OTHER PREDISPOSING FACTORS OF DENTAL CALCULUS

Click to edit Master subtitle style PRESENTED BY: MANISH AGARWAL BDS III YEAR

4/22/12

PREDISPOSING FACTORS
Iatrogenic factors a) Margins of restorations -:changing ecologic balance of gingival sulcus to an area that favours growth of disease-associated organisms at the expense of health associated organisms -:inhibiting patients access to remove accumulated plaque
4/22/12

Fig b): Radiograph of same patient shwn in fig a) after the excessive amalgam has 4/22/12 been removed

Fig a):Radiograph of amalgam overhang on distal surface of max 2nd molar that is the contributing source of plaque retention and gingival inflammation

b) Contours and open contacts -:Overcontoured crowns and restorations

tend to accumulate plaque and possibly prevent self cleaning mechanism. -:Papillary inflammation -:Under contoured crowns -:Food impaction and plunger cusp -:In males, proximal contact 0.7%to 76% defective Marginal ridges 33.5 uneven
4/22/12

Fig a): Inflamed marginal and papillary gingiva adjacent to overcontoured proclain-fused tometal crown on max left central incisor

4/22/12

Fig b): Radiography of poorly fitting proclain-fused-tometal crown shown in fig a

c)Materials
:-Restorative materials are not inherently injurious to the periodontal tissues. Exception: self-curing acrylics :-gingival inflammation :-formation of pseudopockets
4/22/12

Inflamed palatal gingiva associated with a max. provisional acrylic partial denture. Note the substantial difference in color of the inflamed 4/22/12 gingiva adjacent to the premolars and Ist molar

d) Design of removable partial dentures

:-Partial dentures favor the accumulation of plaque, particularly worn day and night

e) Restorative dentistry procedures :-rubber dam clamps, matrix

bands, burs, and gingival 4/22/12 retraction cord

f)Malocclusion
:-Missing Md. first molar: :-Mesial drifting and tilting of Md. secondary and third molar :-Wedge between Mx. first and secondary molar :-Open contact, food impaction, interproximal bone loss :-Tongue thrusting: Spreading and tilting of anterior teeth 4/22/12

Fig a) Lower incisor showing prominent root with gingival recession and lacking attached gingiva Fig b) Same patient shown in fig a after placement of soft tissue graft to gain attached gingiva and treat gingival recession Fig c) Anterior open bite with flared incisors, as observed in association with a habit of tongue 4/22/12

Periodontal complications associated with orthodontic therapy

Plaque retention and composition

Bacterial plaque and food debris, resulting in gingivitis A.a was found in at least one site in 85% of children wearing orthodontic appliances 15% of control subjects
4/22/12

Gingival inflammation and enlargement associated with 4/22/12 orthodontic appliance and poor oral

Gingival trauma and alveolar bone height

Higher alveolar bone loss in adult than in adolescents

Tissue response to orthodontic forces

Excessive force produce necrosis of PDL,alveolar bone and increase the 4/22/12 risk of apical root resorption

Fig a) Max central incisors in which an elastic ligature was used to close a midline diastema. Note inflamed gingiva and deep probing depths. Fig b) Same patient shown in fig a. A full-thickness mucoperiosteal flap has been reflected to expose the elastic ligature and angular intrabony defects around the central incisors. Fig c) Radiograph of

4/22/12

impacted max canine that require surgical exposure and orthodontic assistance

Extraction of impacted third molars

Creation of vertical defects distal to the second molar . Individual older than 25 years. Visible plaque, bleeding on probing, root resorption in the contact area, presence of a pathologically widened follicle, inclination of the third molar and the proximity of the third molar 4/22/12

Habits and self-inflicted injuries

Gingival recession on a maxillary canine caused by self-inflicted trauma from the 4/22/12 patients fingernail.

Trauma associated with oral jewelry

Piercing jewelry in the lip or tongue Mostly teenagers and young adults lingual recession with pocket formation
4/22/12 Bone loss

Fig a) Priced tongue with oral jewelry

Fig b)Probing depth of 8mm with 10 mm of clinical attachment loss on lingual surface of lower cental incisor adjacent to oral jewelry in pricing tongue.

Fig c)Radiograph of lower incisor in fig b, depicting bone 4/22/12 loss associated with pierced

Toothbrush trauma

Acute:
Gingival ulcer

Diffuse erythema and denudation due to overzealous brushing

Chronic: Gingival recession with denudation of the root surface Interproximal attachment loss
4/22/12

Overzealous use of a toothbrush may denude the gingival epithelial surface and expose the underlying connective 4/22/12 tissue as a painful ulcer

Chemical irritation

Sensitivity or nonspecific tissue injury Simple erythema to painful vesicle formation and ulceration. strong mouthwashes, topical application of corrosive drugs (asprin or cocaine), accidental contact with drugs such as phenol or silver nitrate
4/22/12

Fig a) Chemical burns caused by aspirin, with sloughing of gingival tissue and accompanying recession.

Fig b) Biopsy of aspirininduced chemical burns. Note intraepithelial vesicles(V) and inflammatory infiltrate (I) 4/22/12

Tobacco use

Smokers are 2.6 to 6 times more likely to

develop periodontal disease They harbor more pathogenic subgingival microflora Their flora might be more virulent more difficult to suppress certain bacteria such as A.a, P.g, B.f depressed numbers of helper T lymphocytes
4/22/12 reducing serum levels of IgG

Gingival recession and hyperkeratosis of the vestibular mucosa that developed 4/22/12 following the use of chewing tobacco.

Radiation therapy

Total dose of radiation for head and neck tumors is in the range of 5000 to 8000 centigrays fractionation: 100 to 1000 cGy per week Mucositis: avoid irritation such as smoking, alcohol, and spicy foods

Precautions:

prophylatic antibiotics, 4/22/12

THANK YOU
4/22/12