EFFECTS OF PERIODONTAL DISEASE (TOOTH MOBILITY/DRIFTING)

Question 1

MH: DM Type 2; I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37

a. What is the cause and mechanism involved in “mobility in 14 during chewing”? (5)

Answer 1

• Bacterial lipopolysaccharide found in dental plaque activate a series of pro inflammatory cytokines and inflammatory mediators from macrophages, PMNs and fibroblasts that mediate periodontal tissue destruction and bone loss
• Severity depends on dynamic interaction between microbial challenge and host immune inflammatory response, which is modified by genetic and environmental factors
• MMPs and collagenase produced by both host cells and bacteria cause connective tissue breakdown
• Inflammatory mediators activate osteoclastic activity for bone destruction
• Defensive host inflammatory response shift into pathological destructive process
• Advanced loss of clinical attachment proceed apically and therefore less alveolar bone support the periodontally involved tooth, which become mobile under occlusal load as less PDL attachment to keep it firm
• More importantly DM aggravate the periodontal destruction by immunosuppression, upregulation of inflammatory process, impair healing due to action of AGEs

Question 2

MH: DM Type 2; I/O Mobile 14 on chewing, generalized bleeding and swollen gums, 37 pain, bleeding on brushing; multiple bridges and missing teeth, bridge on 35 37

2. Mechanism of tooth drifting. (4) (Formative, 2014)

Answer 2

 Force acting upon the teeth from front, behind and neighboring teeth contact

 However, such force only effective to bring about such tooth position for teeth with complete PDL

attachment

 That implies if periodontal attachment loss/damage > same force may cause the tooth to drift

 Once drifted, force change in direction and magnitude > predispose further drifting

Question 3

a. There is significant reduction of spacing between 21-22 and 32-33. What is this phenomenon called and what are the possible mechanisms? (3)

Answer 3

 Pathological drifting

 Displacement occur when balance among factors that maintain physiologic position is disrupted

 2 major factors: periodontal attachment apparatus and force exerted on the teeth, either weaken periodontal support or change in force acting on teeth

 Inflammation cause periodontal tissue destruction, which allow movement of teeth under normal occlusal force