Secondary Local Factors in Periodontal Disease GN PDF

Secondary local factors in Periodontal Disease Oral and Dental Sciences Aim To have knowledge of and to recognise the various local risk factors which may exacerbate periodontal disease. GDC LLOs: 1.1.4 Explain the aeDology and pathogenesis of oral disease 1.10.1 Explain the principles of preve...

Secondary local factors in Periodontal Disease Oral and Dental Sciences Aim To have knowledge of and to recognise the various local risk factors which may exacerbate periodontal disease. GDC LLOs: 1.1.4 Explain the aeDology and pathogenesis of oral disease 1.10.1 Explain the principles of prevenDve care 1.10.2 Provide paDents with comprehensive and accurate prevenDve educaDon and instrucDon in a manner which encourages self-care and moDvaDon Intended learning outcomes DeIne secondary local factors Explain why local factors may exacerbate periodontal disease List and describe naturally occurring (developmental) local factors List and describe local factors occurring through disease or trauma List and describe iatrogenic local factors Discuss how a dental hygienist/dental therapist may eliminate or modify secondary local factors Risk Factors  What is a secondary local factor in periodontal disease? Where plaque can stagnant · · How Bacteria can harbor. The damage A secondary local factor is something which may increase the risk of periodontal disease due to it providing areas of microorganism colonisa;on through plaque reten;on, thereby making it diOcult for the paDent to achieve opDmum plaque control. - some cross over! How may this exacerbate periodontal disease? Think about what may happen if the paDent who has suscepDbility - cannot reach the area where plaque is building up… Think about E immune response + destruction occurring Image ref: bsperio.org.uk 7 List all of the secondary local factors that you can think of… 8 BSP Secondary local factors Image ref: www.bsperio.org.uk 9 Plaque reten;ve factors Developmental /Natural Due to disease or trauma -caused by Clinician. (Crown placements, Iatrogenic - restorations). Doctor 10 Natural/developmental local factors  Natural/developmental factor. calculus has rough and larger surface for plaque and bacteria to harbor. Dental calculus Plaque = main etiological Refer to your S calculus lecture factor of periodontal disease & calculus-very rarely found without Prague · Harbors. dental Provides a large irregular surface area to - which microorganisms can harbour and plaque - - thrive- Biofilm Can hamper oral hygiene eJorts by the - Creates · paDent different Contests Toxic substances can leach out of the - on tooth. calculus over a long period of Dme ↳ difficult for patient to dean. Image ref: pockerdenDstry.com 12  calculus · different types of below above - formation Supragingival vs subgingival Image ref: en.wikipedia.org On which other surfaces does calculus form? Image ref: researchgate.net SigniLcance? 13 Natural) developmental factor Harbors plaque/bacteria. ~ Which other developmental Tooth anomalies anomalies may you see with lateral Root grooves/concavi;es - incisors Palatal grooves- mainly found Bone loss on upper lateral incisors > - ‘radicular grooves’ -caries pathogens will - RCT ? tract Prognosis becomes worse the quickly up the deeper the groove and the groove further apically that it ↳ destruction extends. 14 Image ref: rootcanalanatomy.blogspot.com Natural/ developmental factor leads to plaque retention on tilted harboring tooth > - ↑recessin bacteria plaques Malposi;oned teeth Image ref: medcraveonline.com calculus Crowding - a Over-erupDon - Stagnation Poor contact point food/plaque/culcums. bacteria & - I Poor posiDon in the arch - secondary local 00 factor Image ref: presDge-dental-care.com.my 15 Malposi;oned teeth cont… Image ref: pocketdenDstry.com -Bone extends apically. TilDng - affects patient management as well - won't deflect plaque RotaDon - affect patients management. - partially erupted Impacted teeth - - wisdom teeth : TraumaDc - overbite effect patients management. Image ref: slideshare.net Image ref: www.implantperiocenter.com 16  not very common. debridement or -often identified through Enamel pearls radiograph. can contribute to periodontal disease and Usually associated with progression. · Harbors furca;ons. Present on bacteria. approximately 5% of molars Image ref: pocketdenDstry.com 17  · Dry mouth (xerostoma) harbor Bacteria and plaque. · What is the Incomplete lip seal & mouth breathing role of saliva? S Antibacterial properties ↳ washes away plaque - Dilutes bacterid Image ref: drmathursdental.com Image ref: tankonyvtar.hu 18 Due to disease/trauma  Disease/trauma factor · Bacteria + impact plaque on stagnation tooth/periodontal structure Think about what’s happening in the area Carious lesions and resorp;on cavi;es of resorp;on ↓ microscopically… Discuss causes O · and risks with patient Image ref: dentalnotebook.com secondary or Image ref mitchmedical.us caries Image ref: drgennero.com resorption 20  anted Structures destruction Disease/trauma factor of period. · Bigger contact points to clean. - more food gets Stuck. Previous periodon;;s, gingival recession more bacteria and plaque can stagnate. ↳ more biofilm, more destruction. Image ref: sweetcroWdental.co.uk Image ref: lowermydentalbills.com 21  plaque/Bacteria retract Oral Piercings… - can cause recession through abrasion. make patients aware advise now to clean can they exacerbate periodontal disease? How? Image ref: govanidental.com Image ref: dentagama.com 22  Give appropriate advice. Oral jewellery · retract Bacteria and plaque. cleaning. · https://www.pinterest.com/pin/760263980831433229/ www.amazon.co.uk/Gold Tooth Grill $_10.JPG (1000×1000) (ebayimg.com) 23 Iatrogenic factors  bacteria to harbor. microscopically an area for advice patient how to maintain optimal Iatrogenic factors control. plaque Disease or damage to Dssues ‘caused’ by the clinician Therefore, any restoraDon or appliance that has areas where plaque can harbour Start thinking… -restorations Examples? ‘TAILOR’ the oral Crown/Bridge placements. hygiene! Dentures What is your role in helping the pa;ent to aUain and maintain op;mal plaque control? 25  advise to remove at night / for Image ref: mydentalgroup.com.au -Calculus can build up dentures Dentures bacteria harbor ParDal dentures, parDcularly acrylic types with substanDal coverage of the Inflammation gingival margins. Where would the -anywhere plaque accumulate? along margin Interproximal clasps. Image ref: thedenturecliniccanberra.com.au 26  Patient advise What advice would Fraume Dentures cont… - Harbors bacteria ! you give to this from pa;ent? friction. O ↑ 27  and causes gingival inflammation Ledges/overhung of restoration - periodontal destruction. from Plaque a factors retentive canleavebehin once removed Dental restora;ons-amalgam/composite/GI/crowns Advice cleaning tailored to patient. inflammation defective margin veneers Ledges of causing bacterial plaque stagnation. Image ref: pocketdenDstry.com Image ref: pocketdentistry.com 28  food gets caught -> poor contact point- ~ Y secondary Consequences…. Bacteria stagnation local factor Motivate patient to man ↳Tavior plan to them. swing , red , loss of stipling. 29  > Stagnation underneath Gattached to teeth either side Bridges Image ref :whitedental.com.sg ConvenDonal nummation > - Super floss. & Advice how to clean Adhesive I wings covering teeth/gingival margins - I of stagnation - area Image ref: estheDcprofessionals.com Image ref: mydentalspecialist.co.uk 30  correct oral hygiene ! tobe naseelp need fixed + removable Oral hygiene for cleaning both teeth AND the Orthodon;c appliances appliance…. S Plaque + Bacteria Stagnated- Image ref:researchgate.net Image ref: piercedmd.com Image ref: en.wikipedia.org clean appliances as well as teeth. (Bonded-secondary local factor I cannot Image ref: researchgate.net floss + sometimes ID brush 31  teeth either side If patient can'tcce implant correctlyIt can affect tailor cleaning to patient interdental Implants interdental Gaps - Biggest often large sitt. brush that - Image ref: mdpi.com O O O 08 Image ref: elegantdentcare.com Image ref: advanceddenDstry.co.uk 32 The role of the dental therapist & dental hygienist  E[cient assessment and recogni;on secondary local factors -noting At paDents Lrst appointment and at reassessment has it improved ? - is Which methods will you use? what there optimal plaque I can Which BPE code will you record? - I do Control ? L gingival health. O Clinical Tailoring Instructions to each patient o calculus deposit/secondary local factor. 34  How may you eliminate or modify secondary local factors? ? -informers/educators. advice What is YOUR main role? has patient had previous education. · diet - What does this depend on? - is oral cavity What else can you do to enable your paDent to manage · cleansing op;mal plaque control? What if you cannot eliminate the local factor yourself? effective communication to patient! Ref to Clinician or specialist Show patient ! If beyond scope of practice Y explain to patient 35 References/reading material BSP, Bri;sh Periodontology Society (2021) Available from: hUps://www.bsperio.org.uk/assets/downloads/BSP_BPE_Guidelines_2019.pdf [Accessed 23rd May 2021|] Kornman K.S. and Loe H. (1993), The role of local factors in the etiology of periodontal diseases. Periodontology 2000, Val. 2, 1993, 83-97. Available from: https://doi.org/10.1111/j.1600-0757.1993.tb00222.x [Accessed 10th June 2021] The Root Canal Anatomy Project: Radicular Groove (2014). Available from: The Root Canal Anatomy Project: Radicular Groove: Maxillary Incisors [Accessed 10th June 2021] Kaminagakura ,E. Salmon, C. Fonseca D.C. Lopes M.C.A and Tango, R.N. (2011), Prevalence and microscopic features of enamel pearls from permanent human molars. Brazilian Journal of Oral Sciences. 10(4):268-271. Available from: DOI: https://doi.org/10.20396/bjos.v10i4.8641613 [Accessed 15th June 2021]. 36