Role of local factors Flashcards
Define periodontal diseases
A group of diseases that can affect single or multiple sites in the oral cavity and may lead to damage and loss supporting periodontal tissue
What are the 2 broad groups all periodontal diseases fall under?
- Gingival diseases
2. Periodontitis
What is the primary aetiological factor that causes periodontal diseases?
Microbial plaque and its products that colonises the gingival crevice and root surface and
What is a risk factor?
A factor that increases the probability of disease developing and progressing but not necessary causing the disease
What do risk factors in disease progression comprise of?
1, Local (intra-oral) factors
2. Systemic factors which affect the appropriateness and magnitude of the host repose
What are the local (intra oral) factors sometimes called?
Plaque retention factors
Describe plaque retention factors
They may influence the accumulation of plaque and can allow certain bacterial species to flourish
What can plaque retention factors prevent?
May prevent effective plaque removal
Changes in what can lead to periodontal destruction?
- Change in the local environment
2. Change in the systemic condition
What can happen if there is a change in the patients systemic condition?
Can predispose the plaque to become more problematic resulting in disease formation and progression
State some local factors that increase chances of getting periodontal disease
- Anatomic factors
- Patient’s habits
- Iatrogenic factors
- Microbiological factors
- Pre-exisitng deposits and disease
What do anatomic factors include?
- Tooth malalignment
2. Idiosyncrasy of tooth and root morphology
How does tooth malalignment increase a persons chance of getting periodontal disease?
As plaque retention can occur from sites due to crowding spacing, rotation, tilting and drifting
May be due to deep overbites and increased over jets
Name some of the idiosyncrasies of tooth and root morphology
- General morphology
- Enamel projections / pearls
- Root grooves
- Cemental tears
What are Enamel projections / pearls?
They are ectopic deposits of enamel
They are normally found apical to the normal cement enamel junction
What percentage of lower molars have Enamel projections / pearls?
Up to 34%
What percentage of upper molars have Enamel projections / pearls?
Up to 25%
What are Enamel projections / pearls associated with?
Gingivitis and attachment loss
Where are root grooves usually located?
Palatally especially on upper lateral incisors
Are also found on lower incisors and upper premolars proximally
How many root grooves extend more than 5mm apically from the CEJ?
58%
What are root grooves associated with?
Increased plaque and pocketing
Where do cement tears occur?
Where there is separation along the cemento-dentinal junction
What can cemental tears initiate?
Could initiate rapid ,non infected breakdown in isolates sites
What to cemental tears disrupt?
Periodontal attachment
What are some patients habits that can influence periodontal diseases?
Mouth breathing
Smoking
How can mouth breathing lead to periodontal disease?
Mouth breathing results in lack of saliva flow
Decreased salivary cleansing
Dehydration of tissues
Hyperplasia of gingival cells
Which area is mostly affects if patients mouth breath?
The upper anterior gingiva
What are the clinical effects of smoking?
1, Increased attachment loss
- Increased bone loss
- Increased pocket depths
- Increased recession anteriorly
- Increased staining
- Increased fibrous gingival tissues
- Decreased bleeding on probing
What are the local effects of smoking?
- Inhibits neutrophils
- Increases keratinisation
- Decreased vascular repose to inflammation
- Alters gingival perfusion
What are iatrogenic factors?
Factors that are injurious and that could have been prevented
Name some iatrogenic factors
- Orthodontic appliances and retainer
- Poorly designed partial dentures
- Poor restoration margins/ contours
- Initiation of roughness / grooves by instrumentation
What are the 2 types of orthodontic appliances?
- Removable
2. Fixed
What are removable orthodontic appliances made up of?
Acrylic base with a wire clasp that keeps the appliance in place
What are fixed orthodontic appliances made up of?
Brackets bands and arched wires
What problems to orthodontic appliances cause?
Make it difficult for patients to clean inter proximal making it more likely for plaque to accumulate around the orthodontic appliance
What must be checked when making a partial denture
The dentures stability
Must follow the rules of gingival clearance
Placement of class, rests and connectors should be done appropriately
What must be avoided when designer dentures?
Gum strippers design must be avoided
What is a gum stripper design
A denture that has no gingival clearance and no clasps so nothing preventing the denture from slipping into the mucosa
What are some effects of
Tremendous gingival inflammation
Hypoplastic gingival
Gingival have been stripped from the surfaces of the palatal aspects of teeth
High plaque retention
What is important when carrying out a class 2 restoration
Make sure margins of there restoration are flushed and smooth with the tooth surface
What must be used When making a class 2 restoration?
Matrix bands and tissue management to avoid overhangs and ledges
What must crown margins not be when a restoration is made?
Crown margins must not be to sub gingival
Which instruments are commonly used when undertaking periodontal root surface debridement?
Hoes and curettes
What is consequence of using hoes?
They can leave grooves in the root surface dentine
What can the precess on grooves in root surface dentine promote?
Promotes the retention of sub gingival plaque
What can we use to try and smooth over grooves made by hoes?
Use a curettes to finish to ensure any slight grooves are covered
Also use ultrasonics with a light grip and in a painting motion
Colonisation of what area of the mouth can lead t increase risk of periodontal breakdown?
Colonisation of the ginigival crevice and root surface by particular microbes can increase risk of periodontal breakdown
Name some species of bacteria implicated in periodontal diseases
- Action actinomycetemcomitans
- P ginigivalis
- B. Forsythus
The presence on what can increase the chances of getting periodontal disease?
- Carious cavities
- Existing periodontal disease
- Calculus
Which type of caries can increase you chances of getting periodontal diseases?
Carious lesion on the enamel and dentine at the gingival margin or below
Root caries
Why can root caries increase your chances of getting periodontal disease
These lesions can isolate and held periodontal pathogenic bacteria by acting as a plaque trap
How can the existence of deep pockets increase your chances of getting periodontal disease?
- Can lead to further destruction
- Pocket physiology allows a toxic milieu to arise
- Exposed furcations also collect plaque and make it harder for patients to properly clean their teeth
What does calculus act as?
A plaque retention factor
Describe supraginigival calculus
Lingual surface of lower anterior teeth
Cream yellow appearance
What link is there between subginigival calculus and teeth?
Teeth with subgnigval calculus had a higher rate of attachment loss
Colonisation of the ginigival crevice and root surface can lead to what?
increased risk of periodontal breakdown
58% of root grooves extend more than how many mm apically from the CEJ?
5mm
