What are the causes and risks for gum disease?

Learn all about the causes and risk factors that can make you more likely to suffer from gum disease.

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Gum disease causes and risks are not as simple as they seem

You may think you’re only at risk of gum disease if you don’t brush or floss your teeth regularly. But the truth is, gum disease is much more complicated than that. There are many things that increase your chances of suffering from it. 

Family history, smoking, other medical conditions and some medicines can all contribute to your risk of gum disease. 

Here, you can find out about all the known causes of gum disease, and the other factors that make some people more likely than others to contract it.

The real culprits: plaque and tartar

The most common cause of gum disease is plaque that has built up around your gum line.  Plaque is a sticky substance containing a lot of bacteria. Regular brushing and cleaning in between your teeth helps keep plaque at bay. But if you don’t clean plaque away, a hard, mineralised substance called calculus (or tartar) begins to form.

Tartar is much harder to remove than plaque, and it retains huge numbers of bacteria. Only professional cleaning by a dentist, hygienist or periodontist can remove tartar. Tartar makes it impossible to clean all the bacterial plaque off your teeth, and so is a key process in the development of gum disease. Left unchecked, tartar can cause gum disease, damaging your gums and even your bone irreversibly. 

Progression of gingivitis

In its early stage, gum disease is called gingivitis. This can be reversed or ‘cured’ with professional cleaning, effective oral hygiene at home and ongoing care and management.

After bacterial plaque forms on teeth, our immune system reacts to it, leading to inflammation of the gums. This reaction takes as little as 2-3 weeks after plaque begins to form. Left untreated, in certain people, this inflammation will go on to cause progressive destruction of the ligaments and bone around teeth. Break down of the ligaments that support teeth results in formation of ‘pockets’ between the teeth and gum.

Over time, these pockets become deeper and the plaque and calculus (tartar) move deeper and deeper under the gum and so become much harder to remove. As this process escalates, you can lose more gum tissue and bone, your teeth become wobbly and eventually may even fall out. 

Gum disease is serious

Gum disease is an actual disease. And must be treated as such. It is the most common cause of tooth loss in adults in the world. As with any other disease, ongoing severe chronic inflammation and infection become a burden on the rest of your body.  Complex molecular inflammatory processes mean an increased risk that you will suffer other general health conditions. These include cardiovascular disease, poorly controlled diabetes, adverse pregnancy outcomes and others. One study found that people with advanced gum disease have an increased risk of death due to heart attack.

More gum disease causes and risks

Failing to brush and floss regularly is the main reason people get gum disease, but there are other factors that can increase your chances of getting gingivitis or periodontitis.

  1. Hormonal changes

     Gums become more sensitive when you’re experiencing hormonal changes. Pregnancy, puberty, menopause, and monthly menstruation alter the level of inflammation in your gums and worsen pre-existing gum disease.
  2. Family history of gum disease

    Studies have shown that up to 30% of the population may be susceptible to gum disease. Finding out if your relatives have a history is a great start if you want to know whether you are more at risk.
  3. Old or defective dental work

    Old fillings or dental crowns and bridges that don’t fit well anymore can no longer protect your teeth the way they are designed to. They may also trap bacteria in places that it’s impossible for you to clean with an ordinary toothbrush or floss. A dentist or periodontist will be able to identify if this is happening, so it’s important to keep up with regular check and clean visits.
  4. Medications
    Some medications can decrease the flow of saliva, causing a condition known as ‘dry mouth’.  Saliva helps protect the teeth and gums, so having little or no saliva can drastically affect your teeth and gums, making you vulnerable to gum disease. 
  5. Smoking

    Cigarettes, e-cigarettes, other nicotine products and smoking marijuana can increase your risk of gum disease. This is because smoking and nicotine affect the blood vessels in your mouth and reduces their resilience and ability to heal.  
  6. Crooked teeth

    It’s rare to be born with a perfect smile, but unfortunately, crooked teeth are harder to clean than straight teeth. Plaque can build up in the overlapping areas between crooked teeth, and this increases the risk of gum disease. If you have crooked teeth, it’s important that you get regular check-ups and cleans to ensure plaque doesn’t get a chance to build up in the spots you can’t reach when you brush and floss at home. 
  7. Immune deficiency

    Diseases and medications that affect the immune system such as HIV/AIDS can lead to an increased risk of developing advanced gum disease.
  8. Diabetes

    People with uncontrolled diabetes have a higher chance of infections and have poorer wound healing, which makes them more susceptible to gum disease. The good news for diabetics is that improving gum health can actually help to improve regulation of blood sugar levels.
  9. Obesity

    New studies have found that people with a high body mass index, large waist circumference and high percentage of body fat are at increased risk of having gum disease.

Does gum disease increase risk of other health conditions?

Numerous studies have found links between gum disease and other general health conditions. These include cardiovascular disease, Type 2 diabetes, problems during pregnancy, osteoporosis, pneumonia, rheumatoid arthritis, Alzheimer’s disease, erectile dysfunction and more. 

Researchers are not completely sure why these links exist. In some cases, it could be caused by common risk factors like lifestyle or genetics. Some research also suggests that bacteria associated with gum disease get into the bloodstream leading to damage in other parts of the vascular system and the body. One thing is clear, the significant inflammation produced by a gum infection can have damaging effects on other parts of the body.

How do I prevent gum disease?

The best tools to prevent gum disease are you and a good home oral hygiene regime. But almost everyone needs some help with this and people who are susceptible to gum disease don't just need good oral hygiene; they need perfect oral hygiene. A dentist, hygienist or periodontist can help you understand your specific risk factors. Even better, they can remove plaque and calculus (tartar) you can't remove yourself, and coach you to look after your teeth and gums better.

Read a full rundown on gum disease prevention and maintenance here.


Regular brushing, flossing and trips to the dentist go a long way towards preventing gum disease. But some people need to do more to prevent it than others.

You may be predisposed to gum disease for any of the reasons outlined here. A periodontist will be able to help you manage the condition, maintain your teeth and avoid complications for years to come. 

Next article

Stages of gum disease