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What are the causes of periodontal disease?

Periodontitis begins with plaque. This invisible, sticky film forms on your teeth when starches and sugars in food interact with bacteria normally found in your mouth.

Although you remove plaque every time you brush your teeth, it re-forms quickly, usually within 24 hours. Plaque that stays on your teeth longer than two or three days can harden under your gumline into tartar (calculus), a white substance that makes plaque more difficult to remove and that acts as a reservoir for bacteria. Unfortunately, brushing and flossing can't eliminate tartar — only a professional cleaning can remove it.

The longer plaque and tartar remain on your teeth, the more damage they can do. Initially, they may simply irritate and inflame the gingiva, the part of your gum around the base of your teeth. This is gingivitis, the mildest form of periodontal disease. But ongoing inflammation eventually causes pockets to develop between your gums and teeth that fill with plaque, tartar and bacteria. In time, the pockets become deeper and more bacteria accumulate, eventually advancing under your gum tissue. These deep infections cause a loss of tissue and bone. If too much bone is destroyed, you may lose one or more teeth.

Although the destructive cycle that starts with the accumulation of plaque is the most common cause of periodontal disease, a number of other factors can contribute to or aggravate the condition. These include:

• Tobacco use. Smoking is the most significant risk factor for periodontal disease. Chewing tobacco also contributes to periodontal disease. Tobacco use in any form damages your immune system, putting you at greater risk of periodontal infection. It also creates a favourable environment for harmful bacteria and interferes with the normal mechanisms for limiting bacterial growth in your mouth. Even exposure to second-hand smoke appears to contribute to periodontal disease. And because smoking impairs healing, smokers are less likely to respond to treatment than non-smokers are.
• Heredity. Sometimes you may do everything right and still develop periodontal disease. In that case, you — along with close to one-third of the population — may have inherited a predisposition to gum problems.
• Drugs. Hundreds of prescription and over-the-counter antidepressants, cold remedies and antihistamines contain ingredients that decrease your body's production of saliva. Because saliva has a cleansing effect on your teeth and helps inhibit bacterial growth, this means that plaque and tartar can build up more easily. Other drugs, especially anti-seizure medications, calcium channel blockers and drugs that suppress your immune system, sometimes cause an overgrowth of gum tissue (gingival hyperplasia), making plaque much tougher to remove.
• Diabetes. A number of health problems can take a toll on your gums. One of the most significant of these is diabetes, which makes you more prone to many infections, including gum infections. But the relationship between diabetes and periodontal disease doesn't end there. Gingivitis and periodontitis impair your body's ability to utilize insulin, making diabetes harder to control. And because diabetes and periodontal disease may make you more susceptible to heart attack and stroke, having both conditions increases your risk of cardiovascular disease.
• Nutritional deficiencies. A poor diet, especially one deficient in calcium, vitamin C and B vitamins, can contribute to periodontal disease. Calcium is important because it helps maintain the strength of your bones, including the bones that support your teeth. Vitamin C helps maintain the integrity of connective tissue. It's also a powerful antioxidant that counters the tissue-destroying effects of free radicals — substances produced when oxygen is metabolized by your body.
• Heart disease and stroke: Having long-term gum disease may increase your risk of heart attack and stroke, and the more severe your gum problems, the greater the risk. Research suggests that the bacteria responsible for periodontitis could travel via the bloodstream to the arteries in your heart creating a cycle of inflammation and arterial narrowing that could contributes to a heart attack. Oral bacteria could also make you more prone to develop blood clots, increasing the likelihood of a stroke. Complications of pregnancy: Women with periodontal disease may be more likely to give birth to a premature baby than are women with healthy gums. The problem is exacerbated by diabetes, considered at high risk in pregnancy. Uncontrolled blood sugar: Diabetes puts you at greater risk of developing periodontal disease and other infections, as it makes blood glucose levels harder to control. Infection anywhere in your body can raise your blood sugar level, requiring more insulin to keep it under control.
• Pneumonia: If you have serious gum disease and lung problems, inhaling (aspirating) bacteria from your mouth into your lungs may result in aspiration pneumonia, a condition that's especially common in hospitals where patients may be sedated or have tracheal tubes.