Local Contributory Risk factors Flashcards
Why do these risks leads to more disease ?
- increase biofilm retention
- increase biofilm pathogenicity
- Inflict direct damage to periodontium
What are the major etiologic factors of Plaque Biofilm
- Development of dental caries
- Initiation and progression of periodontal disease etiologic factors
- Contains bacteria which is detrimental to tissue
What are the 2017 classification of periodontal diseases?
- Periodontal health, gingival disease and conditions
- Periodontal manifestations of systemic diseases and developmental and acquired conditions: trauma occlusal force
What are naturally occuring contributing factors?
Classification: periodontal health givingival diseases and conditions
Category: Gingivitis-dental biofilm-induced
Subcategory: local risk factors
What is the most important local contributing factor?
dental calulus
What is dental calculus?
- Secondary risk factor for periodontal disease
- Most important local contributing factor
- Significant role in pathogenesis of periodontal disease
- irritant to gingival/sulcuar tissue
- Biofil retentive
- Reservoir for bacteria and toxins
- Interferes with self cleansing
- mineralized substances
- Covered on external surfaces by nonmineralized living biofilm
What are the locations of deposits?
Supragingival
Subgingival
Where does supragingival calculus forms?
- Form on clinical crowns, restorations, prothesis or exposed roots
- Site specific: salivary ducts
- Crowded teeth or malcocculsion
- Localized distribution
What are the mineral of supra calculus derive from?
Saliva
What is the formation time?
Varies by individuals
Content of saliva
Ability to remove biofilm
When does mineralization process begins in supragingival calculus?
48hrs to 14 days
Supragingival calculus is?
Yellow-white and formation occurs in incremental layers
What is percent of supragingival calculus is mineralized?
30%
What is the composition of suprgingival calculus?
Inorganic
* makes up 70-90%
* primarily calcium phosphate
* Similar to inorganic bone components
**Organic **
* Make up 10-3-%
* bacterial colonies, proteins and cells
* carbohydrate and lipids from bacteria and saliva
* dead epithelial cells and white blood cells
The inorganic component of supragingival calculus changes through?
Different Crystalline forms
What are the different types of crystalline forms?
- Newly formed- brushite
- Less than 6mon- octocalcium phosphate whitlockite.
- Matured- hydroxyapaptite
What are the modes of attachement for supragingival calculus?
- Pellicle surface
- Occurs on enamel
- not interlocing to tooth
- easy to remove deposits
What is Subgingival calculus?
- Not site specific
- Evenly distributed
- Needs explorer and radiographs to detect
- Forms slower
Where does the subgingival calculus mineral components comes from?
Gingival crevicular fluid
(GCF)
Describe subgingival calculus.
- Dark green to gray to black (bacterial or heme pigment)
- Shaped guided by pressure of pocket wall
- Rings, ledges or veneers
What percentage of Subgingival Calculus is mineralized?
60%
What are the composition of subgingival calculus?
Inorganic
* more minerals
* Calcium Magnesium, floride
* Crystal of hydroxyapatite, brushite, whitlockite
* Sodium amount increase with pocket depth
**Organic **
* No salivary proteins
* Bacterial cells mineralized and within channels
* attached biofilm
* Epithelial cells from pocket wall
* WBC (exudate)
What are the modes of attachment for subgingival calculus?
- Pellicle
- Mechanical lock into cemental irregularities
- Cracks, openings from PDL fibers, grooves from over instrumentation
- Tenacious
- Diffiult removal
If subgingival calculus is covered by biofilm, then bioflim it is associted with
Greater disease progession than biofilm alone
What percentage of radiographs shows visible calculus detection?
only 45%
What are the anticalculus agents?
Pyrophosphates
What are pyrophospathes?
- inhibits hydropaptite growth
- Supragingival calculus
- Do not eliminate existing cal
- useful for pt who builf up cal and on chlorhexidine
What are the classification and category for anatomic contributing factors?
Other conditons affecting the periodontium: periodontal manifestations of systemic disease and developmetnal and acquired conditions
Catergory: Tooth and prosthesis-related factors
What is tooth anantomic factors?
varitations in normal bone structure:
* non pathologic
* Relevant when affected by periodontal disease
* Can alter prognosis
What are some examples of tooth anatomic factors?
Fenestrations
Dehisences
Root Proximity
What is dehiscence ?
Window
- root is denuded and covered only by periosteum and gingiva, marginal bone is intact
What is dehiscence?
- Denuded area extends trhough the marginal bone
- Labial inclination
More like triangle
What is root proximity ?
- Poor alignment of teeth in arch
excessive rooth divergence of multirooted teeth
What is cervical enamel projection?
- Extension of enamel from CEJ apically to entrance of furcation
- Allow for increased biofilm accumulation
- Can predipose to furcation involvement
*Treatment directed by periodontal treatment required for affected tooth
For cervical enamel projections what are the highest incidences?
Buccal aspect mandibular second molar
What is the percentage for cervical enamel projection isolated furcation involvements associated with CEPS?
90%
What is enamel pearls?
- Clump of enamel located in furcation area apical to CEJ
- Often in bifurcation of molars
- Mistaken for calculus
- May be removed as part of therapy
What is root anatomy palatogingival groove?
- Can lead to periodontal pockets
- 5-8% of maxillary incisors
- Starts at cingulum and extends apically for variable distance
- Shallow or deep invagination
- Extends on root 50% of the time
What is done to remove the palatogingival groove?
Odontoplasty
What are cemental tears?
- Piece of detached cementum/with dentin
- Attached to PDL
- Leads to rapid periodontal bone loss and vertical bony defect
- Treatment involves debridement and removal of fragments
What are cemental tears induced by?
Trauma
What are accessory canals?
- Provide a communication between pulp and PDL
- Pulp necrosis can contribute to defect
- 20-50% of molars
- Isolated periodontal lesions one endodontically treated teeth should be evaluated for accessory canals
What does exodontics affects?
- Affects adjecent teeth if soft tissue and bone are damaged
- Remnant calculus can negate healing and foster biofilm accumulation
What are overhanging restorations?
- Biofilm retentive are
- Difficult access
- Increase in flammation
- Caries, bone and attachment loss
What does overhangs alter?
- The composition of subgingival flora
- Periodontitis flora increase
- More attachment loss
Can early removal reverses gingival condition and helps prevent attachment loss?
Yes
Crown Contours and margins helps with?
biofilm formation enhanced by subgingival restorations: surface roughness, marginal fit and contour
What does rough margins do?
- Promtoes biofilm growth
- difficult to remove
What does margin location cause?
- crown margin closer than 2mm to bone = in bone resorption
- bad fit= dull bule or deep red halo
- perisiten bleeding or discomfort
- Can lead to recession over time
What type of crown contours are more compatible with periodontal health?
Flat- because excessive buldge accumulates biofilm and promotes inflammation.
Cement can initiate what?
Inflammation
What are pontic forms?
- Contours and embrasures should be properly designed so patients can cleanse
- Forms that cannot be cleaned should not be used
What are removable partial dentures at risk for?
- Supragingival calculus
- Abutment teeth susceptinle to caries and periodontal associated problems
Restorative Materials are?
- Compatible with gingival tissue
- Assocaited with Gingival inflammation
What does open contacts do?
causes food impaction taht leads to inflammation, bone loss and attachment loss
What are the predisposing factors for food impaction?
- wider/open interproximal contacts
- Uneven marginal ridge relations
- small contact more likely than wide open contact
What does untreated tooth decay do?
- Results in defects in tooth structure
- Biofilm retentive factors
What does orthodontics appliances causes?
- Brackets, bands and wires are associated with biofilm accumulation, gingivitis and caries
- Elastics embedded in sulcus cause periodontal issues
- oral hygiene stressed
What does malocclusion cause?
Causes: biofil accummulation
limits access for oral hygiene care
Unreplaced missing teeth does not ?
initiate periodontal disease
What does mouth breathing cause?
- confined to labial gingiva of maxillary teeth
- increase susceptibility to localized inflammation
- deydration of tissues
- Red, swollen, shiny
- Gingiival enlargement, (may not resolve)
- Required excellent biofilm control
Toothbrushing trauma can cause?
- destruction of attached gingiva
- abrade epithelium
- Cause ulcerations
- excessive recession and rooth exposure
- result in extensive grooving of the root
- biofilm traps and cleaning problems
What does Floss trauma Create?
- Flossing clefts
- Grooves into tooth
What does oral piercing cause?
Dental and periodontal injuries
lips: anterior facial
Tongue: mandibular anterior lingual
Self inflicted injuries can cause?
- Gouging or scratching gingiva with fingernails
- Fingernail fragment
- Toothpicks
- Often results in extensive exposure of root surface
What are chemical injury?
- Topically applied products that causes ulcerations
- interferes with biofilm control and contribute to periodontal inflammation: alcohol burn and aspirin burn
What is rubbing alcohol burn?
- local anesthetic
- mild burn
- heals 2-4 days
