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Risk Factors For Gingivitis

Several studies suggest that gum disease may be passed from parents to children as well as between couples (Asikainen 1996; Saarela 1993). Based on these findings, the American Academy of Periodontology (AAP) recommends that treatment of gum disease may involve entire families and that if one family member has periodontal disease, all family members should see a dental professional for a periodontal disease screening.

Other conditions that may contribute to gingivitis include:

Medications. Certain prescription and over-the-counter drugs can create a favorable environment for plaque buildup. Cold remedies and tricyclic antidepressant drugs decrease salivation, which allows plaque and tartar to form more easily (Koller 2000). Oral contraceptives can increase microbial flora that contribute to gingivitis (Klinger 1998).
Other drugs—particularly anti-seizure medications such as phenytoin (Dilantin®), calcium channel blockers, anti-hypertension drugs, and medications that suppress the immune system—can sometimes cause an overgrowth of gum tissue (Johnson 2003; Morisaki 2001). This condition, called gingival hyperplasia, can make plaque much more difficult to remove and provide more surface for bacteria to develop.

Infections. Viral and fungal infections can also adversely affect gum health. The herpes virus, for example, can lead to acute herpetic gingivostomatitis, a condition characterized by swollen gums and small, painful sores in the mouth (Kasper 2005). Oral thrush is caused by overgrowth of the yeast known as Candida albicans that is normally found in the mouth. Thrush can produce white lesions on the inner cheeks and tongue that can spread to the gums.

Disease. Certain health conditions that may not be directly associated with the mouth can affect gum health. For example, leukemia patients may develop gingivitis if leukemia cells invade the gum tissue (Kasper 2005). Fanconi anemia is a rare genetic disorder that attacks bone marrow and reduces white blood cell production, leaving the patient predisposed to infections and more susceptible to gum disease (Nowzari 2001).

Hormonal Changes. During periods of hormonal fluctuation (e.g., pregnancy and menopause), women may become more susceptible to gingivitis due to decreased salivation and blood supply to the gums. It is also thought that increased hormone levels cause the gums to respond aggressively to bacteria-producing irritation. However, while it is clear that hormone levels play a role in the progression of periodontal disease, hormones do not specifically cause gingivitis (Mascarenhas 2003). Of particular importance to women is that several recent studies indicate that pregnant women with periodontal disease may be more likely to deliver a pre-term, low-birth-weight infant (Jeffcoat 2003).

Poor Nutrition. A diet lacking in adequate amounts of calcium, vitamin C, and B vitamins can increase the risk of developing periodontal disease (Nishida 2000a,b; Kasper 2005).

Smoking. Tobacco use may be one of the largest preventable risk factors for periodontal disease. According to one study, smoking may be responsible for more than half of adult cases of periodontal disease in the US. The same study also found that smokers are four times more likely to develop advanced periodontal disease than people who have never smoked (Giannopoulou 2003). Smoking diminishes oxygen and nutrient delivery to gum tissue and interferes with the synthesis of cytokines that regulate immunity and inflammation. Smoking also poses a risk of periodontal therapy failure, treatment complications, and increased time to treat the disease (Papantonopoulos 1999).

Stress and Depression. Stress has been linked to an increased risk of periodontal disease, possibly because it may trigger an increase in behaviors such as smoking and poor oral hygiene. Sustained levels of financial stress and poor coping abilities, which can trigger habits such as poor diet or smoking, double the risk of developing periodontal disease (Genco 1999). Researchers have also found that clinically depressed patients are only half as likely to benefit from periodontal treatment as non-depressed patients (Elter 2002).