There are factors other than a lack of dental hygiene, such as genetic, environmental or local factors, which may cause periodontal disease. These factors explain why gingivitis may develop into periodontitis.
What are the general, systemic and environmental risk factors?
Two-stage implant surgery:
- Genetic factors: defect in the inflammatory response (positive PST test), alkaline phosphatase deficiency, family history..
- Medication: some medications have unwanted effects such as a decrease in the flow of saliva and gingival hypertrophy. You must inform your dental surgeon of all the treatments you take, as well as of any changes to your medication.
- Stress: stress is a factor that increases the risk of many diseases. It weakens the immune system and causes behavioural changes.
- Malnutrition: vitamin deficiencies, and especially a vitamin C deficiency, lead to a fragile periodontium.
- Diabetes: diabetes is responsible for a reduction in the body’s defences and impaired healing following microcirculation disorders. Diabetes aggravates periodontal disease, especially if it is unregulated.
An important risk factor: tobacco
- Cigarette smoke is absorbed not only by the lungs but also by the gums.
- Nicotine leads to a narrowing (vasoconstriction) of the small blood vessels of the periodontium
- The periodontium receives less blood, is less able to defend itself and does not heal as well during periodontal treatment.
- Finally, tobacco leads to hyperkeratosis (thickening of the outer keratin layers) of the gum and masks signs of inflammation which would normally lead a person to see a dentist (the gums do not bleed and are not very red even though substantial periodontal pockets exist).
What are the local factors?
- Inappropriate dental restoration
- Occlusion problems (or how the teeth of the upper and lower jaw fit together): malocclusion, teeth grinding
- Parafunctional habits: chewing an object (pencil, nails, pipe, etc.)
- Lost teeth not replaced
- Tooth crowding
The best protection against periodontal disease is actually prevention by having the teeth scaled once or twice a year.
For a patient at risk, conventional brushing is not enough to prevent development of the disease and specific plaque control measures need to be taken.