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Local Contributory Factors for Periodontal Disease. Chapter 5 (Dental…
Local Contributory Factors for Periodontal Disease. Chapter 5
Dental Calculus
considered most important local contributing factor
is associated most frequently with sites that are adjacent to a salivary source such as parotid, Wharton's duct, and salivary caruncle
the minerals are deposited within 24 to 72 hours of plaque formation
sub gingival calculus is derived from GCF and any inflammatory exudates
most often forms rings around the roots of the tooth or in ledges
supra gingival calculus in 30% mineralized, whereas sub-gingival calculus is 60% mineralized
plaque on the surface of the calculus contains living bacteria and is detrimental to the tissue. Calculus is a contributing factor for periodontal disease. Calculus acts as irritant to gingival margin or sulcular tissue.
Attachment in 4 ways. 1) mechanical locking into irregularities in cementum. 2) areas of cementum resorption. 3) by means or organic pellicle. 4) by penetration into bacteria (not accepted by all researchers)
is essentially calcified dental plaque, but may form even in the absence of bacteria
always covered by plaque and retains toxic bacterial products
porous and provide a reservoir of bacteria and endotoxin
Long term studies of periodontal patients support calculus removal to promote healing and prevent further loss of attachment
commonly called tartar
only about 45% of surfaces with clinically visible calculus are detected radiographically
Anatomic Factors
root morphology and position of teeth in the arch
root morphology
cervical enamel projections, enamel pearls, & palatogingival grooves (lingual grooves)
lingual grooves are present on about 5% to 8% of maxillary incisors, tend to accumulate plaque, and can become the focus of a narrow deep pocket
higher incidence of CEPs is on the buccal aspect of the mandibular second molar
proximal furcations on maxillary molars present particular problems because of even more limited access
tooth position
tooth position anomalies lead to increased plaque accumulation and more tissue inflammation clinically in patients who do no t have good OH habits
Iatrogenic factors
restorative dentistry
rough surfaced and over contoured amalgams , composites, crowns , bridges , and other types of restorations have been associated with increased gingival inflammation and periodontal disease
sub-gingival restorations that invade the biologic width and restorations with defective or overhang ing margins may have a profound effect on periodontal health
Exodontics
failure to remove calculus from adjacent tooth surfaces during the extraction may negate the chance for proper healing on adjacent teeth
patients usually stop chewing on the side of the site of extraction in addition to the decrease in mastication , plaque starts to for, and patients also avoid brushing on the side of the site of extraction
orthodontics
present excellent retentive areas for bacterial growth & can contribute significantly to inflammation
ortho patients may need more frequent recalls to keep up with oral hygiene
traumatic factors
toothbrush trauma
can result in extensive recession
toothbrush abrasion is one of the two most common factors associated with recession
extensive grooving of the root surfaces creating plaque traps and causing cleaning problems
factitious disease
gouge or scratch gingiva with finger nail or other object
results in extensive exposure of the root surface and localized inflammation
change in the local gingival anatomy often leads to a greater plaque accumulation and inflammation
food impaction
one of the more common local factors that may contribute to the initiation and progression of inflammatory periodontal disease
may cause inflammation and or chemical irritation; can create excellent breeding ground for bacteria
chemical injury
caused by topical gels, mouth rinses, dental bleaching material, and topically applied aspirin tablets
injuries of this nature are usually transient, but may temporarily interfere with plaque control and contribute to periodontal inflammation
In office bleaching systems use higher concentration of hydrogen/carbamide peroxide; gingival inflammation common adverse effect
occlusion
does not initiate gingival or periodontal inflammation or pocket formation
may increase the rate of progression of periodontitis if plaque induced inflammation is also present
oral piercing
frequently seen; may cause dental/periodontal injury on the facial aspect of the mandibular incisors, tongue piercings affect lingual aspect of mandibular incisors
REFLECTION:
I have experienced plaque accumulation because of an orthodontic appliance , I have been chemically burned because of food impaction, and I have jabbed my gingiva with a toothbrush before. I did not think much of it then, but to know that all of these can foster the environment and lead to periodontal disease progression is frightening. I enjoy learning things like this to later pass on to my patients and even family.