Periodontal Risk Factors

What Is My Risk of Periodontal Disease?

Risk factors increase or decrease your risk for certain conditions.

For example, cholesterol increases your risk of cardiovascular disease. Certain risk factors may increase your risk of developing periodontal disease. Additionally having periodontal disease, may increase your risk of other problems throughout the body.

How is Periodontal Disease Related to Overall Health (Systemic Link):

Periodontal Disease
Bacteria & Toxins Enter the Blood Stream

Arrow Inflammation
(Systemic Link)
Arrow Other Diseases in Body
(Listed Below)


Periodontal disease is related to overall health by inflammation. This link to overall health is also called a systemic link.

Inflammation throughout the body occurs when periodontal bacteria and bacterial by-products (toxins) enter the blood stream from the periodontal pocket in the mouth. These bacteria and toxins travel by the blood stream to the rest of the body and can have negative effects on different organs and areas of the body. In this way, periodontal disease can increase the risk of other diseases.

As the depth of the pocket increases and/ or as the number of teeth with pockets increase, so does the amount of bacteria and toxins entering the blood stream.

If all the teeth in the mouth have severe periodontal disease, the size of the ulcerated area in all the pockets is about the size of an ulcer on the entire forearm.

Inflammation has been shown to aggravate and worsen other diseases like pancreatic cancer, rheumatoid arthritis, and Alzheimer’s disease.

If the other diseases are damaging the body, this may put you at greater risk of developing periodontal disease. Systemic diseases effect the entire body and include Diabetes, blood cell disorders (leukemia), autoimmune disorders (Rheumatoid arthritis, Sjogren’s Syndrome, Lichen Planus, Pemphigus, Pemphigoid, Erythema Multiforme), HIV infections, AIDS, etc. These diseases can lower the bodies resistance to infection (immune system) and place an individual at increased risk for more severe forms of periodontal disease called aggressive periodontitis.

To assess your risk of gum disease, visit the American Academy of Periodontology.

Important Risk Factors Affecting the Health of Your Gums Include:

If you have one or more of the below risk factors then you may need periodontal treatment. Additionally, periodontal treatment may help to prevent risk of the below problems. To assess your risk of gum disease, visit the American Academy of Periodontology.

  1. Inadequate Oral Hygiene
  2. Tobacco usage (Smoking and Smokeless)
  3. Diabetes
  4. Stress
  5. Clenching and Grinding of Teeth
  6. Medication(s)
  7. Poor nutrition
  8. Women & Periodontal Disease
  9. Men & Periodontal Disease
  10. Genetics and Family History
  11. Obesity
  12. Age
  13. Respiratory Diseases & COPD
  14. Osteoporosis
  15. Cardiovascular Disease
  16. Cancer
  17. Gastric Esophageal Reflux Disease (GERD)(GRD) and Bulimia
  18. Lack of Regular Dental Care
  19. People with Rheumatoid Arthritis Have More Periodontal Disease
  20. Oral Piercings (Tongue, Lip, Cheek) Can Cause Periodontal Problems

(1) Inadequate Oral Hygiene Leads to Periodontal Disease & Tooth Decay!

Oral Hygiene is the process of keeping your teeth and gum tissue healthy.

Oral hygiene helps to prevent periodontal disease by removing plaque (link cause perio). Brush and floss at least twice a day! Please see our section on how to brush and floss. Also see our suggestions on oral hygiene products.


(2) How Does Tobacco Negatively Effect Periodontal Disease & Dental Implants?

You are probably familiar with the associations between tobacco use and lung disease, cancer, and heart disease.

Many studies have linked periodontal disease with tobacco usage. Patients who smoke or use tobacco of any form (smokeless, dipping, snuff, or chewing) have more severe periodontal disease than non-tobacco users. Tobacco users have more calculus buildup, deeper pockets, and greater bone loss. In addition, your chance of developing oral cancer increases with the use of tobacco.

Smokeless tobacco can cause oral cancer, gum disease, increased tooth decay and periodontal bone loss. It can also cause cancer of the upper digestive tract.

Chemicals in tobacco such as nicotine and tar slow down healing, decrease you ability to fight infection, and the predictability of success following periodontal and dental implant treatment.

Ask us how we can help you quit smoking!

Quitting tobacco will reduce the risk of developing the above problems.



(3) How Does Diabetes Affect Periodontal & Oral Health?

Individuals suffering from diabetes, particularly uncontrolled diabetics, have a higher risk of developing bacterial infections of the mouth, especially periodontal disease.

Having periodontal disease can also increase your risk of diabtetic problems. This occurs by mouth infections (like periodontal disease) impairing your ability to process insulin, resulting in greater difficulty controlling your diabetes. Diabetics tend to have more severe periodontal disease. Due to poorer healing and increased risk of infection, treatment of diabetics with gum disease is more difficult. Pregnant women with diabetes are more likely to have gum disease. You can help resist periodontal infection by maintaining control of your blood sugar levels. Furthermore, controlling your periodontal disease will help keep your diabetes under better control. For overall health it is critical to control both diseases.

To assist you in treatment, Drs. Craddock and Godat need to know your diabetic history and the current status of your glycemic control (Glucose or Sugar Range, and A1c Percentage).

(4) Stress Effects on Periodontal Disease

Emotional and psychological stress has been shown to decrease the bodies immune system’s ability to fight off infection. Patients under stress have been found to have worse periodontal disease. This is especially true when someone goes through a life crisis (divorce, loss of job, death of a family member, etc). During times of excess stress it is especially important to keep good brushing and flossing habits and maintain regular dental follow up. It is also important to find ways to control stress. One may also develop or increase the frequency of a destructive bite habit during stressful times. Be sure to tell your dentist of your increased stress, so they can check for any indicators of periodontal disease or destructive bite habits.

(5) Clenching & Grinding of Teeth

Bite Therapy Section

(6) Medications Can Affect Your Oral Health

Some medications can have negative side effects in the mouth and particularly the gums.

Anti-seizure medications (such as Phenytoin, Dylantin or Dilantin), blood pressure medications (such as the Calcium Channel Blockers, Procardia, Cardizem, Norvasc (Nifedipine), Verapamil, etc.), steroid abuse with anabolic androgenic steroids (AAS),and immunosuppresant therapy (such as Cyclosporin) for organ transplant patients can cause gum overgrowth (also called gingival overgrowth or gingival hyperplasia). Sometimes gum overgrowth can also occur with mouth breathing, while wearing braces and for unknown reasons. This gingival overgrowth can lead to gum infections (periodontal disease). With gingival overgrowth, the gums can grow over the teeth, appear irregular, and bleed easily. This excess tissue can be seen when one smiles and has a negative impact on the smile and face. This can lead to a depressed psychological state and low self-esteem. The adverse effects of gingival overgrowth can be reversed with a gingivectomy or esthetic crown lengthening by improving the health of the gums and mouth as well as the beauty of the smile.

Minocycline an antibiotic to treat acne and arthritis may stain the bone black. This may show through the gums and result in dark gums.

Other medications may cause dry mouth (xerostomia). These medications include [Allergy Medications (antihistamines), Blood Pressure Medications (particularly diuretics), Painkillers (especially narcotics), Antidepressants (Paxil, Zoloft, etc), as well as many others.]. This condition leaves the mouth without enough saliva to wash away plaque and food debris and can result in rampant tooth decay and periodontal disease.

(7) Poor Nutrition

Diet plays an important role in treating periodontal disease.

For example, consuming less than 60 mg of Vitamin C (about one orange) per day can increase your risk of periodontal disease.

Calcium can also help to build strong bones and teeth. Eating well helps to prevent periodontal disease.



(8) Women & Periodontal Health

Throughout a woman’s life, hormonal changes affect tissues throughout the body with fluctuations in levels during puberty, use of oral contraceptives, pregnancy and menopause. At these times, the chance of periodontal disease may increase, requiring special care of your oral health. Osteoporosis may also increase your risk of periodontal disease. Periodontal treatment may be necessary during these times of your life.


During puberty, there is increased production of hormones. These higher levels increase gum sensitivity and lead to greater gum irritation from plaque and food particles. The gums can become swollen, turn red, and feel tender. Usually this problem goes away with good oral hygiene (brushing and flossing). One might still benefit from a periodontal examination.


Similar gum symptoms occasionally appear several days before menstruation. There can be bleeding of the gums, a bright red swelling between the teeth, or sores on the inside of your cheek (link Oral Pathology Mouth Sore Section). The symptoms clear up once the period has started. As the amount of hormones decrease, so do these problems. You may benefit from a periodontal examination to see if you have a periodontal problem.


Your gums and teeth are also affected during pregnancy. Between the second and eighth month, your gums may also swell, bleed, and become red or tender. Large lumps may appear in the gums as a reaction to local irritants (plaque and calculus). However, these growths, called Pyogenic Granulomas (pregnancy tumor) are generally painless and not cancerous. They may require professional removal. Additionally, pregnant women with diabetes (gestational diabetes) are more likely to have gum disease.

Periodontal health should be part of your prenatal care. Any mouth infections during pregnancy, including periodontal infections, can place a baby’s health at risk. This can result in a Pre-Term Low Birth Weight Baby. This risk may be as high as 7 to 20 %.

Researchers have found periodontal bacteria in the amniotic fluid. Recently researchers reported the first documented link between a mother with pregnancy-associated gum disease to the death of her fetus. Journal of Dental Hygiene

Preeclampsia is an abrupt rise in blood pressure during pregnancy. This condition may also be effected by the bacteria from periodontal disease.

Patient Exam

A dental exam and cleaning prior to becoming pregnant or immediately after becoming pregnant is advisable to avoid a pregnancy problems from periodontal disease.

Sometimes periodontal treatment is necessary during pregnancy. Frequently improving oral hygiene and non-surgical periodontal scaling and root planing are sufficient to control your gum infection.

The best way to prevent periodontal infections is to begin with healthy gums and continue to maintain your oral health with proper dental hygiene and regular professional dental cleanings with careful periodontal monitoring.

Oral Contraceptives

Swelling, bleeding, and tenderness of the gums may also occur when you are taking oral contraceptives, which are synthetic hormones.

You must mention any prescriptions you are taking, including oral contraceptives, prior to medical or dental treatment. This will help eliminate the risk of drug interactions, such as antibiotics with oral contraceptives, where the effectiveness of the contraceptive can be lessened and an unwanted pregnancy may occur.


Changes in the look and feel of your mouth may occur if you are menopausal or post-menopausal. It is important to keep osteoporosis controlled to prevent bone loss and tooth loss. They include feeling pain and burning in your gum tissue and salty, peppery, or sour tastes. This is called burning mouth syndrome and may benefit from careful oral hygiene at home and professional cleaning. If you have mouth sores, click here for more info.

(9) Men & Periodontal Health:

Men with a waist of 40 inches or more (considered a risk for heart disease (link below cardiovascular) have a 19 % higher risk of gum disease.

Men with a history of gum disease are 14 % more likely to develop certain types of cancer than men with healthy gums. In fact, researchers uncovered that men with periodontal disease may be: June 2008 The Lancet Oncology

    Men with Periodontal Disease are:

(10) How Does Genetics & Family History Affect Periodontal Disease?

Genetics and Perio Disease

If someone you are related to in your family (parents, siblings, etc) has periodontal disease, then you may be susceptible to periodontal disease as well. This occurs since 20 to 50 % of the risk (link) of developing periodontal disease is related to genetics.

It is important to note, if you have periodontal disease, the rest of your family (siblings, children, etc), may also need a periodontal examination to make sure they are not suffering from periodontal disease.

(11) Obesity Increases Risk of Gum Disease:

Obese adults have a 29% increased risk of periodontal disease than non-obese people. Men with a waist of 40 inches or more (considered a risk for heart disease) have a 19% higher risk of gum disease.

To assess your risk of gum disease, visit the American Academy of Periodontology.

(12) Age

The older you are the more likely you are to have periodontal disease. If you are young (less than 40 years old) and have periodontal disease, you may have an aggressive form of periodontal disease – Acute Necrotizing Ulcerative Gingivitis (ANUG) (Vincent’s Infection, Trench Mouth), Localized Aggressive Periodontitis (which used to be called Localized Juvenile Periodontitis, LJP), or generalized aggressive periodontitis. Additionally the younger you are the more likely you will have more periodontal problems in the future.

(13) Respiratory Diseases & Chronic Obstructive Pulmonary Disease (COPD)

It is well known respiratory diseases such as Chronic Obstructive Pulmonary Disease (COPD), the sixth leading cause of death, are worse in smokers. Recent research suggests there is also an association with patients with Periodontal Disease.

(14) Osteoporosis:

Osteoporosis may increase the severity of bone loss in periodontal disease. To assess your risk of gum disease, visit the American Academy of Periodontology.

Note, patients on medications to treat Osteoporosis may be at risk of bisphosphonate-associated osteonecrosis (BON) of the jaw.

Bisphosphonate Drugs, Osteoporosis & Oral Osteonecrosis

Bisphosphonates are a family of drugs used to treat bone problems like osteoporosis, osteopenia, and bone cancer. If an Oral Bisphosphonate Drug (Fosamax (alendronate sodium), Boniva (ibandronate), and Actonel (risedronate), etc) has been taken for more than three years, there are certain precautions we need to take prior to treatment. We will obtain a special test, called a CTX Test, to determine the potential for risk of developing bisphosphonate-associated osteonecrosis (BON) of the jaw after treatment. As long as the test is in a safe range, the risk of this complication is low. If you have taken these oral drugs for less than three years, then no test is necessary and we can proceed with your needed treatment.

The Intravenous (IV) Form of the Bisphosphonate Drugs Zometa (zoledronic acid), Aredia (pamidronate disodium), and Reclast (pamidronate disodium), are very potent drugs to treat bone cancer (such as multiple myeloma) or osteoporosis. These drugs are more likely to result in BON and limit the type of dental treatments available. At the exam, we can determine what types of treatment can and cannot be utilized.

Other drugs are available to treat osteoporosis – estrogen or hormone replacement therapy, selective estrogen receptor modulators (like Evista), Calcitonin Hormones (like Forteo SubQ and Miacalcin Nasi), and Anabolic medications (like parathyroid hormone). Ask your doctor about switching to a non-bisphosphonate drug.

(15) Cardiovascular Disease (Heart Attack & Stroke)

Periodontal Disease
Bacteria & Toxins Enter the Blood Stream
Arrow Inflammation
(c-Reactive Protein)

Cardiovascular Disease

Heart Attack

& Stroke

Cardiovascular Disease

In addition to bacteria and toxins promoting buildup of arterial plaque, inflammation from periodontal disease increases a protein in the blood stream called CRP or C-Reactive Protein. Increased CRP increases one risk for cardiovascular disease.Studies over the last several decades show there may be a relationship between periodontal disease and cardiovascular disease (Heart Disease and Stroke). This risk may be as high as the risk of developing cardiovascular disease from high cholesterol. In fact, the leakage of bacteria and toxins from periodontal disease into the blood stream may promote the buildup of arterial plaque in arteries (atherosclerosis). The buildup of plaque in arteries leads to cardiovascular disease.

This means if you have periodontal disease, you may be at increased risk of a heart attack or stroke.

(16) Cancer

New studies have found chronic periodontitis patients might be a high-risk profile for head and neck squamous cell carcinoma (a very aggressive form of cancer).

Leukemia may first be detected as periodontal problems. If you have leukemia you need to have your periodontal situation monitored closely to prevent periodontal problems.

For men and cancer, please refer to the section under Men’s health and periodontal disease.

If you suspect you have oral cancer, please view our section on biopsies and oral pathology.

(17) Gastric Esophageal Reflux Disease (GERD or GRD) & Bulimia

In Gastric Esophageal Reflux Disease (GERD), the acidic stomach contents are pushed back up the esophagus and into the mouth.

The acid can cause a burning feeling in the esophagus and results in severe discomfort. The negative effects of GERD many also be confused with Bulimia. This acid also has negative effects in the mouth from bad breathe (halitosis), to loss of gum tissue (gum recession), to erosion of the teeth leading to cavities or severe loss of tooth structure. Sometimes the tooth destruction can result in losing one to a few to all the teeth.

Dental implants might be the best way to replace teeth as they are not susceptible to the acid like teeth.


(18) Lack of Regular Dental Care Can Result in Periodontal Problems

Lack of daily good oral hygiene and not maintaining regular dental appointments can result in dental as well as periodontal problems.

(19) People with Rheumatoid Arthritis Have More Periodontal Disease

Swollen joints and missing teeth often go hand in hand, according to a new study in the Journal of Periodontology. In the Australian study of 130 people, the 65 people who had rheumatoid arthritis were more than twice as likely to have periodontal disease with moderate to severe jawbone loss as the control subjects. In addition, they averaged 11.6 missing teeth, compared to 6.7 in the control group.

Periodontal disease and rheumatoid arthritis have very similar pathologies,” said Robert Genco, D.D.S., Ph.D., editor of the Journal of Periodontology. “Damage caused by the immune system and chronic inflammation are central to both diseases. A better understanding of the biological processes common to these diseases may help us find new ways to treat them with medications that modify the body’s response to inflammation.”

At this point, researchers are not saying the relationship between the two diseases is causal. However, some scientists think a bacterial infection may trigger the disease process in some of the estimated 2.1 million people with rheumatoid arthritis. Some dental professionals had speculated that people with arthritis have more periodontal disease because limited dexterity decreases oral hygiene. However, researchers in this study found no difference in plaque deposits between the group with rheumatoid arthritis and the control group, indicating that the progression of periodontal disease in the arthritis group was due to factors other than a difference in oral hygiene.

People with rheumatoid arthritis should take note of this connection,” said Michael McGuire, D.D.S., president of the American Academy of Periodontology (AAP). “They should be on a close lookout for signs of periodontal disease, such as red, swollen gums that bleed easily. The earlier you detect periodontal disease and treat it, the better off you are.”

(20) Oral (Tongue, Lip, Cheek) Piercings Can Cause Periodontal Problems

Oral piercings may cause periodontal problems. Oral piercings have been shown to cause gum recession and bone loss around teeth.

You can also inadvertently bite piercings in the mouth and crack or fracture teeth so bad you may need fillings, root canals, and/ or crowns. If the tooth break is bad enough, functional crown lengthening may be necessary to save your tooth. Sometimes the tooth/ teeth cannot be saved and may be replaced with dental implants.

Piercing problems can also include airway compromise, allergic reactions to metal, risk of bleeding, galvanism, hyperplastic and scar formation, increased salivary flow, aspiration of jewelry, interference with dental xrays, interference with speech, problems with chewing and swallowing, localized and systemic infections, nerve damage, pain, and swelling.