Why Adults are more susceptible to Gum Disease than Children

prevalence of gum disease in United States

Have you ever noticed that gum disease most often affects ADULTS rather than children? Is it because children are more resistant than adults to these diseases or is it just a coincidence?

Today, many researches and experiments are done to look for the existing relationship between gum disease and age.
In 1999-2004, according to the National Health and Nutrition Examination Survey (NHANES), the prevalence of aggressive gum diseases increased from 3.84% between the ages of 20 and 34 to 10.41% between the age of 35 and 49 to 11.88% between 50 and 64.
While these diseases affect less than 1% of children, with perhaps an exception among Hispanic children in Texas (USA) where it is estimated that between 1% and 4% of children are affected.
It is therefore clear that the frequency of periodontal diseases increases with age. However, gingivitis (inflammation of the gums) is common in children and adolescents, although the incidence is lower in children than adults.

ANAES in 2002 showed that 80% of adults have recognized inflammations of the gum. This figure drops to 9% among children aged 5 to 16 years.
Gingivitis is common. Its prevalence, severity and extent among young people increase with age. On the other hand, if epidemiological studies show that the tendency to develop gingivitis (which means inflammation of the gum) is correlated with age. The Severity is less intense in children for the same amount of plaque than adults. What the following pictures show.
children gum

the gum of the child before the plaque revelator

plaque children's teeth

The gum of the child after the plaque revelator

For a large quantity of bacterial plaque, the gums of the child seem healthy. Whereas if it was the gum of an adult, it would be inevitably inflamed.


These numbers suggest that age is a major risk factor for gum disease. Read on to discover why the more time passes, the more susceptible we become to gum disease.

The reasons for susceptibility of Adults to Gum Disease

The gums of children is more resistant

The gum of the child is thicker and more vascularized. The density of the immune cells and fibers will be important which will have the effect of increasing the resistance of the young gum to bacterial attacks responsible for gum disease.

The sulcus which represents the space between the tooth and the gum is less deep in the child than that of adults. This space being favorable for the development of pathogenic bacteria will make adults more susceptible to developing gum disease.

It has been shown that most bacteria capable of causing gum disease are anaerobic bacteria, which means that their growth is conditioned by an environment where there is very little oxygen.

This space called the sulcus being very narrow does not let the oxygen pass which presents a favorable environment for the growth of anaeobic bacteria capable of colonizing the periodontal tissues (which surround the tooth).

Which explains the difference of the bacterial flora between the adult and the child.

In addition to the weak cellular and immune potential of the gingiva of the adult compared to that of the child, other factors can intervene making the adult more likely to develop gum disease.

Tartar and bacterial Plaque

Plaque is a bacterial mass adhering to the tooth. Once mineralized, it becomes tartar.
The plaque is not very marked in children, it's also rare to observe tartar in temporary dentition, because only 5% of children under 4 years are concerned. However, the presence of plaque increases with age, which increases the risk of developing gingival infections.

It has been shown that, for a period of 7 days without brushing, older subjects had more plaque than younger subjects. This is related to the composition of saliva and the number of teeth that is higher in adults.

Over time, the duration of exposure of the gum to plaque and its amount increases, which further explains the susceptibility of Adults to develop gum disease.

Habits and Behaviors

Some negative habits and behaviors such as smoking, alcohol, snacking between meals and stress are risk factors for gum disease.

Smoking impairs inflammatory and immune responses to pathogenic bacteria, and exerts both systemic and local effects. Periodontal disease is increased both in prevalence and severity in smokers.

Smokers present compared to non-smokers:
  • 6 times more risk of develop gum disease.
  • More periodontal pockets (advanced sign of periodontal diseases).
  • More gum recessions (the exposure in the roots of the teeth caused by a loss of gum tissue).
  • More bone loss
  • More dental loss
  • Less gum bleeding (which can mask early signs of gum disease)
Stopping smoking improves periodontal health.

Continued alcohol consumption significantly raises the risk for developing cancer of the gums. The American Cancer Society reported recently that:
  • The ethanol in alcoholic beverages is directly linked to raising the risk for developing mouth cancer and dissolving dental health.
  • Alcohol acts as an irritant and can damage cells and change the cells’ DNA, leading to the possible development of mouth cancer.
  • Alcohol acts as a solvent and aids harmful chemicals in entering mouth tissues – especially when paired with smoking.
  • Alcohol abuse slows the immune system’s response to penetrating harmful chemicals, which leads to the possibility of oral cancer, periodontal disease and eventually bacterial overgrowth and mouth tissue infections.
  • Dehydration from alcohol consumption causes bacteria and plaque buildup because it is not washed away by saliva.


Stress is also a factor not to be neglected. Patients with inadequate stress behavior strategies (defensive coping) are at greater risk for severe periodontal disease. Stress is associated with poor oral hygiene, increased glucocorticoid secretion that can depress immune function, increased insulin resistance, and potentially increased risk of gum disease. Men who reported being angry on a daily basis had a 43% higher risk of developing gum disease compared with men who reported being angry seldom.

Studies have found some gum disease indicators such as tooth loss and gingival bleeding to be associated with work stress and financial strains.

Some bad habits are responsible for the modification of the oral flora.
Indeed, in the healthy state we have a flora called commensal flora that protects us from other dangerous bacteria and lives in our mouth without causing damage to our tissues. After an imbalance, the bacteria present in the healthy state will disappear to give way to other pathogenic bacteria capable of causing gum disease.

Infections

Certain viruses such as Human Immunodeficiency Virus (HIV) can cause periodontal diseases by weakening our immune system.
Epidemiological studies have shown that HIV-infected populations compared to non-HIV-infected populations have more bone lysis and more gingival recessions.

Hormonal Modification

Hormonal modification can occur after puberty, menopause, pregnancy or after taking some drugs.
It has the consequence of modifying the tissue metabolism, the imbalance of the immune system as well as the growth of certain bacteria. Gum disease caused by Hormonal Modification is manifested by severe gingivitis What the following picture shows.
gum disease aggravated by pregnancy

Gingivitis aggravated by Pregnancy


We all agree that type 2 diabetes is a hormone disorder disease. It is prevalent in adults aged 40 and over. Diabetes causes blood vessels to thicken, which slows the flow of nutrients and the removal of harmful wastes.

This can weaken the resistance of gum and bone tissue to infection. When diabetes is poorly controlled, high glucose levels in mouth fluids may help germs grow and set the stage for gum disease.

Unbalanced diabetes is a major risk factor that predisposes to gum disease or aggravating an existing periodontal disease.

Periodontitis is considered the 6th complication of diabetes (Loe, 1993) Diabetics with poor metabolic control have more severe and extensive periodontal disease than healthy people.

Periodontal Diseases and Coronary Artery Disease

After more than 20 years of research, it is now well established that there is an association between periodontal disease and coronary artery disease.

Several biological mechanisms have been proposed to explain the relationship between periodontal diseases and coronary artery disease.
When the gum is infected, it allows bacteria to enter the bloodstream. These attach to the blood vessels of the heart and cause the formation of bacterial plaque responsible for cardiovascular problems. Then, periodontal diseases are accompanied by inflammation of the gums (swelling and bleeding). This inflammation can diffuse into the circulation and reach other organs via molecular signals.

Gum disease is capable of predisposing to vascular disease due to the rich source of gum bacteria species and, to our immune response which can sometimes cause us damage.

Drug-Induced Disorders

Some medications significantly decrease salivary flow which is not good because of the protective role of saliva. These include antihypertensives, narcotic analgesics, some tranquilizers and sedatives and antihistamines.

Other drugs, particularly those in liquid or chewable form that contain added sugar, alter the pH and composition of plaque, making it more able to adhere to tooth surfaces.

Drugs can be a contributing factor in gum diseases. Drugs such as nifedipine, cyclosporin and phenytoin induce gingival swelling.

Nutritional Factors

Malnutrition has been reported to be an important risk factor for gum disease. Several explanations for the association between malnutrition and gum disease in younger adults have been provided. Younger people may have different dietary patterns than older study participants. Research in dietary trends in adolescent's ages from 11 to 18 reveals a significant decrease in raw fruit and nonpotato vegetables, which are sources of vitamin C. In addition, adolescents have decreased their calcium intake and increased their intake of soft drinks and noncitrus juices. This is important to oral health because low dietary intake of calcium and vitamin C has been associated with periodontal disease. People who consume less than the recommended dietary allowance for calcium and vitamin C have slightly higher rates of gum disease.

Conclusion

The gum structure of the child differs from that of the adult by its resistance potential to external aggression.
The more the child grows, the more his anatomy changes and the more his gum becomes sensitive to bacterial aggressions, which statistics have also shown.

Similarly, the composition of the oral bacterial flora is under the dependence of many factors evolving during the growth and maturation of the child. It will be different depending on the individual characteristics, habits and behaviors, the type of bacterial contamination, nutrition and the environment where the child grew up.


To better understand gum disease, I recommend you read my article on The 5 most serious Periodontal Diseases