Local predisposing factor of periodontal disease

Local predisposing factor of periodontal disease

1. Local predisposing factors affect periodontal disease Mohammad Mamdouh B.Sc.2012 ,Postgraduate candidate Fixed Prosthodontics Department, Faculty Of Dentistry, Minia University

2. Local predisposing factors in periodontal disease Are oral conditions or habits that increase an individual`s susceptibility to periodontal disease These factors don't initiate gingivitis or periodontitis but contribute to the disease process initiated by dental plaque Increase plaque retention Interfere with plaque removal Induce direct damage to periodontal tissues

3. Local factors Dental plaque Tobacco Use Calculus Orthodontic Therapy Iatrogenic Factors Restorative Dentistry Procedures Malocclusion Design of Removable Partial Dentures

4. Dental Plaque Dental plaque can be defined as the soft deposits that form the biofilm adhering to the tooth surface or other hard surfaces in the oral cavity, including removable and fixed restorations.

5. Dental Plaque Subgingival plaque Supragingival plaque

6. Plaque Composition 1-Microorganisms which exits within an intercellular matrix . Gram positive: S. sanguis , A. viscousus . (initial colonizers) Gram negative: P. intermedia, F.nucleatum . (secondary colonizers)  

7. Plaque Composition 2-The intercellular matrix consists of Organic constituents of the matrix include polysaccharides, proteins, glycoproteins and lipid material. Inorganic component of plaque is predominately calcium and phosphorus and other minerals such as sodium, potassium and fluoride

8. 1-Calculus Consist of mineralized bacterial plaque that forms on the surfaces of natural teeth and dental prostheses

9. 1-Calculus Supragingival Calculus Sub gingival Calculus

10. Formation of calculus Between the first and 14th days of plaque formation(4 to 8 hours). Saliva  supra gingival calculus G. Fluid  sub gingival calculus. Calcification begins along the inner surface of the plaque.

11. 2. Dental Stains Dental stains may lead to tissue irritation by creating a rough tooth surface, which contributes to plaque accumulation and retention.

12. 3- latrogenic factors Deficiencies in the quality of dental restorations or prostheses are contributing factors for gingival inflammation and periodontal destruction . a-Over hanging Margins of Restorations b. Over contoured crown c. Open Contacts

13. 3- latrogenic factors a -Over hanging Margins of Restorations Contribute to the development of periodontal disease by :- 1- changing the ecology of the gingival sulcus to an area that favors the growth of disease associated gram-negative anaerobic microorganism 2- inhibiting the patient performed plaque control

14. 3- latrogenic factors b. Over contoured crown : Over contoured crowns and restorations tend to accumulate plaque possibly prevent the self- cleaning mechanisms of the adjacent cheek, lips and tongue.

15. 3- latrogenic factors c. Open Contacts : Food particles create a favorable environment for plaque accumulation.  Acts as a direct mechanical irritant to the tissue.

16. 4-Design of removable partial dentures After the insertion of RPD : Mobility of abutment teeth Gingival inflammation Periodontal pocket formation Increase  RPD accumulation of plaque if worn day and night induce changes in the plaque composition spirochetes

17. 5. Restoratives dentistry procedures In general restorative materials are not injurious to the periodontal tissues with possible exception of self cure acrylic resin Surface texture of restorative materials differ in their ability to retain plaque Dental procedures themselves can damage gingival tissues and produce gingival recession as tooth preparation, rubber dam placement and gingival retraction

18. 6. Malocclusion Irregular alignment of teeth or crowding as found in cases of malocclusion enhance retention of bacterial plaque and make plaque control more difficult . Several investigators have found a direct relation between crowding and periodontal disease

19. 7- Anatomic variation of soft tissue and teeth Cervical enamel projection  they develop more commonly on buccal surfaces of mandibular molars These projections are plaque retentive and can cause loss of periodontal att. at furcation area Enamel pearls  in furcation area of maxillary molars High frenum attachment  become problem if the attachment is too close to the marginal gingiva , tension on frenum may pull the gingiva away from the tooth  plaque acc. & prevent proper tooth brushing & pocket and gingival recession

20. 8. Orthodontic Therapy Orthodontic therapy may affect the periodontium by favoring plaque retention , by : 1- directly injuring the gingiva as result of overextended bands 2- creating excessive forces , unfavorable forces or both on the tooth and supporting structures. Plaque retention and composition Orthodontic appliances modify plaque composition  anaerobic g- ve bacteria As ( prevotella intermedia ) Gingival trauma Orthodontic bands shouldn't be placed beyond the level of epithelial attachment because This will result on apical proliferation of jun. epithelium  gingival recession

21. 9- Hypofunction Insufficient occlusal force may be injurious to the supporting periodontal tissues number & thickness of cancellous bone trabeculae  atrophy of periodontal ligament Hypofunction results from open bite , absence of functional antagonists and unilateral chewing habits that neglect one side of the mouth .

22. 10- Unreplaced Missing Teeth Mesial drifting of adjacent teeth Over eruption of apposing teeth  open contact between teeth  plaque retention , food impaction  gingival inflammation and bone resorption

23. 11- Food Impaction And Food Retention Defined as forceful wedging of food into the periodontium by occlusal forces , it can lead to gingival trauma and inflammation . Attachment loss, bone loss Food retention : caused by lateral pressure from lips , cheeks or tongue which may force food interproximally into wide embrasure spaces Lead to gingival inflammation & bleeding & gingival recession

24. 12- Parafunctional Habits Can produce direct injury to gingival and periodontal tissues Bruxism : - involuntary unconscious and excessive grinding of teeth - Etiology  nervous tension ( stress)  occlusal interference (high filling) - Effect : teeth  wear & mobility PDL  widening Muscle of mastication  hypertrophy TMJ  clicking

25. 12- Parafunctional Habits Tongue thrusting : - Etiology  Thumb sucking  Nervous thrusting  Nasal congestion or obstruction  Large tonsils or adenoid  large tongue – short lingual frenum

26. 12- Parafunctional Habits Toothbrush trauma : abrasions of the gingiva as well as alterations in tooth structure may result from aggressive tooth brushing with a hard toothbrush  gingival recession & exposure of root Mouth breathing : associated with gingival inflammation Chemical irritation : Ex: mouthwash & topical app. Of aspirin

27. Bibliography Carranza´s. Clinical Periodontology. 9th ed. 2003. pg:15-55. Gururaja R. Textbook of Periodontology. 2nd ed. pg : 6. Klaus H. Color Atlas of Dental Medicine. Periodontology. Vol 1. 1989. pg : 1- 10.

28. Thank you