extrinsic factors Flashcards
Features of Calculus? (5)
- does not cause CIPD
- surface plaque is responsible
- not a mechanical irritant
- extends radius of destructions
- inhibits plaque removal
What are extrinsic modifying factors?
enhance plaque retention and inhibit plaque removal i.e. calculus, overhangs
There is no correlation b/t malocclusion and ….? (8)
- angle’s classification
- overbite
- overjet less than 6mm
- crowding
- spacing
- axial inclination of incisors
- corssbite
- destructive periodontal dx
W/ malocclusion, ___% increase in bone loss was found for _____ inclined molars?
10%, mesially
W/ malocclusion, buccally found an increase in……?
deposits and inflam in areas of overcrowding
W/ malocclusion, what can overcome the ill effects of tooth overcrowding?
good OH
W/ malocclusion, unless ______ and _______ are associated with ______, they are not related to severity of periodontal dx?
open contacts and uneven marginal ridges;
food impaction
What is the definition of food impaction? What does it result in?
the forceful wedging of food into the periodontium by occlusal forces;
increased probing depth and attachment loss
Food impaction may be associated with…? (3) Factors predisposing to food impaction should be?
- open contacts
- uneven marginal ridges
- plunger cusps;
eliminated during initial therapy
How does dental morphology effect oral health?
concavities, grooves, and furcations inhibit or prevent plaque removal
Furcation anatomy: the size of the average furcation entrace is ____ than a small gracy currette ____% of the time. What are the sizes of each?
smaller, 58%; gracey = 1mm, furcation = 0.75 mm
Furcation anatomy: ___% of furca root surfaces of mandibular molar have a furcal concavity. The majority of….?
100%; maxillary furca root surfaces also have concavities
Which teeth have concavities?
the maxillary first premolar
mandibular incisors, cuspids, and 1st premolars have mesial and distal concavities
Developmental grooves: ___% of maxillary lateral incisors have _____ grooves. The prognosis is….? These grooves are associated _______ as measured by….? (4)
2-6%, distopalatal grooves; poor when associated with deep pocketing;
poor perio health as measured by degree of plaque, inflam, probing depth, and attachment loss
Cervical enamel projections on ____% of max and mandib molars which extend ….? Since only an ___ attachment can form to enamel, this may predispose to….?
4-5%; extend to the furcation entrance;
epithelial attachment, breakdown in presence of inflam.
What are initiating factors?
can cause the disease by themselves, even in an immunologically competent host
Extrinsic (local) factors influence……? influence is reflected and measured _____????????? Local factors generally act by…..?
proximally influence the periodontal health status; locally;
either enhancing plaque retention or inhibiting plaque removal
Calculus plays a major role in…..?
maintaining and accentuating periodontal disease by keeping plaque in close contact with gingival tissue and creating areas where plaque removal is impossible
Calculus always has…..?
living plaque on its surface
Does calculus cause gingival inflammation?
No, sterile calculus does not cause gingival inflam; only when plaque is introduce is gingivitis initiated
Is calculus a mechanical irritant?
No, it is not primarily a mechanical irritant, however calculus extends radius of destruction farther away from the tooth by providing a surface for plaque attachment beyond tooth surface
Hancock found that with food impaction, probing area was least? intermediate? greatest?
areas with tight contacts;
with loose contacts;
with open contacts
Malocclussions may predispose to…..? This has been associated with?
mouthbreathing; more severe gingival inflam when compared to non-mouth breathing controls but the mechnaism is unknown
furcation anatomy: in max first molars, roof of furcation is ____ to all root separations ___% of the time
coronal; >50%
The maxillary first bicuspid has a pronounced ____ _____ which is ___mm deep at the CEJ and deepens to ___mm at the 5mm level. Therefore, even…..?
mesial, 0.44mm; 1mm
even very early periodontitis on this surface involves the concavity
What is the fiber barrier principle?
gingival CT is superior barrier to the spread of inflam than the hemidesmosome-basement lamina attachment of epithelium. This principle is NOT universally accepted
Mucogingival factors: No amt of gingiva necessary for perio health in the presence of….? an adequate width of gingiva should be present to prevent recession when….? (2)
adequate, atraumatic oral hygiene procedures;
- a restoration is placed with subgingival margins
- major or minor connectors of RPD’s or overdentures infringe upon the gingiva
Frenal attachments predispose….?
to gingival inflam only if they retain debris or interfere with OH procedures
definition of caries affecting the gingiva?
carious lesions that retain plaque in contact with the gingiva
If a ptn cannot remove the plaque from the carious lesion, the caries should be…..? Otherwise…? _______ is necessary in this case to achieve perio health.
excavated and the tooth at least temporarily restored during initial thearpy; otherwise gingival inflam will be difficult to control in this area;
restorative dentistry
Improper restoration ___ and ____ _____ tend to accumulate plaque and impede plaque removal (i.e.? (2)) The gingiva doesnt need excessive ___ ____ for protection. _____ is preferred over ____ for gingival health. Inadequate embrassure space……?
contours and marginal adaptation; over contoured restoration and open margins); bulge anatomy, under contoured over over contouring;
displaces the interdental papilla and contributes to gingival health
An average of ___% of adults and ____% of restorations have overhangs. One study showed that ___% of restorations show marginal defects and that ___% of the defects equal or exceed ___mm and are associated with….?
30%; 25-50%;
75%, 55%; 2mm; increased interproximal bone loss
What increases with increasing dimensions of overhangs?
- alveolar bone loss
- probing depth
- attachment loss
- inflam
- plaque accumulation
Removal of overhangs results in….? Overhangs cause _________ inflam until _____ _____ introduced. Subgingival margins associated with ________ and _____ vs supragingival margins.
better perio health and increased alveolar support;
little or no inflam, bacterial plaque;
increased plaque and inflam
Mouth breathing results in……? May be caused by?
gingivitis of facial (usually max) gingiva; the reason is unknown but may be caused by malocclusion, blockage of nasal septum (deviated septum, adenoids), etc.
Occlusal trauma does not initiate? (3) Only 1 group (gothenburg, sweeden group) showed trauma from occlusion….? This study used? Most studies?
gingivitis, periodontitis, or pocketing; accelerates deepening of preexisting perio pockets;
A dog model in which only 2 teeth initially made contact, an extreme situation
do not show any affect of occlusal trauma on the epi and CT attachment of tooth
Occusal trauma can cause an increase in ___ ___ ___ from that caused by….? This __ __ ___ is ……?
alveolar bone loss, periodontitis alone;
extra bone loss; reversible if traumatic forces is reduced and inflam eliminated
Pocket depths: sites with previous hx of dx are…..? Microbiota in untreated deeper pockets shifts towards…..? Not yet know if….?
more likely to show future progression than sites with no previous dx hx; more anaerobic population; deeper pockets recolonize faster following cleaning
What other local factors can lead to attachment loss independent of bacterial plaque?
- factitious dx
- chemical injury
- toothbrush abrasion
- mechanical injury
What is a facitious disease?
ptns that gouge their tissues with their finger nails or derive pleasure by gouging their gingiva well beyond what is necessary to maintain plaque free tooth surface
What chemical injuries involved in gingival health? The use of chewing tobacco may result in?
indiscriminate use of aspirin tablets, strong mouthwashes, and various escharotic drugs may result in ulceration
use of chewing tobacco may result in loss of attachment as well as alteration of mucosa
Toothbrush abrasion can completely….? The abrasion results in…?
destroy narrow band of attached gingiva and result in extensive recession;
extensive grooving of the root surfaces, which may cause cleansing problems for ptn and management problems for dentist
What mechanical injuries can occur?
injudicious use of wedges, gingival retraction cords, and impression materials may damage gingiva.
improper use of elevators during tooth ext may traumatize gingiva and adjacent teeth
What are the extrinsic modifying factors discussed in handout?
- Calculus
- malocclusion
- food impaction
- dental morphology
- mucogingival factors
- caries affecting the gingiva
- faulty dentistry
- mouth breathing
- occlusal trauma
- pocket depths
- others: facitious dx, chemical injury, toothbrush abrasion, mechanical injury
