Spaces In Between the Teeth
Periodontal disease can result in spaces in between the teeth that may appear like black triangles. These spaces can be very difficult to treat. They can be made less unattractive by a combination of procedures that include orthodontics (braces), crowns (caps), and/or periodontal (gum) surgery. The best way to avoid these spaces is to seek periodontal treatment in its early stages.
Missing Teeth
One or more missing teeth can be predictably replaced with the aid of dental implants. Dental implants can look and feel like natural teeth.
Changes in the appearance of the gums like receding gums can occur as a result of normal tooth development, periodontal disease, trauma, or tooth loss. By working with a restorative dentist who has expertise in cosmetic dentistry and through the aid of modern periodontal techniques, individuals can design a smile that is both aesthetic and youthful in appearance.
By Laura Minsk, DMD