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CH. 5: Local Contributory Factors for Periodontal Diseases (TRAUMATIC…
CH. 5: Local Contributory Factors for Periodontal Diseases
IATROGENIC FACTORS
Restorative Dentistry
SubG restorations that invade the biological width and restorations with defective overhanging margins may have profound effect on periodontal health.
Injuries to the gingiva can occur during careless restorative dentistry. Ex. wedges, retraction cords, etc.
Exodontics
Extractions can adversely effect adjacent teeth if their attachment apparatus is damaged. Calculus must be removed in order for the tissue to heal properly.
Patients tend avoid chewing and brushing in those areas!!
Orthodontics
Fixed appliances present excellent retentive areas for bacterial growth.
DENTAL CALCULUS
Dental calculus is considered the most important
local
contributing factor but is not the cause of the disease.
The term
calculus
is Latin for
pebble
or
stone
Clinical Significance of Calculus
Supragingival calculus is 30% mineralized. Subgingival calculus is 60% mineralized.
Four
modes of attachment:
1)
mechanical locking into irregularities,
2)
cementum resorption,
3)
organic pellicle,
4)
penetration into bacteria
Defined as
"minerlized plaque"
ANATOMIC FACTORS
Root Morphology
Anomaly:
a deviation from normal tooth development or function
Watch out for those lingual grooves, enamel pearls, and furcations!!!
Tooth Position
Crowding, tilting, rotations, etc can increase plaque accumulation especially with poor oral hygiene.
TRAUMATIC FACTORS
Toothbrush Trauma
Can completely destroy a narrow band of attached gingiva and result in extensive recession
Toothbrush abrasion is one of the two most common factors associated with recession
Factitious Disease
persistently gouging or "scratching" the gingiva with fingernails or other devices
usually results in extensive exposure of the root surface and localized inflammation
Food Impaction
One of the more common local factors that may contribute to the initiation and progression of inflammatory periodontal disease.
May result in open contacts, uneven marginal ridges, irregular positions of teeth, and nonphysiologic contours of teeth and restorations
The cause of initial breakdown of tissue in an area of food impaction is not clear.
May be due to the physical trauma from forceful wedging of food.
May also be due to chemical irritation from food retention.
Chemical Injury
Topically applied aspirin tablets, dental bleaching material, string mouthwashes, etc may burn gingival tissue.
Like that time i used the Crest white strips
Occlusion
Occlusal trauma DOES NOT initiate gingival or periodontal inflammation or pocket formation but heavy occlusal forces can cause mobility and radio graphic appearance of bone loss.
Occlusal trauma may increase the rate of progression of periodontitis if plaque-induced inflammation is also present.
Oral Piercings
Frequently seen in patients today.
Lip piercings may cause dental/periodontal injury on the facial aspect of the mand. incisors while tongue piercings may affect the lingual aspect.
