Smoking and diabetes are the two clearest risk factors for gum disease, and prevalence climbs with age: about 60% of adults 65 and older have it, against about 42% of all American adults over 30.1 Medications that dry the mouth, genetics, and pregnancy hormones raise risk as well, which means "higher risk" describes a great many people.
What's the baseline risk?
By the CDC's own measurement, about 42% of American adults over 30 have some form of gum disease; that's the average, before any risk factor is added.1 It's worth stating before naming any risk group, because it recalibrates the whole conversation. "Higher risk," in other words, means higher than a condition that already affects roughly two in five adults. We cover the prevalence story in full in how common is it?
What are the two clearest risk factors?
Across CDC and NIDCR guidance, smoking and diabetes stand above the rest.
Smoking is consistently identified as one of the strongest modifiable risk factors for gum disease. It does double damage: it promotes the disease itself, and it impairs healing. Smokers respond less well to gum treatment than non-smokers. It can even mask the warning signs, since smoking reduces gum bleeding, one of the earliest signals most people would otherwise notice.
Diabetes and gum disease run in both directions. Per CDC guidance, people with diabetes are at higher risk for gum disease (high blood sugar feeds the conditions gum infections thrive in), and gum disease, in turn, can make diabetes harder to manage. The CDC also notes that treating gum disease may help lower blood sugar over time.2 That two-way street matters enough that we gave it its own article: gum disease and diabetes.
Does risk climb with age? About 60% at 65+
Yes, gum disease prevalence climbs steadily with age, and for adults 65 and older the CDC's measurement puts it at about 60%.1 That's not because aging gums are doomed; it's largely because periodontitis is cumulative. Damage adds up over decades, and inflammation that was never fully controlled at 40 is still on the books at 70. It's also the age group where the stakes of tooth loss are highest, which is exactly why the five-year tooth-loss research was done in older adults. See gum disease and tooth loss.
By 65, gum disease isn't the exception. At about 60% prevalence, it's the majority experience.
What are the quieter risk factors?
Medications that dry the mouth, genetics, and pregnancy hormones carry no headline statistics but show up consistently in clinical practice. All three are flagged in NIDCR/NIH and ADA patient guidance:4
Medications that dry the mouth. Hundreds of common prescriptions (for blood pressure, depression, allergies, and more) reduce saliva flow. Saliva is the mouth's built-in rinse cycle; with less of it, plaque accumulates faster and gums become more vulnerable.
Genetics. Some people are simply more susceptible to gum disease than others with identical habits. A strong family history of gum disease or early tooth loss is a legitimate reason to be more vigilant, not a sentence.
Pregnancy hormones. Hormonal changes during pregnancy make gums more sensitive to plaque, and gum inflammation during pregnancy is common enough that it has its own name: pregnancy gingivitis. It's one more reason dental care during pregnancy is standard guidance, not an indulgence.
The risk factor nobody lists: income
There's one more divide the survey data makes impossible to ignore, and it isn't biological: in CDC NHANES data, about 49% of lower-income adults report never flossing at all, compared with about 28% of higher-income adults.3 Nearly half versus barely a quarter, for one of the cheapest health behaviors in existence.
Floss costs a few dollars; the divide isn't about affording it. It tracks with access to dental care, with whether anyone ever taught the habit, and with how preventive health advice reaches some communities and not others. The practical effect is that daily prevention is scarcest in the same populations where other risk factors (smoking, diabetes) tend to cluster. We examine this divide on its own in the income flossing gap.
An honest note about what "higher risk" should change
There's a quiet trap in risk-factor lists: people read them fatalistically, as if being higher-risk means dental care is less worth the trouble. The evidence points the opposite way. Higher-risk groups are exactly the people for whom the research shows professional care matters more, not less: people with diabetes, smokers, and older adults have the most inflammation to control and the most to lose from letting it run. If several items on this page describe you, the takeaway isn't resignation. It's that your dentist visits and your daily routine are carrying more weight than the average person's, and that catching gum disease while it's still at the reversible stage matters more for you than for anyone.
Common questions
Does smoking make gum disease more likely, or just harder to treat?
Both. Smoking is consistently identified as one of the strongest modifiable risk factors: it promotes the disease and it impairs healing, so smokers respond less well to gum treatment than non-smokers.4 It can also mask the warning signs, because smoking reduces gum bleeding, one of the earliest signals most people would otherwise notice.
Can treating gum disease help my diabetes?
Per CDC guidance the relationship runs both ways: people with diabetes are at higher risk for gum disease, gum disease in turn can make diabetes harder to manage, and treating gum disease may help lower blood sugar over time.2 We walk through that two-way street in gum disease and diabetes.
If I have none of these risk factors, is my risk low?
Lower risk isn't no risk. The baseline here is a condition that already affects about 42% of American adults over 30, by the CDC's own measurement.1 Risk factors shift the odds; they don't remove the need for daily care and routine dental visits.
Does being higher risk mean dental care is less worth the trouble?
The evidence points the opposite way. Higher-risk groups (people with diabetes, smokers, and older adults) have the most inflammation to control and the most to lose from letting it run, which is why professional care matters more for them, not less. Catching the disease while it's still at the reversible stage matters more for you than for the average person.
- Eke PI, et al. / CDC: periodontitis prevalence among US adults, NHANES 2009–2014; NIDCR data pages (2024). About 42% of adults over 30; about 60% of adults 65 and older.
- CDC, Oral Health & Diabetes guidance (2024). Diabetes raises gum disease risk; gum disease can make diabetes harder to manage; treatment may help lower blood sugar over time.
- CDC / NCHS, NHANES flossing analysis (Fleming et al.), income-stratified figures. CDC Stacks cdc/77006. Self-reported survey data.
- NIDCR/NIH and ADA patient guidance on periodontal (gum) disease: smoking, medications and dry mouth, genetics, and pregnancy as risk factors.