1. The bacteria need an environment in the mouth conducive to growth such as someone:

 -Who has poor oral hygiene

 -Who has crowns or bridges or other types of extensive work in their mouths (more places for bacteria to hide out of reach)

 -Who has receding gums (research has shown these areas are more prone to colonization of bugs)

 -Who has had periodontal treatment with a periodontist but does not regularly see the periodontist for supportive periodontal care

2. The bacteria must attain sufficient numbers or concentration to trigger an immune response and the associated inflammation

Professional care such as the revolutionary LANAP (Laser Assisted New Attachment Procedure) can eliminate existing risk factors without the invasiveness and fear associated with traditional gum surgery and bone grafts but an appropriate maintenance plan and understanding on the part of the patient needs to be part of the equation for a lifetime of healthy smiles.