Periodontal Disease - Risk Factors

Ethnic, Socioeconomic, and Geographic Factors

Dental disease is most likely to affect the poor. Children and the elderly suffer the worst oral care, and ethnic minorities follow. A 2002 study reported that the amount of oral bacteria was greater in people who visited their dentist least and when educational levels were low. Ethnicity played no role. It is distressing enough that 44 million Americans lack medical insurance, but almost two and a half times that number (108 million Americans) lack dental insurance. In a survey of residents of five states (Arizona, California, Hawaii, Oregon, and Wisconsin), the rate of total tooth loss was less than 20%. In three states (Kentucky, Louisiana, and West Virginia) it was greater than 40%.

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Drug-Induced Gingivitis

Gingival overgrowth can be a side effect of nearly 20 different drugs, most commonly phenytoin (Dilantin), cyclosporine (Sandimmune), and a short-acting form of the calcium channel blocker nifedipine (Procardia).

Other Causes of Gum Inflammation

A number of other conditions can also cause gum inflammation, and some have been associated with periodontal disease. They include:

Mouth breathing.
Psychologic stress. A review of studies that investigated the association between psychological stress and periodontal disease confirmed the impact of stress on the immune system. Thus, stress can probably influence chronic inflammatory diseases, like periodontitis. Psychological stress should therefore be assessed before and during treatment. As of yet, however, there is no definite proof of that stress leads to periodontal disease.
Alcohol abuse. One study reported a higher incidence of periodontal disease, tooth decay, and possibly precancerous areas in patients at a rehabilitation center for alcohol abuse.
Canker sores (aphthous ulcers).

Click the icon to see an image of a canker sore.

Self-injury in psychologically disturbed patients.
Hereditary gingival fibromatosis. A rare genetic disease associated with both gum overgrowth and hairiness. It is often associated with gingivitis and periodontal disease.
Desquamative gingivitis. With this condition the outer layer of the gum tissue desquamates (peels away), exposing an acutely red surface. It usually occurs as a result of an allergic reaction or of skin diseases such as lichen planus, benign mucous membrane pemphigoid, bullous pemphigoid, and pemphigus vulgaris. (Bacteria may also play a role in this gum disease.) This condition generally resolves when the underlying problem is treated. It is fairly common in middle-aged women.