Untitled Quiz

Leading to tilting & lateral spreading of teeth – Labial drift of maxillary anterior teeth

• Excessive Lateral force can cause traumatic pressure to the periodontium
• Aggressive brushing can cause toothbrush trauma, which can lead to acute changes like abrasions & ulceration of the gingiva and chronic changes like recession of the gingiva + denudation of the root surface.

Bruxism

• Nonfunctional voluntary or involuntary mandibular movement (during night or day)
• Manifested by grinding, clinching, and clicking of the teeth
• Applying a load of over 20 Kg on a tooth over a period of 2-5 sec.
• Causes:
  • Nervous tension
  • Occlusal interference

Diagnosis

• Wear facets (advanced attrition)
• Increase tooth mobility
• Wide PDL space
• Hypertonicity of the muscles of mastication
• TMJ Discomfort (joint arthritis)

Food Impaction & Retention

• Forceful wedging of food into the periodontium by occlusal force (mastication)
• Retained food does not pass by itself
• Exaggerates the wedging effect of opposing cusps to the interproximal spaces
• Can lead to:
  • Pressure feeling and urge to dig out material interproximally
  • Gingival inflammation & bleeding
  • Foul/bad taste
  • Gingival recession
  • Periodontal abscess
  • Bone loss
  • Root caries

Chemical irritation & Radiation

• Chemical irritation is caused by frequent use of strong mouthwashes, some dentifrices, and denture materials.
• Radiation therapy has cytotoxic effects on both normal cells and malignant cells.
• Acute gingival inflammation: erythema – vesicles – ulceration
• Desquamation of the gingiva: ulceration – susceptibility to infection – retard healing

Mouth Breathing

• Surface dehydration & plaque accumulation
• Erythema, edema, enlargement of the gingiva of the maxillary anterior region
• Severe gingivitis & bleeding

Iatrogenic Factors

• Inadequate dental procedures that contribute to the deterioration of the periodontal tissues
  • Margins of Restorations:
    • Overhanging margins (16.5% to 75% of cases)
      • Growth of gm-ve bacteria
      • Reduce patient access to remove accumulated plaque
    • Location of gingival margins of restoration margins:
      • Apical to gingival margin: + + plaque + + gingivitis + + pockets
      • At gingival margin: Less plaque, less gingivitis, less pockets
      • Supragingival: Periodontal health
  • Contours and Open Contacts:
    • Over contoured crowns and restorations
    • Opening of the contact point
    • Over-erupted cusp that lies directly over a contact point (plunger cusps)
      • Wedging effect of the opposing cusp is exaggerated
      • Food impaction
  • Design of Removable Partial Dentures
    • Partial dentures should be worn only during the daytime
    • Partial dentures favor the accumulation of plaque, particularly if they cover the gingival tissue
  • Restorative Dentistry Procedures
    • Rubber dam clamps, matrix bands, and burs can cause varying degrees of mechanical trauma and inflammation

Complications Associated with Orthodontic Therapy

• Plaque Retention:
  • P. intermedia and AAC (in 85% of children) compared with only 15% of control subjects
• Gingival Trauma:
  • Orthodontic bands if forcefully placed will detach the gingiva from the tooth
• Excessive Orthodontic Forces:
  • ++ Force: necrosis of the periodontal ligament & alveolar bone & apical root resorption.
  • Gingival recession.
  • Elastic ligature which used to close a diastema: severe attachment loss & may migrate apically along the root.
• Periodontal condition must be treated before initiating orthodontic therapy

Systemic Influences on the Periodontium

• Endocrinal disorders (Hormonal)
• Hematologic disorders
• Genetic disorders
• Drug-induced disorders
• Nutritional influences
• Psychosomatic
• Aging
• Viral
• Smoking

Endocrinal Disorders

1. Diabetes Mellitus

• Complex metabolic disease characterized by chronic hyperglycemia. Inability of glucose to be transported from the blood to the body cells due to decrease Insulin production, action, or both.
• Extremely important disease from a periodontal standpoint.
• Two Basic Types:
  • Type I Diabetes: Before age of 25, 10% of all diabetics, required insulin injection, viral cause/autoimmune destruction of beta cells
  • Type II Diabetes: After age of 40, 80-90% of all diabetics, diet/oral hypoglycemic agents, level of plasma insulin is normal but decreased cellular response to insulin.
• Severe Periodontal Destruction, Bleeding gums, severe gingival inflammation, periodontal abscesses, and loss of attachment (CAL)
• Periodontitis Type 1 Diabetes: Start after age 12. Destruction occurred around 1st molars & incisors.
• B – Viral… Herpetic oral ulceration: Periodontal lesions clinically… Not found in edentulous pts. OR in Chronic Leukemia. Leukemic gingiva: Enlargement – Bleeding – Ulceration

2. Agranulocytosis

• Disappearance of circulating granulocytes due to ingestion of medications (drugs) like barbiturates, sulfonamides, and gold salts.
• Painful, large ulceration
• Necrosis of the gingival margin without inflammation

Associated with Genetic Disorder

• Hereditary gingival fibromatosis
• Cyclic Neutropenia
• Chediek Higashi S
• Lazy Leukocyte S
• Papillon- Lefèvre Syndrome
• Down’s Syndrome
• Aggressive Periodontitis
• Hypophosphatasia

1. Hereditary Gingival Fibromatosis

• Associated with permanent teeth
• Enlarged gingiva
• Exaggerated stippling
• Excessive production of collagen due to permanently activated fibroblasts

2. Cyclic Neutropenia

• Destructive periodontitis (deep p.pockets)
• Gingival edema & hyperplastic
• Periodic destruction of alveolar bone
• Periodic/monthly decrease in the number of neutrophils (infancy & childhood)
  • Gingival Pathological changes RECUR with exacerbation of the disease

3. Chediek Higashi S

• Defect in neutrophils killing mechanisms
• Genetically transmitted disease (defect in intracellular killing of neutrophils). Due to genetic defects (abnormal mutation of neutrophils lysosomes). Lack of normal lysosomes granules fused together to form mega bodies
• Destructive periodontitis: lack of normal protection of neutrophils

4. Lazy Leukocyte S

• Defect in PMN chemotactic response
• Susceptibility to severe microbial infections. Exaggerated inflammatory response. Susceptible to severe periodontitis with destruction of bone and early tooth loss

5. Papillon- Lefèvre Syndrome

• Hyperkeratotic skin lesions & destruction of the periodontium
• Skin and periodontal lesions start at the age of 4-5 years. By the age of 10-15 years, most of the permanent teeth are lost
• Etiology:
  • Virulent pathogens: P. intermedia & AAC
  • Long term stress: Gingival & periodontal diseases

Aging

• Both incidence & severity of periodontal disease increase with age
• Due to the cumulative effect of dental plaque over time
• The more the age, the more the duration of the disease

Viral

Viral

• Acquired Immunodeficiency S: AIDS
• HIV destroys helper lymphocytes (Human Immunodeficiency)
• Oral findings:
  • Destructive periodontitis
  • NUG - NUP: Interproximal bone loss & necrosis (sequestration)
  • Oral candidosis
  • Kaposi’s sarcoma

Smoking

• Nicotine has been shown to decrease gingival blood flow & GF which may impair revascularization in gingiva & alveolar bone – ( ++ NUG )
• Decreases local O2 tension (V.C) of gingival capillaries (increases anaerobic bacteria)
• Reduces G.F (increases bacterial adhesion to dental tissues)
• Inhibits collagen production & increase collagenase activity of gingival fibroblast
• Inhibits chemotaxis & phagocytosis
• Increases PGE2 & collagenase of neutrophils
• Decreases the NO. of T helper lymphocytes & Salivary IgA (inhibits Opsonization)
• Increases anaerobic bacteria (due to lowered O2)
• Increases bacterial adhesion to dental tissues