Local Contributory Factors for Periodontal Diseases
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Local Contributory Factors for Periodontal Diseases
Contributory are factors that increase plaque deposition and retention, inhibit plaque control, and contribute to the development of gingivitis and periodontitis. By themselves they do not initiate gingival inflammation, but allow for plaque accumulation and make it difficult to remove plaque. Dental plaque is considered the most important local contributing factor. The mineralization process starts supragingival and progresses suggingival. Calculus is covered by plaque and retains toxic bacterial products. Tartar is the common name for plaque. Checking for calculus radiographically isnt effective being that only 45% of surfaces with clinically visible calculus are detected radiographically. . Supragingival calculus can occur on any clinical crown, exposed root surface, prosthesis, or restoration. Usually in areas adjacent to salivary glands. Any retention site, such as a maligned tooth, a missed area of plaque removal, or an area where mastication does not remove all debris, is a primary site for supragingival calculus. The mineral component for supra calculus is saliva. The minerals are deposited in within 24-72 hrs of plaque formation. The process can take twelve days or less. Sub calculus is derived from GCF and any inflammatory exudates. Supra calculus is 30% mineralized, whereas sub is 60%. Sub is harder to remove because of its hardness. Calculus is yellow-white for supra and gray black for sub calculus. The overlying bacterial plaque continues to be the etiologic factor in periodontal disease. There are four modes of attachment of subgingival calculus to root surfaces:
Attachment by means of mechanical locking into irregularities in the cementum.
Attachment into areas of cementum resorption.
Attachment by means of an organic pellicle
Attachment by penetration into bacteria
Both bacterial plaque and the pellicle calcify making it difficult for removal. Calculus also binds to tooth surface irregularities, making mechanical calculus removal difficult. Not firmly attached to dental implants because of the titanium surface. Root morphology and position of the teeth are anatomic factors of importance for plaque accumulation. Palatal grooves (palatogingival grooves or lingual grooves) are present on about 5-8% of maxillary incisors, accumulate plaque and cause and narrow deep pocket. Tooth position may influence plaque accumulation and access for oral hygiene and therapy. Iatrogenic factors are procedures, techniques, and materials that indirectly/ directly contribute to the initiation and progress of periodontal disease. Restorative dentistry may provide rough surfaces and over contoured amalgams, composites, crowns, bridges may increase gingival inflammation and perio disease. Subgingival