Risk factors. This is an interesting and complex subject that occupies much of the research being done in the dental community today. What IS a risk factor? The formal definition of the Merriam Webster dictionary is as follows: “Something that increases risk or susceptibility.” The presence of a risk factor increases the probability of an implied negative event occurring. Let me give an example. My friend and I decide to go for a long hike in the woods. The forest ranger advises us that a pack of wolves have been reported in the area, and we should be aware of the potential danger if we encounter the pack. My friend decides he may need some food for this long hike and buys a sandwich from Rosa’s (excellent subs by the way) and some Slim Jims, and stuffs them in his pockets. It all smells great….however, if the wolf pack finds us, he is at much higher risk of getting attacked than I am. The fragrant lunch is a risk factor when we venture into the woods with a wolf pack present.
The process of developing periodontitis is complex and not always clear. There is the interaction between our body’s immune system and the never ending onslaught of different bacteria populating our oral cavity. Part of this interaction is genetic. How well your body fights an infection is different for everyone. But some factors can affect how we fight infections and make it difficult to eliminate them.
So, what are risks factors for gum disease? Some risk factors include but are not limited to: cigarette smoking, diabetes, dental restorations (fillings, caps, bonding, partial dentures, bridges), poor tooth position, dry mouth (age and drugs can cause this), poor diet, immune system suppression (disease and drugs can cause this), poor oral hygiene, no regular dental visits, etc. The biggest of these risks factors is cigarette smoking and diabetes. I don’t mean to diminish the importance of the other factors listed, but studies have shown the greatest risk for developing severe periodontal disease is when smoking and/or diabetes are present. Smoking a half pack of cigarettes per day can increase your risk by up to 400 %!!! Diabetes can increase your risks for periodontal disease by a similar amount, especially if you are an uncontrolled diabetic. If you want to keep your teeth and reduce your risk of developing advanced gum disease, stop smoking and get your diabetes under control. This is easy to recommend, but very difficult to accomplish.
Some of these risks factors are logical and seem straight forward, but how do dental restorations make us more prone to periodontal disease? Any filling, crown, or bonding is made of a material other than natural tooth. Where this material meets the actual tooth is never a perfect margin. A small, but significant defect exists at this junction even with an excellent restoration. This discontinuity between tooth and filling is a great place for bacteria to populate, live, and thrive. We have made a bacteria housing project, often located below the gum tissue margin that is difficult to clean. This area is at higher risk for developing gum disease. Extra attention should be given in cleaning this area at home and with your dental hygienist at cleaning visits.
Not all risk factors for periodontal disease can be controlled or eliminated. But by managing/eliminating factors we CAN control, we go a long way in reducing our chances of having severe periodontitis (bone loss around the teeth). I am NOT suggesting you stop a medication prescribed for you that is causing your dry mouth. However you may want to ask your physician to switch to a medication with less side effects. And live a healthy lifestyle! Anything that improves your overall health will improve your immune system and its ability to fight infection. Please feel free to ask us or your dentist any questions regarding periodontal risk factors. Be well my friends!