Why is it that some people who take good care of their teeth still get a lot of dental problems?

It was traditionally thought that bacterial plaque growing on the teeth was the sole cause of the two most common dental diseases, caries (cavities) and periodontal (gum) disease.  Yet all dentists observe patients who take very good care of their teeth but still have a lot of disease.  Conversely, dentists commonly observe patients who take poor care of their teeth and get away with it, teenagers of the fluoride generation being the most common example.  The difference is in how people react to the bacteria in plaque, which varies from person to person based on an ever-lengthening list of known factors:  underlying medical conditions, susceptibility to inflammation, immune system status, quantity and quality of saliva, hormonal fluctuations, medication side effects, inherited resistance, mouth breathing, nutritional status, age, gender, race...on and on.  State of the art dental diagnostics looks at this in total and makes an evaluation of the patient's dental disease susceptibility, or risk, and makes a plan to manage and minimize that risk accordingly.

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