Otherplaque retentive factors

PLAQUE RETENTIVE FACTORS:

PLAQUE RETENTIVE FACTORS BY: JASPREET SINGH ROLL NO. 35

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IATROGENIC FACTORS MARGINS OF RESTORATION CONTOURS AND OPEN CONTACTS MATERIALS DESIGN OF RPD 2 ASSCIATED WITH CLNICAL PROCEDURE MALOCCLUSION AND PERIODONTAL COMPLICATION ASSOCIATED WITH THERAPY EXTRACTION OF IMPACTED 3 RD MOLAR RADIATION THERAPY

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HABITS AND SELF INFLICTED INJURIES TOOTHBRUSH TRAUMA CHEMICAL IRRITATION MOUTH BREATHING TONGUE THRUSTING TOBBACO USE OTHERS 4 ANATOMIC CONTRIBUTING FACTORS PROXIMAL CONTACT RELATION ENAMEL PEARLS AND CEP ROOT ANATOMYCEMENTAL TEARS ACCESORY CANALS ADJACENT TEETH

PREDISPOSING FACTORS :

PREDISPOSING FACTORS 1 IATROGENIC FACTORS Inadequate dental procedures that contribute to the deterioration of the periodontal tissues are referred to as iatrogenic factors. These include: a MARGINS OF RESTORATIONS: b CONTOURS AND OPEN CONTACTS c MATERIALS d DESIGN OF REMOVABLE PARTIAL DENTURES

MARGINS OF RESTORATION :

MARGINS OF RESTORATION Overhanging margins of dental restoration contribute to the development of periodontal disease by : 1)Changing the ecologic balance of the gingival sulcus to an area that favors the growth of disease associated organisms at the expense of the health associated organisms. 2)Inhibiting the patient’s access to remove accumulated plaque.

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The location of the gingival margin for a restoration is directly related to the health status of adjacent periodontal tissue Subgingival margins are associated with large amount of plaque more severe gingivitis and deeper pockets. Margins placed at the level of the gingival crest induce less severe inflammation whereas supragingival are associated with a degree of periodontal similar to that seen with nonrestored interproximal surfaces.

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Roughness in the subgingival area is considered to be a major contributing factor to plaque build up. sources of marginal roughness include the following: Grooves and scratches in the surface of carefully polished acrylic resin, porcelain or gold restorations . Separation of the restoration margin and luting material from the cervical finish line thereby exposing the rough surface of the prepared tooth. Dissolution and disintegration of the luting material between the preparation and restoration leaving a space. Inadequate marginal fit of the restoration.

CONTOURS AND OPEN CONTACTS :

CONTOURS AND OPEN CONTACTS Over contoured crowns and restoration tend to accumulate plaque and possibly prevent the self-cleaning mechanism of the adjacent cheek, lips and tongue. Contour of the occlusal surface as established by the margin ridges and related developmental grooves normally serves to deflect food away from the interproximal spaces. The integrity and location of the proximal contacts along with the contour of the marginal ridges and developmental grooves typically prevent interproximal food impaction

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As the teeth wear down their originally convex proximally surfaces become flattened and the wedging effect of the opposing cusp is exaggerated. Cusp that tend to wedge food forcibly into interproximal embrasures are known as plunger cusps. The interproximal plunger cusp effect may also be observed when missing teeth are not replaced and the relationship between proximal contacts of adjacent teeth is altered. The presence of abnormalities does not necessarily lead to food impaction and periodontal disease.

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Excessive anterior overbite is a common cause of food impaction on the lingual surfaces of maxillary anterior teeth and the facial surfaces of the opposing mandibular teeth.

MATERIALS :

MATERIALS Plaque that forms at the margins of the restoration is similar to that founded on the adjacent non restored tooth surfaces. The composition of plaque formed on all types of restorative materials is similar , with the exception of that formed on silicate. The undersurface of pontics in fixed bridges should barely touch the mucosa . Access for oral hygiene is contributing to plaque accumulation, which will cause gingival inflammation and possibly formations of pseudopockets.

DESIGN OF REMOVABLE PARTIAL DENTURES:

DESIGN OF REMOVABLE PARTIAL DENTURES After the insertion of partial dentures, the mobility of the abutment teeth, gingival inflammation and periodontal pocket formation increases because partial dentures favor the accumulation of plaque particularly if they cover the gingival tissue. Partial denture that are worn during both day and night induce more plaque accumulation than those worn during day only.

2 ASSCIATED WITH CLINICAL PROCEDURE MALOCCLUSION:

2 ASSCIATED WITH CLINICAL PROCEDURE MALOCCLUSION A MALOCCLUSION Irregular alignment of teeth as found in cases of malocclusion may make plaque control more difficult.

PERIODONTAL COMPLICATION ASSOCIATED WITH THE ORTHODONTIC THERAPY:

PERIODONTAL COMPLICATION ASSOCIATED WITH THE ORTHODONTIC THERAPY Orthodontic therapy may affect the periodontium by favoring the plaque retention or by directly injuring the gingiva as a result of overextended bands and by creating excessive force on tooth and supporting structures.

Plaque retention and composition:

Plaque retention and composition Orthodontic appliances not only tend to retain bacterial plaque and food debris resulting in gingvitis but also are capable of modifying the gingival ecosystem . An increase in Prevotella melaninogenica. P. intermedia and Actinomyces odontolyticus and decrease in the proportion of facultative microorganisms were detected in the gingival sulcus after placement of orthodontic bands .

Gingival trauma and alveolar bone height:

Gingival trauma and alveolar bone height Orthodontic treatment is often started soon after eruption of the permanent teeth, when junctional epithelium is still adherent to the enamel surface. Orthodontic bands should not be forcefully placed beyond the level of attachment because this will detach the gingiva from the tooth and result in apical proliferation of the junctional epithelium, with increased incidence of gingiva recession.

Tissue response to orthodontic forces:

Tissue response to orthodontic forces The orthodontic tooth movement is possible because the peridontal tissues are responsive to externally applied forces. Alveolar bone is remodeled by osteoclasts inducing bone resorption in areas of pressure and osteoblasts bone forming in areas of tension.

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Moderate orthodontic forces result in bone remodeling and repair and excessive force result in necrosis of peridontal ligament and adjacent alveolar bone. It is important to avoid excessive force and too rapid tooth movement in orthodontic treatment.

B: EXTRACTION OF IMPACTED THIRD MOLARS:

B: EXTRACTION OF IMPACTED THIRD MOLARS Numerous clinical studies have reported that the extraction of impacted third molars often results in the creation of vertical defects distal to the second molars. This iatrogenic effect is unrelated to flap design and appears to occur more often when third molars are extracted. ASSOCIARED WITH CLINICAL PROCEDURES

C: RADIATION THERAPY :

C: RADIATION THERAPY Radiation therapy has cytotoxic effects on both normal cells and malignant cells Periodontal attachment loss and tooth loss were greater on the radiated side in cancer patients treated with high dose unilateral radiation compared with non radiated control side of dentition ASSOCIARED WITH CLINICAL PROCEDURES

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Radiation therapy induces Obliterative end arteritis result in soft tissue ischemia and fibrosis Irradiated bone becomes hypo vascular and hypoxic Saliva production is permanently impaired Xerostomia results in greater plaque accumulation and a reduced buffering capacity from the remaining saliva

3 HABITS AND SELF INFLICTED INJURIES :

3 HABITS AND SELF INFLICTED INJURIES A Toothbrush trauma Abrasion of the gingiva as well as alterations in tooth structure may result from aggressive brushing in a horizontal or rotary fashion Deleterious effect of abusive brushing is accentuated when highly abrasive dentrifices are used The acute changes vary in their appearances and duration, from scuffing of epithelial surface to denudation of underlying connective tissue with formation of a painful gingival ulcer

Cont.:

Cont. Chronic toothbrush trauma results in gingival recession with denudation of root surface . Improper use of dental floss may result in lacerations of interdental papilla Interproximal attachment loss is generally a consequence of bacterial induced periodontitis , where as buccal and lingual attachment loss is frequently result of toothbrush abrasion .

B TOBACCO USE:

B TOBACCO USE Smoking is one of the most significant risk factors currently available to predict the development and progression of periodontitis . Depending on the clinical parameters used to access periodontal disease, smokers are .6 to 6 times more likely to develop periodontal disease than non smokers . A diminished response to non surgical therapy has been reported for smokers

TOBACCO USE:

TOBACCO USE Possible explanations may be Smokers harboring more pathogenic sub gingival bacteria (recent research show that there is no statistically higher than those found in non smokers ) Their flora may be more virulent (no significant differences found as compared to non smoker) Diminished host response may contribute to increased disease susceptibility

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Depressed no. of helper T lymphocytes which are important to stimulate B cell fxn for Ab production

HABITS AND SELF INFLICTED INJURIES :

HABITS AND SELF INFLICTED INJURIES C CHEMICAL IRRITATION Acute gingival inflammation may be caused by chemical irritation resulting from either sensitivity or non specific tissue injury . The indiscriminate use of chemicals such as strong mouthwashes, topical application of corrosive drugs such as aspirin , and accidental contact with drugs such as phenol or silver nitrate are common examples that cause irritation of gingiva .

HABITS AND SELF INFLICTED INJURIES :

HABITS AND SELF INFLICTED INJURIES D: Mouth Breathing Mouth breathing can dehydrate the gingival tissue and increase susceptibility to inflammation. These patients may or may not have increased levels of dental plaque Tongue Thrust

HABITS AND SELF INFLICTED INJURIES :

HABITS AND SELF INFLICTED INJURIES E Tongue Thrusting Tongue Thrusting is often associated with an anterior open bite during swallowing tongue is thrusted forward against the teeth instead of being placed against the palate When the amount of pressure against the teeth is great it can lead to tooth mobility and cause increased spacing of ant. teeth

HABITS AND SELF INFLICTED INJURIES :

HABITS AND SELF INFLICTED INJURIES F Others Fingernail biting Using toothpicks Trauma associated with oral jewelry (tongue and lip piercing )

4 ANATOMIC CONTRIBUTING FACTORS :

4 ANATOMIC CONTRIBUTING FACTORS PROXIMAL CONTACT RELATION CERVICAL ENAMEL PROJECTIONSAND ENAMEL PEARLS INTERMEDIATE BIFURCATION RIDGE ROOT ANATOMY CEMENTAL TEARS ACCESSARY CANALS ROOT PROXIMITY ADJACENT TEETH

1) PROXIMAL CONTACT RELATION :

1) PROXIMAL CONTACT RELATION Open interproximal contacts or uneven marginal ridge relations are factors that may predispose to food impaction. It can lead to inflammation , bone loss, and attachment loss . However, open interproximal contacts that are easily cleansable may be as healthy as those with a proper contact relation.

2 CERVICAL ENAMEL PROJECTIONS AND ENAMEL PEARLS :

2 CERVICAL ENAMEL PROJECTIONS AND ENAMEL PEARLS CEP appear as narrow wedge shaped extensions of enamel pointing from CEJ towards furcation area . Most frequently on mand. Molars and more likely occur on 2 nd than 1 st molars Clinical significance of CEPs is that they are plaque retentive and can predispose to furcation involvement .

3 ROOT ANATOMY:

3 ROOT ANATOMY Palatogingival groove Attachment area Root trunk length Interroot separation Root fusion

4 CEMENTAL TEARS:

4 CEMENTAL TEARS A cemental tear is a piece of detached cementum, often with some dentin, that may remain attached to periodontal ligamental fibres It can lead to rapid periodontal bone loss and produce a vertical bony defect .

5 ROOT PROXIMITY :

5 ROOT PROXIMITY Close approximation of tooth roots , with an accompanying thin interproximal septum , leads to an increased risk periodontal destruction. Crowns of these teeth especially ant. Teeth are very closely approximated and may have long interproximal contacts , and minimal embrasure space, which makes plaque removal difficult .

6 ADJACENT TEETH:

6 ADJACENT TEETH Retention of periodontally compromised tooth , or a periodontally compromised tooth, may have a deterimental effect on a adjacent periodontally healthy tooth. Adjacent third molars are of particular concern in patients with periodontitis

7 ACCESSARY CANALS :

7 ACCESSARY CANALS Accesssory canals may furnish a communication between canal and the PDL Pulpal necrosis could contribute to formation of periodontal defect through an accessory canal

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