Plaque Induced Gingivitis Aggravated with local Factors

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Plaque Induced Gingivitis Aggravated with local Factors:

Plaque Induced Gingivitis Aggravated with local Factors )Chapter 10 (10 th ed. Chapter 22 (11 th ed.)

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The primary cause of periodontal disease is bacterial plaque, along with other predisposing factors. Predisposing factors include calculus, malocclusion, faulty restorations, complications associated withorthodontic therapy, self induced injuries, tobacco and radiation therapy

I Calculus:

I Calculus Mineralized bacterial plaque that forms on natural teeth and restorations Calculus is divided to : Supragingival Subgingival




Prevalence Anerud et. Al.,1991 study Comparison between Sri Lankan tea labors and Norwegian academicians for 15 years … .Develop calculus shortly after teeth eruption Maximum calculus at 25-30 years … .80% showed calculus only on lingual surfaces of lower teeth and buccal surfaces of upper teeth with no longer progression


Composition Inorganic content: 39% calcium 19% phosphorus 1.9% carbon dioxide 0.8 % magnesium Crystals of: Hydroxyappatite:58% Magnesium White Lockite 21% Octacalsium phosphate 12% Brushite 9%

Organic Contents:

Organic Contents 1.9-9.1% carbohydrates: galactose, glucose,.. 5.9-8.2% proteins: amino acids 0.2% natural fates: free fatty acids

Attachment to Tooth Surface:

Attachment to Tooth Surface 1- By organic pellicle

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2- Mechanical locking into surface irregularities

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3- Close adaptation of calculus to gently sloping mounds of untreated cementum

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4-Penetration of calculus bacteria into cementum ( not acknowledged by all investigations)

Formation of Cementum:

Formation of Cementum 1- Mineralization theory: a) Increase in pH due to loss of CO2 & ammonia produced by bacteria b) Colloid proteins in saliva binds calcium and phosphate c) Phosphatase liberated from plaque bacteria precipitate calcium phosphate

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2- Seeding agents induce small foci of calcification that enlarge and coalesce to form a calcified mass( epitactic concept, heterogeneous nucleation) The seeding agent is suspected to be intracellular matrix of bacteria

Role of bacteria:

Role of bacteria plaque mineralization start extracellular Some bacteria have liability to form intracellular apatite crystals (diphtheroids & veillonella) Bacteria form phosphatases, change pH leading to mineralization Correlation between plaque and gingivitis is more strong than that between calculus and nacteria

Etiologic Significance:

Etiologic Significance The non mineralized surface of calculus is the main irritant

Materia Alba, Food debris and Stains:

Materia Alba, Food debris and Stains Materia alba: bacteria, desquamated cells, leukocytes that lacks regular pattern Yellowish to grayish whit, sticky but less adherante



II Iatrogenic Factors:

II Iatrogenic Factors 1- Margins of restorations Position of restorations: Supragingival, gingival and subgingival Roughness of subgingival margins may be caused by:

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1- Grooves and scratches in surface of restorations 2- Separation of restoration margin and luting material 3- Dissolution of luting material 4- Inadequate margin fit

Overhanging margins of restorations:

Overhanging margins of restorations

Over contoured margins of restorations:

Over contoured margins of restorations

Poor fitting restorations:

Poor fitting restorations

Marginal leakage:

Marginal leakage

Orthodontic appliance:

Orthodontic appliance





Chemical burn:

Chemical burn

Injurious dental material:

Injurious dental material

Tobacco chewing:

Tobacco chewing

Anatomic Variations:

Anatomic Variations


Readings Carranza's Clinical Periodontology !0 th edition : Chapter 10 : 270-280 11 th edition: Chapter

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