Assessing Risk For Gum Disease

How to determine your risk

Dear Doctor,
I am a 35-year old woman and have had bleeding gums for years. My parents both lost their teeth because of gum disease. What are my chances of losing my teeth?

Dear Sara,
Given your history, your chances of developing periodontal (gum) disease appear quite high. Periodontal disease (“peri” – around; “odont” – tooth) refers to the progressive loss of attachment between the fibers that connect the bone and gum tissues to the teeth, and the consequential loss of the tooth supporting bone itself.

Your chances of developing periodontal disease increase considerably as you get older. Generally, the greater the quantities of dental bacterial biofilm (plaque) and the longer it's left in contact with the gums, the greater the amount and severity of periodontal disease. Effective brushing and flossing are fundamentally important to disrupting the biofilm and preventing disease. The best way to determine if your oral hygiene techniques are effective is to have them evaluated by a dental professional. In addition, studies have shown that periodontal disease and tooth loss are correlated with aging; thus making the need for proper oral hygiene even more critical over a lifetime.

Anyone who has bleeding gums needs to know that it is a sign of gum disease.

Anyone who has bleeding gums needs to know that it is a sign of gum disease. Healthy gum tissue does not bleed and brushing so hard as to cause bleeding is harmful to your gums and teeth. If you are pregnant or taking certain birth control pills that elevate hormone (progesterone) levels, your gum tissues may be more responsive to bacterial biofilm and thus bleed more easily. Studies also suggest that there are genetic differences between men and women that affect the risk of developing gum disease. While women tend to take better care of their oral health than men do, women's oral health is not markedly better than men's. This is because hormonal fluctuations throughout a woman's life can affect many tissues, including the gums.

Family history of gum disease is an important factor for the development of periodontal disease. Research suggests that the bacteria that cause periodontal disease can be transferred through saliva. This means the common transmission of saliva in families can put children and couples at risk for contracting periodontal disease from another family member. In addition, up to 30% of the population may be genetically susceptible to gum disease. The good news is that there are newly developed tests, easily carried out in the dental office that can assess your genetic susceptibility. Despite aggressive oral hygiene habits, genetically susceptible individuals may be 6 times more likely to develop periodontal disease — don't forget, you inherit your immune (resistance) response from your parents.

If you smoke tobacco you are at much greater risk for the development and progression of periodontal disease. Smokers have more disease causing biofilm bacteria and collect it more quickly. Smokers also lose more attachment between teeth and gums (“pocketing”), which leads to more loss of the bone that supports the teeth.

If you have heart disease, respiratory disease, rheumatoid arthritis, osteoporosis (“osteo” – bone; “porosis” – porous or sponge-like), high stress, or diabetes, research continues to suggest that periodontal disease may be linked to these conditions. Researchers believe that bacteria associated with periodontal disease may pass into the blood stream and threaten other parts of the body. Over the past decade, research has focused on the role chronic inflammation may play in various diseases, including periodontal disease. A correlation has been shown between the inflammatory mechanisms associated with periodontal disease and the following:

• Cardio-vascular disease (“cardio” – heart; “vascular” – blood vessel)
• Premature, low birth weight babies in some women
• Some individuals with Alzheimer's disease

Periodontal disease is often silent, meaning the symptoms (the things you notice) may not appear until an advanced stage of the disease. Due to this fact, the following self-assessment will help you identify if you are at risk:

• Have your gums receded and/or do your teeth appear longer?
• Are any of your teeth feeling or getting loose?
• Have you recently had a tooth or teeth extracted because they were loose?

If you answered, “yes” to any of the above questions, then you are at risk of gum disease and should make an appointment with a dentist or periodontist (a specialist in the diagnosis and treatment of gum diseases and disorders).

As you implied in your question, you correctly identified some of the risk factors for periodontal disease — bleeding gums and family history. But all is not lost; it can be arrested and successfully treated. Your best bet is to see a dentist or periodontist to professionally and thoroughly assess your risks and make recommendations. Losing your teeth is not inevitable, even with a strong family history of periodontal disease.