Risk and Modifying Factors for Periodontal Disease

Now that you’ve learned about predisposing factors in detail, we will now move on and discuss two other equally-important factors that contribute to the development of periodontal disease – risk and modifying factors. Again, these factors are systemic factors that are either a medical problem or a behavioral condition. They differ in the sense that a risk factor increases your chances of developing the disease, while modifying factor hastens disease progression by affecting the body’s immune response.

A certain condition can both be a risk and a modifying factor, and that’s what we will focus on in this article. Diabetes and tobacco use will be excluded, since their effects are discussed exclusively in separate articles.

Disorders that Affect Immunity:

Immune disorders contribute to periodontal disease via any of these two ways. First is by exaggerating the body’s immune response to bacteria in plaque and second by impairing the response itself, making the individual at high risk for infection.

Disorders that affect immunity include immune depressive, gastrointestinal, metabolic (i.e. diabetes), hematologic (a.k.a. blood), and genetic disorders. Genetic disorders, in particular, have been found to make an individual susceptible to periodontal disease despite having aggressive oral hygiene practices.

Identifying the disease through genetic tests even before it shows up allows for early intervention and help save the teeth that would otherwise be lost to periodontal disease.


Stress is not a disease itself, but rather a serious condition that could lead to health problems such as high blood pressure and cancer to name a few. Recently, it also has been found to be linked to periodontal disease.

According to studies, stress depresses the body’s immune system, making it more difficult to fight off disease-causing organisms.


Certain medications can impact periodontal health. These include birth control pills, calcium channel blockers, and antiepileptics to name a few. Birth control pills mess with periodontal tissues by exaggerating the body’s immune response to plaque, while calcium channel blockers and anti-epileptics cause gingival enlargement which makes plaque removal very difficult.

Periodontal inflammation caused by birth control pills tend to resolve once the individual stops the medication, while minor surgery may be needed to remove the enlarged tissue and restore the gums back to their normal form.


A diet that lacks in essential nutrients affects the health of the gums by compromising the body’s immune response. It can also worsen an existing periodontal problem. Vitamin C deficiency, otherwise known as scurvy, causes decreased collagen synthesis and poor wound healing.

In addition, studies have found that obesity increases one’s risk for periodontal disease. More can be learned about the association between these two in this article.

Endocrine Factors:

Endocrine conditions that could affect periodontal health are observed mostly in women. These are puberty, menstruation, pregnancy, and menopause. All of them cause an increase in estrogen and progesterone levels.

Some studies also mention that these hormones can encourage growth of bacteria that causes periodontal disease. Each one of these four endocrine-related conditions manifests as different periodontal problems, and you can learn more about them in detail by reading this article.

Periodontal Disease in Women

How it has something to do with the different phases of their life

A woman’s periodontal health is influenced by number of factors, the most important of which is the fluctuating hormone levels. The two hormones that contribute to periodontal disease in the female are the sex hormones estrogen and progesterone. Both of these increase blood flow to the gum tissue, causing its increased sensitivity to plaque and other offending agents.

In addition, there are also some studies which say that increased levels of estrogen and progesterone actually promote growth of disease-causing bacteria. As a result, the gums become easily swollen.

The following conditions are some of the instances where women’s hormones go out of whack, causing them to be more susceptible to periodontal disease.



During puberty there is increased level of progesterone which causes the gums to appear red and swollen. It is also likely bleed easily upon slight manipulation. This reaction of the gum tissue can easily be reversed by removing the irritant. This can be done through meticulous oral hygiene practices and regular professional cleaning by your dentist.

Nonetheless, as pubertal period comes to an end, this reaction tends to lessen or tone down. Even so, it is still important take good care of your oral health.


Some women may also experience this so-called menstruation gingivitis, which appears about three to four days prior to a woman’s period and begins to clear up after her period has begun. It is characterized by bleeding, swollen gums that are bright red in color.

In some cases, the salivary glands may also become swollen, while the tongue and the inside of the cheek may develop painful sores. Some women, though, don’t experience any changes at all. But for those who experience any discomfort, your dentist may recommend cleaning, topical anesthetics, or other special treatments to provide some relief.


Pregnancy has long been suggested by numerous studies as a possible risk factor for periodontal disease, as it causes hormone levels to rise considerably. Gingivitis is present during the second month of pregnancy up to the eighth month, and it starts to wane during the ninth month.

To control the disease, your dentist may prescribe more frequent cleaning visits especially during the second trimester or early third trimester.

Sometimes, an overgrowth of tissue called “pregnancy tumor” may show up during the second trimester. It is a localized, painless, and non-cancerous swelling that usually appears between the teeth and is also believed to be caused by excessive plaque accumulation. It is characterized as having a mulberry-like mass that bleeds easily. It usually resolves on its own once the baby is born, but some women opt for surgery especially if the tumor is so big that it interferes with function.

The association between these two conditions is a two-way street as hormonal fluctuations during pregnancy may predispose to periodontal disease, while any infectious disease like periodontal disease pose a risk to the unborn baby’s health.

According to studies, periodontal disease cause pregnant women to have premature and/or low birth weight babies.

However, further studies are needed to confirm the effects of periodontal disease on adverse pregnancy outcomes. Still, experts recommend pregnant or planning-to-be pregnant women to have a periodontal evaluation especially if they notice some changes in their mouth during pregnancy.


Women who are in their menopausal or post-menopausal stage may experience changes like dry mouth, altered taste, burning sensation, increased sensitivity to heat and cold, pain, and other discomforts. A small percentage may also develop menopausal gingivostomatitis, which is described as dry, shiny gums that bleed easily. The color of the gums range from very pale to deep red. According to some experts, supplementation with estrogen may help relieve symptoms.

Every phase of a woman’s life brings about many changes, some of which are good while others are not-so-good. Such changes may include ones that affect your oral health.

If you start to see of feel any changes that you think may be related to any of the conditions above, talk to your dentist or periodontist. They will be happy more than happy to address any concerns you have regarding your oral health.