Exam 2 Ch. 17 Local Contributing factors (Steph) Flashcards
for periodontal disease are intraoral conditions or habits that increase an individual’s susceptibility to periodontal infection or that can damage the periodontium in specific sites within the dentition.
Local contributing factors
individual tooth or specific surface of a tooth.
Disease site
mineralized bacterial plaque biofilm, covered on its external surface by nonmineralized, living bacterial plaque biofilm.
Dental calculus
a thin, bacteria-free
membrane that forms on the surface of the tooth during the late stages of eruption.
Pellicle
is the study of the anatomic surface features of the teeth. There are a variety of local contributing factors that relate to tooth morphology.
Morphology
is an apical deviation of the cementoenamel junction (CEJ) toward the direction of the furcation entrance
Cervical enamel projections
a well-defined ectopic, spherical-shaped deposit of enamel found on the root surface
Enamel pearl
treatment that results in an inadvertent, adverse outcome
Iatrogenic factor
When excess restorative material extends over the cavity margin or normal contours of the tooth
Overhanging restoration
Whenever there is a space or gap between the edge of a restoration and the natural, unprepared tooth structure
Open margin
The space apical to the contact area of two adjacent teeth
Embrasure space
an intraoral substitute—such as crown, fixed bridge, or
removable denture—used to restore missing parts of teeth, missing teeth, and missing soft or hard tissues of the jaw and palate.
Prosthesis
refers to the zone of soft tissue occupied by the junctional epithelium and the connective tissue attachment fibers immediately apical to (below) the junctional epithelium
Biologic width
to reflect the zone of soft tissue coronal to the alveolar crest.
Supracrestal tissue attatchment
habits such as tongue thrusting, mouth breathing, or the improper use of toothbrushes, toothpicks, and other dental cleaning aids can also cause direct damage to the periodontium.
Factitious injury
intentional injury to the tissues by the patient to deliberately feign or exaggerate a physical or psychological symptom with the goal of receiving a reward.
Malingering
forcing food (such as pieces of tough meat) between teeth during chewing, trapping the food in the interdental area
Food impaction
is the application of forceful pressure against the anterior teeth with the tongue
Tongue thrust
the process of inhaling and exhaling air primarily through the mouth, rather than the nose, and often occurs while the patient is sleeping.
Mouth breathing
is the aggressive, forceful use of a toothbrush in a horizontal or rotary fashion
Traumatic tooth brushing
bony defect from traumatic toothbrushing with root exposure
Dehiscence
a “window” of bone loss bordered by alveolar bone on its coronal aspect.
Fenestration
excessive occlusal forces cause damage to the periodontium
Trauma from occlusion
is defined as excessive occlusal forces on a sound periodontium with no previous history of periodontal breakdown
Primary trauma from occlusion
occurs when normal or excessive occlusal forces are placed on teeth with an unhealthy periodontium previously weakened by periodontitis, thus contributing harm to an already damaged periodontium.
Secondary trauma from occlusion
normal forces produced during the act of chewing food
Functional occlusal forces
result from tooth to tooth contact when not in the act of eating. Clenching, bruxism.
Parafunctional occlusal forces
the continuous or intermittent forceful closure of the maxillary teeth against the mandibular teeth.
Clenching
forceful grinding of the teeth.
Bruxism
An abnormal frenal attachment located in close proximity to the gingival margin will distend the gingival sulcus (as the muscular fibers in the frenum repeatedly pull on the gingival margin).
Frenal pull
Calculus is considered a local risk factor because:
A. The surface of calculus is irregular and provides a place for bacteria to grow undisturbed
B. The bacteria derive many of their needed nutrients from the hard calculus deposits
C. The surface of calculus can damage the adjacent soft tissue through direct trauma
D. Calculus is the primary cause of periodontal disease
A. The surface of calculus is irregular and provides a place for bacteria to grow undisturbed
Which of the following is NOT a mechanism for attachment of calculus to a tooth surface?
A. Attachment by means of pellicle
B. Attachment to the blood clots that can form on the tooth
C. Attachment to irregularities that occur in the surface of a tooth
D. Attachment by direct contact of the calcified component and the tooth surface
B. Attachment to the blood clots that can form on the tooth
The term overhanging restoration refers to restorations (or fillings) that:
A. Are accidentally placed on the wrong tooth
B. Are not smoothly contoured with the tooth surface
C. Contain grooves or concavities in the surface of the restoration
D. Cover the entire anatomical crown of the tooth
B. Are not smoothly contoured with the tooth surface
Pathogenicity of plaque refers to:
A. The ability of plaque to contribute to tooth staining
B. The likelihood that the patient will be able to detect the plaque
C. Damage to the periodontium from occlusal forces
D. Disease causing potential of the plaque
D. Disease causing potential of the plaque
Parafunctional occlusal forces are forces placed on the teeth that:
A. Occur only during the act of chewing food
B. Occur from repeated use of chewing gum
C. Result from tooth to tooth contact other than during chewing food
D. Can be detected only after occlusal adjustment
C. Result from tooth to tooth contact other than during chewing food
Which of the following can result in direct damage to the periodontium?
A. Failure to remove plaque from the surfaces of teeth
B. A dental prosthesis that impinges on the gingiva
C. Way too many soft foods in the diet
D. Both A and B
D. Both A and B
Local contributing factors do not actually initiate either gingivitis or periodontitis, but these factors can contribute to the progression of an already established disease that is previously initiated by
bacterial plaque biofilm.
Examples of potential local contributing factors can include
dental calculus
faulty dental restorations
developmental factors in teeth
plaque retentive features of cavitated lesions
certain patient habits
trauma from
occlusion.
What are the three primary mechanisms by which local factors can increase the risk of developing periodontal disease or increase the severity of existing disease?
- increase plaque biofilm retention
- increase plaque biofilm pathogenicity
- cause direct damage to the periodontium
A local factor can increase plaque biofilm retention. (Clinical example)
rough edge on a restoration
Local factor that increases plaque biofilm pathogenicity (Clinical example)
calculus deposits harbor plaque biofilm, allowing the biofilm community to grow uninhibited for an extended period
A local factor can cause direct damage to the periodontium. (Clinical example)
- Ill-fitting dental appliance that puts excessive pressure on the gingiva
- history of traumatic toothbrushing
- occlusion trauma
- high frenal attachment
What is the most obvious example of a local contributing factor that can lead to increased plaque biofilm retention?
dental calculus
Mineralization of plaque biofilm can begin from _____________ after plaque biofilm formation.
48 hours up to 2 weeks
The inorganic part of calculus makes up how much % of the overall composition of calculus?
70% to 90%
The inorganic part of dental calculus is primarily
calcium phosphate, but the dental calculus also contains some calcium carbonate and magnesium phosphate.
The inorganic part of calculus is similar to?
inorganic components of bone
Calculus located where may not be detected on radiographs?
lingual or facial surfaces of teeth
The organic part of calculus makes up of how much %?
10% to 30%
Components of the organic part include materials derived from what?
plaque biofilm
dead epithelial cells
dead white blood cells
Newly formed calculus deposits appear as
crystalline form called brushite
In calculus deposits that are a bit more mature, but less than 6 months old, the crystalline form is primarily
octacalcium phosphate
In mature deposits that are more than 6 months old, the crystalline form is primarily
hydroxyapatite
The 2017 AAP/EFP World Workshop recommends that the term “biologic width” be replaced by the more appropriate term
supercrestal tissue attachment
Why is malingering difficult to diagnose?
Because patients do not like to admit to causing their injury.
Is fenestration associated with gingival recession?
no
Some of the clinical signs of trauma from occlusion that have been reported include the following:
- Tooth mobility
- Sensitivity to pressure
- Migration of teeth
Some of the radiographic signs of trauma from occlusion that have been reported include the following:
- Enlarged, funnel-shaped PDL space
- Angular alveolar bone resorption
The changes seen in primary occlusal trauma include a
wider PDL space, tooth mobility, and even tooth and jaw pain
Secondary trauma from occlusion occurs to a tooth in which the surrounding periodontium has experienced
apical migration of the junctional
epithelium, loss of connective tissue attachment, and loss of alveolar bone.
A frenum’s primary function is to provide
stability to the lips, cheeks, and tongue
What are the 4 major oral frena?
- Maxillary labial frenum
- mandibular labial frenum
- buccal frenum
- mandibular lingual frenum
Frenal problems occur most often where?
On the facial surface between the maxillary and mandibular central incisors and in the canine and premolar areas
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