Lecture 05 - Local Contributory Factors PDF

DH 308 – Lecture 05 Local Contributor / Perpetuating Factors 1 Biofilm Retentive Factors  Factors that can affect the periodontal health in the individual patient include: ◦ Over-contoured or worn dental restorations ◦ Food impaction areas ◦ Ortho...

DH 308 – Lecture 05 Local Contributor / Perpetuating Factors 1 Biofilm Retentive Factors  Factors that can affect the periodontal health in the individual patient include: ◦ Over-contoured or worn dental restorations ◦ Food impaction areas ◦ Orthodontic bands and brackets 2  Average Supracrestal Attached Tissue  The connective tissue attachment occupies 1.07 mm of space above the crest of the alveolar bone.  The Junctional epithelium attachment below the base of the gingival sulcus occupies another 0.97mm of space above the connective tissue attachment.  The combination of these two measurements is called Supracrestal Attached Tissue* ◦ ~2.04 mm (average). * Supracrestal Attached Tissue used to be called Biologic Width ◦ It can ranges from 0.75 mm to 4.3 mm. 3 Violation of Supracrestal Attached Tissue  When restoration margin is placed too far below the gingival tissue crest, two responses observed. 1. Bone loss of an unpredictable nature along with gingival tissue recession. 2. Gingival inflammation without bone level change 4 Crown Contours and Margins  Over-contoured crowns, bridges, and other cast and ceramic restorations have been associated with gingival inflammation and periodontal disease.  Subgingival placement of fixed restorations enhances plaque biofilm formation for a variety of reasons: ◦ Greater surface roughness of the materials ◦ Fit of the margin to the remaining tooth structure ◦ Contour of the restoration 5 Crown Contours and Margins (Cont.) 6 Crown Contours and Margins (Cont.)  Seven items should be considered in relation to dental hygiene care: 1. A healthy gingival sulcus is required before restorative treatment is performed to ensure that the height of the gingiva in relation to the restoration margin can be determined. 2. Margins of restorations should be kept away from the gingiva. 3. Crown margins have a thin line of cement to which biofilms can readily adhere. 7 Crown Contours and Margins (Cont.) 4. Temporary crowns should ◦ have margins that fit well ◦ should be polished to minimize roughness 8 Crown Contours and Margins (Cont.) 5. Restorations should preserve the embrasure space 6. Crowns must be contoured to facilitate oral hygiene ◦ furcation areas 7. Proper OHI customized to the present dental conditions 9 Amalgam Overhangs  Amalgam overhangs contribute to pathologic conditions, such as gingival inflammation. ◦ Amalgam finishing and overhang removal is a legally permitted duty for dental hygienists in many states. 10 Removable Partial Dentures  Partial dentures, complete dentures, and all other removable appliances can collect supragingival calculus.  Wearers of partial dentures should also be instructed to clean the appliance daily at home with an accepted denture cleaner, denture brush, and clasp brush. 11 Removable Partial Dentures (Cont.)  Natural teeth in function with removable partial dentures ◦ Present with deep PD ◦ Increased susceptibility to caries ◦ Proper OHI and home care instructions 12 Conditions That Affect Periodontal Health  Orthodontic appliances  Malocclusion  Oral habits such as mouth breathing  Loss of the first molars in children  Tobacco and alcohol use 13 Orthodontics  Increase plaque accumulation, gingivitis, and caries.  Bone loss occurs for adult orthodontic patient when periodontal disease is not controlled.  Excessive and rapid orthodontic force increase the risk of apical root resorption. 14 Root Resorption after Ortho Tx Before After 15 Orthodontic Appliances (Cont.) 16 Trauma  Toothbrush trauma  Flossing trauma  Self-inflicted injuries/Habits  Oral jewelry ◦ Tongue piercing affects lingual aspects of mandibular incisors.  Chemical irritation ◦ Allergy, aspirin burn, bleaching material,  Food impaction  Smokeless tobacco  Radiation therapy –mucositis  Trauma from occlusion ◦ Occulusal trauma does not cause initial pocket formation. 17 Malocclusion  Poorly aligned teeth can change embrasure spaces and make dental hygiene care more challenging. 18 Unreplaced Missing Teeth  Increased occlusal pressure on the remaining teeth ◦ contribute to tooth migration or drifting.  Migration usually occurs in a mesial direction (Mesial Drift).  Premolars can drift distally. 19 First Molar Loss First molar loss and other malocclusions and migrations are associated with gingival inflammation and pocket formation. 1. Second and third molars drift mesially and tilt 1. loss of the vertical dimension. 2. Mandibular premolars drift distally and can tilt. 20 First Molar Loss (Cont.) 21 Mouth Breathing  Mouth breathing leads to localized gingival inflammation that is usually confined to the labial gingiva of the maxillary anterior teeth.  The tissue becomes reddened, swollen, and shiny and bleeds easily. 22 Mouth Breathing (Cont.)  Associated with higher levels of plaque and gingivitis.  Inflammation does not respond to therapy.  Palliative care includes placing petroleum jelly over the tissue or using a saliva substitute product. ◦ What type of patient may be at risk? 23 Anatomic Anomalies  Variations of normal tooth anatomy need to be identified to ensure that the correct instrumentation 24 Anatomic Anomalies (Cont.) 25 Tongue and Lip Piercing 26 Tobacco and Alcohol Use  Both tobacco and alcohol use, singly and in combination, have been related to the amount and severity of periodontal disease. ◦ Smoking and excessive alcohol use frequently occur together ◦ Combination greatly increases the risk of esophageal, throat, and other oral cancers. 27 Tobacco Use  The use of all tobacco products, cigarette smoking, cigar smoking, and smokeless tobacco have been strongly identified as risk factors for periodontal disease.  Increased amounts of calculus and dental stains ◦ development of acute aggressive forms of periodontal disease are more common on smokers. 28 Tobacco Use (Cont.)  Toxic effects of tobacco use occur, regardless of the form of tobacco.  Tobacco-induced changes include: ◦ Increased keratinization ◦ Vasoconstriction of the gingival tissues occurs. ◦ Nicotine metabolites are found in saliva and gingival crevicular fluid. ◦ Polymorphonuclear leukocytes have a reduced ability to phagocytize substances ◦ Vascular reaction to inflammation is reduced. 29 Tobacco Use (Cont.)  Tobacco-induced changes include: (cont.) ◦ Tissue destruction is observed in the gingiva and bone underlying the location where smokeless tobacco rests in the mouths of users. ◦ Smoking has a negative effect on healing during periodontal therapy  pocket reduction and gain in clinical attachment are greatly reduced. 30 Alcohol Use  Alcohol use is a contributing factor to the severity of periodontal disease.  Consumption of 3.5 drinks or more per week was associated with greater pocket depths.  Patients consuming five or more drinks per week ◦ 65% more likely to have gingival bleeding ◦ 36% more likely to have severe attachment loss. ◦ Present with more dental biofilm accumulation (alcohol reduces salivary flow) 31