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There are a number of factors that can eventually lead to gum disease, from poor oral hygiene and plaque build-up to tartar and gingivitis. In addition to these so-called causes of periodontitis, certain risk factors increase an individual’s chance of developing gum disease as well. These include smoking, chewing tobacco, malnutrition, diabetes, genetics, crooked teeth, pregnancy, stress, broken fillings, a weakened immune system, consuming certain medications, and old age.

Most cases of gum disease start with the build-up of plaque. Plaque is a sticky bacteria-containing film that forms on the teeth when bacteria interact with leftover starches and sugars from food. While regular brushing and flossing remove a good amount of plaque, the substance is quick to form again. If plaque remains on the teeth for a period of time, it may harden and become tartar or calculus. Tartar is another bacteria-containing substance that is more difficult to remove than plaque and therefore has the potential to cause greater damage. Unlike plaque, brushing and flossing do not remove tartar, so professional dental cleaning is necessary.

When plaque and tartar are left on the teeth, it can lead to gingivitis, the first stage of gum disease. Gingivitis is characterized by irritation and inflammation of the gum tissue at the base of the teeth, otherwise known as gingiva. The good news is that a combination of proper dental hygiene and professional treatment can reverse it completely. On the other hand, untreated gingivitis will most often lead to periodontal disease, filling the mouth with more bacteria, plaque, and tartar. As such, gingivitis itself can be seen as a risk factor for periodontitis.

Moving from causes to risk factors, smoking increases the risk of infection and inflammation in the mouth, which may lead to tooth or bone loss. Being malnourished often goes hand in hand with poor oral health, since the body lacks the proper nutrients to keep the gums healthy. Diabetes may cause gum disease as a result of poorly managed blood sugar levels, while pregnancy can make the gums more vulnerable to plaque due to hormonal changes. Moreover, emotional stress affects the immune system’s ability to fight bacteria, which can significantly impact one’s dental health.

Certain conditions and treatments can weaken an individual’s immune system and increase their risk of developing gum disease. For instance, HIV lowers the number of CD4 cells, thereby damaging the immune system. If HIV progresses to AIDS, the immune system is even weaker and is therefore unable to respond to infection or disease. Similarly, a weakened immune system as a result of chemotherapy puts patients at a greater risk of periodontal disease, as well as other diseases. In short, this cancer treatment lowers the number of white blood cells and reduces the body’s ability to fight infection.

In addition to compromised immunity due to HIV/AIDS and chemotherapy, there are a few medications that are considered to be risk factors for gum disease as well. These include anticonvulsants, calcium channel blockers, oral contraceptives, and steroids. Anticonvulsants, or drugs that calm hyperactivity in the brain, are used to treat epilepsy and prevent migraines. Calcium channel blockers are a class of medications used to lower blood pressure. Oral contraceptives, otherwise known as birth control pills, contain hormones to prevent pregnancy. Lastly, steroids are a type of man-made chemical that acts like hormones and reduces inflammation.